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Difficult commissioning choices: lessons from English primary care trusts

Vergel, Y.B. and Ferguson, B. (2006) Difficult commissioning choices: lessons from English primary care trusts. Journal of Health Services Research & Policy, 11 (3). pp. 150-154. ISSN 1355-8196

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Objective: In England, primary care organizations (primary care trusts, PCTs) have scope to influence the provision of health care at the margin. However, when faced with difficult commissioning choices, restriction of services potentially leaves them vulnerable to legal challenge. PCTs are developing different approaches to priority setting but there is a need to develop processes that lead to more consistent, accountable and fair decision-making. Our objective was to describe recent local developments on prioritization decision-making.

Methods: Rationing policies in PCTs in West Yorkshire and North & East Yorkshire and North Lincolnshire (NEYNL) Strategic Health Authority areas in 2003 were examined. To evaluate priority setting, we compared the descriptive findings with an internationally recognized ethical framework for priority setting, 'accountability for reasonableness' (AFR).

Results: PCTs varied as regards the stage of policy development they had reached. Rationing by exclusion was the most common approach to prioritization, but in general PCTs failed to make the rationale for their decisions explicit and accessible. The importance of an appeals process was recognized by the majority of PCTs. Those that had developed a formal process to address difficult commissioning decisions were an exception.

Conclusions: Adopting AFR as a prioritization framework can serve to improve the fairness and consistency of the decision-making process, reducing the vulnerability of PCTs to legal challenge. Characteristics of rationing policies already in place fulfil some of the AFR conditions but there remains scope for further improvements in their design and dissemination.

Item Type: Article
Institution: The University of York
Academic Units: The University of York > Health Sciences (York)
Depositing User: York RAE Import
Date Deposited: 22 Apr 2009 13:09
Last Modified: 22 Apr 2009 13:09
Published Version: http://dx.doi.org/10.1258/135581906777641749
Status: Published
Publisher: Royal Society of Medicine
Identification Number: 10.1258/135581906777641749
URI: http://eprints.whiterose.ac.uk/id/eprint/6714

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