Framework to help commissioners make fair resource allocation decisions

Wooden framework for a house
Lottery balls

Improved resource allocation will reduce incidence of the ‘postcode lottery’

This paper describes the development of a framework to help commissioners make effective decisions with regards to local resource allocation decisions. The aim is to reduce variation in prescribing patterns across England, also known as the ‘postcode lottery.’

While the framework was originally developed by the former National Prescribing Centre, which is now the Medicines and Prescribing Centre at NICE, the authors feel that it can be transferred to the new NHS, and in particular the clinical commissioning groups (CCGs).

The steering group that developed this framework was made up of academics, practitioners, opinion leaders, and and experts in resource allocation at local, regional, and national level, and the framework itself is based on evidence-based principles.

Characters fixing a bridge

Clinical Commissioning Groups can use the framework to improve their effectiveness

Summary of the framework

A copy of the framework is viewable here and in the original paper, and lists the nine competency sets required by Clinical Commissioning Groups:

  1. Assessment of evidence for clinical and cost effectiveness
  2. Finance and contracting
  3. Administration
  4. Screening of in-year requests
  5. External communication and engagement
  6. Governance and safety
  7. Deliberation, reasoning and ethical judgement
  8. Group communication
  9. Chairing

The authors were very good at explaining the strengths and weaknesses of frameworks in general, discussing criticisms of frameworks published by other authors, but they concluded that it would still be a valuable educational resource for commissioners. It was launched in April 2012, and “evidence is emerging from some CCGs to suggest that it is being used as a starting point”, together with an example of one locality which has used it as a benchmarking tool to identify areas for improvement.


The aim is to reduce variation in practice patterns across England


The framework was developed before the NHS re-organisation, and since then the developing organisation, NPC, has moved under the umbrella of the National Institute of Health and Care Excellence, together with the framework and its support material which included a collection of guides, e-learning and newsletter resources. The paper has a link, but it is to the archived site, where these resources are still available. Hopefully they will transfer to the new site, so that this useful framework can be applied to ensure that commissioners allocate resources fairly and make consistent decisions across the country. The benefits would be reduced variations in service delivery, and more efficient and cost effective health care practices.

Clinical commissioning groups can use this framework together with the local decision-making educational resources to identify where they need to improve their skill-base, and then they can use the supporting resources to help fill those gaps.


Addressing the ‘postcode lottery’ in local resource allocation decisions: a framework for clinical commissioning groups (PDF)
J Russell, T Greenhalgh, H Lewis, I MacKenzie, N Maskrey, J Montgomery, C O’Donnell
Journal of the Royal Society of Medicine, 2013, 106:120-123

Supporting material

Local decision-making – collection of elearning materials and case studies to help implement the framework.

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Caroline De Brún

Caroline De Brún

Caroline has been a medical librarian in a variety of NHS and academic roles since 1999, working in academic, primary and secondary care settings, service improvement, knowledge management, and on several high profile national projects. She has a PhD in Computing and currently develops resources to support evidence-based cost and quality, including QIPP @lert, a blog highlighting key reports from health care and other sectors related to service improvement and QIPP (Quality, Innovation, Productivity, Prevention). She also delivers training and resources to support evidence identification and appraisal for cost, quality, service improvement, and leadership. She is co-author of the Searching Skills Toolkit, which aims to support health professionals' searching for best quality clinical and non-clinical evidence. Her research interests are health management, commissioning, public health, consumer health information literacy, and knowledge management. She currently works as a Knowledge and Evidence Specialist for Public Health England, and works on the Commissioning Elf in her spare time.

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