Rationalizing rationing in health care: experience of two primary care trusts

Background Priority setting, or rationing, in healthcare is an unavoidable consequence of competing demands on the resources available. This is a description of the experience of the two Primary Care Trusts in using an explicit scoring tool to prioritize proposals submitted for new funding within the local health economy. Methods A Priorities Forum Panel was established, comprising representatives from the local NHS trusts. The Panel reviewed and scored new funding proposals and then ranked them for priority funding. Results Over 100 proposals were submitted (total cost: approximately £44 million). Sixty-six proposals were scored (total cost: over £26 million). Around £5 million was available for funding, resulting in few of the top-scoring proposals being supported. The proposals which were linked to the implementation of National Institute for Health and Clinical Excellence (NICE) guidance were generally given a lower priority compared with those likely to relieve local pressures and facilitate the implementation of specific National Service Framework criteria. Conclusions Funding of the locally driven priorities took precedence over some of the nationally driven priorities, such as funding of specific NICE guidance. The shortfall in resources did not allow for the funding of a significant number of high-scoring proposals.