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Clinical prioritisation

We need to commission healthcare services that are evidence based and effective in delivering improved outcomes for people living in Birmingham and Solihull.

Clinical prioritisation is a key component of commissioning, with healthcare interventions evaluated in order to decide what investments and/or disinvestments in services should be made to meet the needs of our local communities.

The NHS has limited resources and as a commissioner, the CCG has to remain within its allocated budget, as well as ensuring that it commissions clinically effective healthcare based on the benefit to our patients and the best available evidence. This means that difficult decisions may have to be made.

To help the CCG assess the value of treatments and what services we should invest in, the CCG has a clinically-led prioritisation framework. All decisions are made in line with the Prioritisation of healthcare resources policy and the Decommissioning and disinvestment policy.

Clinical Priorities Advisory Group

The CCG’s Clinical Priorities Advisory Group (CPAG) meets on a monthly basis and is made up of clinicians, commissioners and patient representatives. It makes recommendations for prioritisation in the best interests of people living in Birmingham and Solihull.

The group makes its recommendation on the basis of the score for each commissioning proposal but does not make the actual decision. The final decision is made in line with the CCG's operational delegated financial approval limits and, depending on the value, may include the CCG’s Governing Body. In most cases, engagement with the public, providers and clinicians will have been carried out – find out more on our Get involved pages – and there will also have been an equality impact assessment undertaken.

How is prioritisation done?

Each service or intervention considered as part of a commissioning proposal is referred to the CPAG, which carries out a rigorous process of collating and reviewing evidence to determine:

  • The benefit to patients – whether it leads to significant and long lasting improvements
  • Value for money – whether similar outcomes can be achieved for less cost: All programmes are reviewed as part of the Best Value Review
  • Whether there is good evidence to support the proposal.

The Birmingham Public Health team supports the CCG with the collation and review of evidence, which enables services to be scored to recommend that they are either commissioned or disinvested in.

In considering the evidence, the CPAG will look at:

  • How well does this treatment or service work?
  • Which groups of patients get most benefit?
  • How cost effective is the intervention – how much health gain compared to the cost?
  • Does it support people with existing conditions?
  • Does it address health inequalities?
  • Is it a local or national priority?

The role of public health in the prioritisation process

Summary of the score card framework

How can I get involved?

Our patients are encouraged to submit comments to support the review of specific healthcare services. You can find out what is coming up for review, and send your comments by emailing This email address is being protected from spambots. You need JavaScript enabled to view it..

You can view the final scores made by the CPAG group here.

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