Priority setting: an overview

The Department of Health has begun a push to create “world-class commissioning” and is developing a range of tools, approaches, outcome measures and competences to support this. This initiative is the most serious attempt to reposition commissioning as central to the way the NHS operates since the introduction of the purchaser provider split in 1990. The NHS Confederation welcomes this initiative and the Primary Care Trust Network is fully engaged in influencing policy in this area.

One of the key skills that any commissioner will need is the ability to identify priorities. It is still the case that a large amount of the resources committed reflect historic patterns of provision, the particular approach of local providers or even individual clinicians. To change this there will be a need for high-quality, evidence-based and systematic decision making to support the development of the commissioning plan and to feed into the annual contracting round.

In addition, the number of high-cost treatments and increasingly vocal interest groups makes the task of allocating resources one of the most politically sensitive and complex issues facing any part of the NHS.

The purpose of this report, and the series of Briefings that follows it, is to support the development of decision making in this difficult area. Although it is aimed primarily at those directly involved in resource allocation, the series should also be helpful to a wider audience including providers and policy makers.

The series has been written by practitioners in the field and so are based on experience in this evolving field. The evidence base is still in an early stage of development, so this should still be regarded as work in progress and primary care trusts will need to develop their own approach to this area.

Improving the quality and transparency of decision making, involving the public, patients, providers and other stakeholders, and building the capacity of commissioners to take and then implement these decisions will be an important task over the next few years as we work towards a more world-class vision of commissioning