Developing a prioritisation framework in an English Primary Care Trust

Edward Cf Wilson,John Rees,Richard J Fordham

doi:10.1186/1478-7547-4-3

Edward Cf Wilson, John Rees + Show 1 more

Open Access

https://doi.org/10.1186/1478-7547-4-3

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Abstract

BackgroundIn the English NHS, Primary Care Trusts (PCTs) are required to commission health services, to maximise the well-being of the population, subject to the available budget. There are numerous techniques employed to make decisions, some more rational and transparent than others. A weighted benefit score can be used to rank options but this does not take into account value for money from investments.MethodsWe developed a weighted benefit score framework for use in an English PCT which ranked options in order of 'cost-value' or 'cost per point of benefit'. Our method differs from existing techniques by explicitly combining cost and a composite weighted benefit score into the cost-value ratio.ResultsThe technique proved readily workable, and was able to accommodate a wide variety of data and competing criteria. Participants felt able to assign scores to proposed services, and generate a ranked list, which provides a solid starting point for the PCT Board to discuss and make funding decisions. Limitations included potential for criteria to be neither exhaustive nor mutually exclusive and the lack of an interval property in the benefit score limiting the usefulness of a cost-value ratio.ConclusionA technical approach to decision making is insufficient for making prioritisation decisions, however our technique provides a very valuable, structured and informed starting point for PCT decision making.

Highlights

In the English National Health Service (NHS), Primary Care Trusts (PCTs) are required to commission health services, to maximise the well-being of the population, subject to the available budget
Primary Care Trusts (PCTs) are responsible for commissioning an appropriate basket of health care services to achieve this in their local population
Devising the framework The framework for calculating benefit scores was devised and tested at a workshop held in October 2003

Summary

Introduction

In the English NHS, Primary Care Trusts (PCTs) are required to commission health services, to maximise the well-being of the population, subject to the available budget. There are numerous techniques employed to make decisions, some more rational and transparent than others. The demand for health care will always exceed the capacity of the available resources. Decisions must be made as to which treatments and services to commission (purchase), in order to maximise the well-being of the population, subject to the available budget. The objective of the English National Health Service (NHS) is not explicitly defined. Primary Care Trusts (PCTs) are responsible for commissioning an appropriate basket of health care services to achieve this in their local population (approximately 100,000 – 200,000). PCTs can commission from a variety of care providers including (page number not for citation purposes)

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