Setting priorities in health: The challenge of clinical commissioning

A national study into how PCTs have prioritised NHS resources, highlighting the strengths and weaknesses of their processes.

Research report co-author Dr Suzanne Robinson on what can be done to support clinical commissioning groups as they take on the priority-setting role

The Nuffield Trust and the Health Services Management Centre (HSMC) at the University of Birmingham have carried out a national research study into how primary care trusts (PCTs) have gone about setting priorities for health care spending. Setting priorities in health maps the activities taking place across the NHS and explores the effectiveness of these practices within specific local contexts. 

PCTs have made significant strides in their priority-setting processes, with the majority of PCTs having formal arrangements in place.  However, across the NHS the picture is of a complex patchwork of different approaches and tools.

Emerging clinical commissioning groups will take on responsibility for prioritising NHS resources, and will need to make significant efficiency savings over the coming years. There is much that can be learned from PCTs’ experiences in priority setting and commissioning. Clinical commissioning groups will need robust evidence on which to base their decisions, and will need to work with local clinicians, provider organisations, patients and the public when making these decisions.

Overall, the need to make explicit and fair decisions over the targeting of resources has moved to the centre stage of government policy & commissioning has emerged as the key vehicle for its delivery

NHS England (formally the NHS Commissioning Board) will play a key part in supporting local commissioners in making difficult priority-setting decisions. This research highlights what the key policy drivers have been for PCTs, what governance is required in priority setting, and what the technical and political challenges are.

The research report: Setting priorities in health: A study of English primary care trusts, by Suzanne Robinson, Helen Dickinson, Iestyn Williams, Tim Freeman, Benedict Rumbold and Katie Spence of HSMC and Nuffield Trust, sets out the methods and findings from the research, which involved a national survey and five detailed case studies. An accompanying research summary: Setting priorities in health: The challenge of clinical commissioning, by Nuffield Trust Director of Policy Dr Judith Smith, includes analysis of the findings alongside a summary of the research, and relates the findings to the challenges facing a new generation of health commissioners.

This is the first in a series of reports that Nuffield Trust is publishing as part of its research project: The quest for efficiency in the English NHS,  a comprehensive programme of work that aims to help the NHS respond to the financial challenges ahead by examining how health services can improve productivity and deliver more for less.

These publications will be of interest to policy-makers, commissioners, clinicians and academics with an interest in how scarce NHS resources are allocated and how care can be effectively commissioned in the new NHS.


Health Services Management Centre, University of Birmingham

Suggested citation

Robinson S, Dickinson H, Williams I, Freeman T, Rumbold B and Spence K (2011) Setting priorities in health: The challenge of clinical commissioning. Research report. Nuffield Trust and Health Services Management Centre, University of Birmingham.