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Five-minute guide to...deciding your PBC priorities

The third of our eight-part guide on the basics of PBC, produced by Beverley Slater and Michelle Webster of the Improvement Foundation

The third of our eight-part guide on the basics of PBC, produced by Beverley Slater and Michelle Webster of the Improvement Foundation

Official definition

Prioritise investment according to local needs, service requirements and the values of the NHS.

Put into layman's terms

Making decisions that help NHS money go further for local patients.

What it involves

1 Identifying clear objectives and decision-making processes.

2 Using national and local information to inform your decisions.

3 Involving all the relevant stakeholders.

Important because…

Healthcare resources are finite and there are competing claims on these resources.

How to go about it

The aim is to make rational, transparent and fair investment decisions. Decisions must be robust enough to withstand challenge and have full patient and public involvement. They should be driven by a clear needs assessment, including anticipation of future needs, and public health priorities, and be supported by excellent analysis and information.

Any commissioning organisation, PCT or PBC group needs to identify an annual set of commissioning priorities in line with the national priorities in the NHS operating framework – and then identify additional local priorities.

These will be shaped by up-to-date local and national information, including needs assessments, national guidance and any opportunities for service redesign. In practice, PCTs and PBC groups may wish to lead their own processes, as their priorities might differ slightly, but nevertheless each should contribute to and be informed about the other.

In order to objectively choose between competing options, commissioning groups should have a prioritisation process based on explicit values. This will usually involve:

• identifying services for change, scoring and ranking them, and shifting or allocating resources based on those rankings

• GPs and managers working together

• working with data analysts and financial personnel

• using information from multiple sources

• taking public and patient input on board.

This process is likely to be led by a local expert familiar with prioritisation tools, such as a public health practitioner or health economist. The ‘priority selector tool' from the NHS Institute, developed to help services outside hospital, is a useful tool.

Programme budgeting and marginal analysis (PBMA) is a useful approach that can be used to analyse spending and to shift resources accordingly (see links below).

Background/relevant policy

Prioritising investment is one of the 11 core competencies for world-class commissioning, and a statement of NHS priorities is one of the main focuses of the annual NHS Operating Framework.

Pitfalls to avoid

Decision processes that are less systematic or transparent can leave commissioners poorly equipped to deal with local political challenges such as single issue pressure groups or adverse publicity.


Department of Health - programme budgeting

NHS Institute– search for ‘prioritise commissioning opportunities'

Michelle Webster is national commissioning lead and Beverley Slater is national knowledge management lead for the Improvement Foundation, which runs advanced commissioning courses

Next month: Designing a new service

How the commissioning cycle works

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