[Italian guidelines in accordance with the new National Guidelines System: critical issues and perspectives.]

Law No. 24/2017 on professional responsibility has assigned a fundamental role to the guidelines, giving the Istituto Superiore di Sanità, through the new Centro Nazionale per l'Eccellenza Clinica, la Qualità e la Sicurezza delle Cure (CNEC), the role of methodological guarantor and of national governance of the guidelines production process. In a scenario marked by the increasing use of defensive medicine, the adherence to guidelines recognized as reliable by an institutional body can lead to the desired reduction of the malpractice claim, as well as to considerable clinical advantages, with the improvement of the quality of healthcare and of health outcomes and the reduction of unjustified variability of clinical practices in the national territory. If the opportunity that the new National Guidelines System (SNLG) offers is great and must be seized, at the same time the connection between guidelines and health responsibility presents some critical issues. In this context, it is of utmost importance to promote an efficient production mechanism of good quality national guidelines, informed by the best evidence available and responding to the population health needs, based on the criteria of relevance and clinical, economic and social impact, as well as to make the SNLG the pivotal instrument to achieve that alignment of clinical efficacy, professional and organizational appropriateness, fairness, security and humanization of care that can guarantee the sustainability of our National Health Service and its capacity to face the difficult challenges of the future.