A retrospective clinical audit on depression management in line with NICE NG222 guidelines at a primary care setting in rural England
S. U. Rajah, L. Mahesh KumarIntroduction
Depression is a globally prevalent mental health condition and a leading cause of disability, frequently managed within UK primary care. The National Institute for Health and Care Excellence (NICE) NG 222 provides guidance for diagnosing and managing depression. This audit is underscored by the discontinuation of national supervision for depression care, a scarcity of audits on the updated guidelines, and the need to assess adherence in a rural setting where patients may face unique barriers to accessing healthcare.
Objectives
To assess and improve the adherence to NICE guideline NG222 “Depression in adults: treatment and management” by auditing the management of newly diagnosed depression, focusing on the documentation of suicide risk assessment and first-line treatment for less-severe depression, therefore to improve patient outcomes.
Methods
A retrospective audit was conducted at a general practice (GP) in rural England. Patients newly diagnosed with depression between June 2022 and May 2025 were identified using an Egton Medical Information Systems (EMIS) search. For the first criterion, a random sample of 20 patients was reviewed for documented suicidal ideation enquiry. For the second, 11 patients with less-severe depression (PHQ-9<16) were assessed to determine if antidepressants were offered as a first-line treatment without documented patient preference. The data extracted was compared to set standards of 95% and 90% respectively.
Results
The practice did not meet the set standards (Table 1). For criterion 1, 85% (17/20 cases) had documented enquiry of suicidal ideation, falling short of the 95% standard (Figure 1). For criterion 2, adherence was 81.8% (9/11 cases), below the 90% standard for offering non-pharmacological treatment first for less-severe depression (Figure 2).
Results Table 1. Long description.