The public and professional interface with priority setting in the National Health Service

The agenda of purchasers of health care in the National Health Service (NHS) is increasingly dominated by the issue of priority setting. This is a consequence of the interplay of limited budgets, increasing demands on health care services and a contracting process that makes explicit resource decisions that were previously implicit through clinical discretion. Purchasers are increasingly concerned to show that their decisions are rationally informed and embody a professional and public consensus. This paper examines literature that suggests variables, other than rational determinants, play a part in the process of priority setting at the purchaser and provider level. The interface of public, political and professional agendas in this process help explain the lack of national uniformity in both setting priorities and their translation into practice. Consequently, there is a need for more comprehensive exploration of the relationship between the setting of priorities and their effect on practice.