1. Suzanne Robinson*, Helen Dickinson*, Iestyn Williams*, Tim Freeman*,
Benedict Rumbold** and Katie Spence *
* Health Services Management Centre ** The Nuffield Trust

2. Research into PCT priority
setting
 University of Birmingham and
Nuffield Trust study
 One of the first studies to have
looked at PS activity nationally
 Aim to map and explore current
priority setting activities in
English PCTs
 Survey- to all 152 PCTs
(response rate 80/152 PCTS in
England (53%) )
 5 in-depth case studies

3. • What priority setting tools, processes and activities are
practised currently as part of the commissioning process of
English PCTs.
• What barriers are experienced by PCTs seeking to
implement explicit priority setting, and how are these
addressed?
• What barriers are experienced by PCTs seeking to
implement explicit priority setting practices?
• What learning can be derived that will be instructive for
future priority setting within the NHS and elsewhere?

4. Table 1 Priority setting activity at the case study sites
Type of priority setting activities Wave one sites Wave Two sites
(Appendix 1 provides more detailed Morebeck Donative Nethersole Chetwynd Chatterton
definitions of these different activities)
Overall budget allocation (core budget
spend)
✔ ✔
New resource allocation ✔ ✔ ✔
Reprioritising across budget areas ✔ ✔
Disease care pathway redesign ✔ ✔
Disinvestment /decommissioning of existing
service provision ✔ ✔

11. Picking the low hanging fruit
 Easier targets such as varicose
veins, IVF, routine orthopaedics,
closing daycentres and care
homes
 What next?
 Many large scale disinvestment
projects planned, few as yet
achieved
 Hospitals are where the real
savings are to be made…

13.  Be a difficult and challenging business
 Often happens at the margins
 Be difficult in terms of decommissioning services-
‘easier to invest than disinvest in services’
 Focus on technical aspects and processes
 Be very political (P) (p)
 Be difficult in terms of implementation of
decisions
 Require strong leadership and motivation

14.  Attempts to take a more explicit approach – gov’t
policy through WCC has been one of the drivers
for this
 Development of tools and techniques to aid PS
 Some commissioners are engaging with other
stakeholders- taking health economy approach
 Lots of good practice examples and work around
PS and investment
 Work around disinvestment is also becoming
more important and prominent in some areas

15.  Positive impact of a system wide approach –
‘PS is everyone's business!’
 Shared decision making engagement with
relevant stakeholders
 Technical process can be an active part in PS –
appeal to stakeholders and help with
engagement
 Understanding of evidence and what relevant
evidence is available locally
 Providing incentives to help with change and
implementation of PS decisions

16.  Strong leadership being able to negotiate the
difficult political and cultural aspects of
health care
 Motivation and engagement of middle
managers and front line staff
 Governance structures
 Once decision is made having a manager/s
who lead and implement the chance

17.  Power of PCT – relative power in balance within
health economies –
 PCTs not having sufficient levers to instigate
change
 National political arena does not specifically
support prioritisation and rationing of services
 Incentives of other polices - such as PBR, pressure
of ‘must dos’
 Lack of strong evidence base and capability and
skill to analyse and interpret evidence
 Lack of strong and effective leadership