Great Expectations - Will Prioritisation Challenge Make CCGs Something of a Bleak House?

For the two hundred odd CCGs which will be formally established on 1 April 2013, the expectations are high. The Government wants to see improved patient outcomes, reduced health inequalities and the best results possible on a whole-population basis.

Without additional investment on offer this means monies must be better targeted and more efficiently used than ever - CCGs will be after the best possible outcomes for the most prudent input. To this end prioritisation becomes more important than ever and tough love and difficult decisions will become the territory of doctors rather than the big bad wolf of a PCT up the road.

The Department has thus far indicated that it will not be issuing downward directives but will rely on CCGs to engage in rational decision-making for their populations its influence seen instead mainly through the operation of the Commissioning Outcomes Framework. Commissioners are already indicating their resistance to this however feeling they will be unfairly hemmed in the COF by its very nature inimical to local assessment of need.

That local assessment requires not just technical analysis of the ice-cold metrics of clinical and cost effectiveness but also an evaluation of community values the resultant decision legitimised by transparency accountability and participation.

In order to understand how local values influence decision-making a research and policy network has been established. with a case study website where examples of prioritisation decisions can be collated and discussed. The aim of this programme is to convert the data and anecdotal evidence into a practical decision support tool for prioritisation and it is hoped that CCG decision-making will be fertile ground for such development.

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