ABSTRACT
Priority setting in the UK is proceeding mainly by the development of clinical guidelines rather than the exclusion of services. The Department of Health publishes guidance on planning and priorities each year, while regional bodies make efforts to secure compliance. The UK is the only one of the countries studied where the government has resisted suggestions for a national initiative to debate and determine priorities. Priority setting has existed since the NHS began, but previously took the form mainly of waiting lists for treatment. National effort is concentrated on the development of evidence-based medicine. Decisions are still left to local action, but the Department of Health has urged purchasers to base them increasingly on evidence of clinical effectiveness. The widest scope for setting priorities was provided by growth money to finance service development. The UK is unique in having a corps of GPs who set their own priorities by holding budgets.
