Most primary care trust commissioners believe they have struggled with setting priorities for health spending in their area, according to a new research report.

Research published today by the Nuffield Trust and Birmingham University’s health services management centre says although PCTs were able to influence how growth funds were spent they struggled to change how existing funding was used.

Researchers said the findings showed new commissioners – primarily the clinical commissioning groups which are gradually taking over from PCTs – should be braver and move beyond the “comfort zone” of new and marginal expenditure.

Directors of commissioning from 80 PCTs took part in the study, and the majority identified more weaknesses than strengths in how they had made decisions in the past.

They named obstacles, including a lack of evidence on which to base decisions, shifting government policy, the annual planning cycle which means priorities are set only once a year, and lack of involvement from local authorities, patient groups and the public.

The study also found PCTs seemed reluctant to make big decisions about stopping some funding despite this being a key priority.

Of the 54 per cent who said they had made a big decision to cease investment or decommission a particular service, just over half reinvested the saving in the same disease or service area.

Nuffield Trust head of policy Judith Smith said: “This study underlines the importance of priority setting for commissioners but also that it is very difficult to do well.”

She said it was difficult for commissioners to be confident enough to “withstand challenges from the public, patients and professionals”.

Ms Smith added: “It gives us a really important and valuable insight into how PCTs did this [attempted to reconfigure services] and the message is that it was difficult for them even in a time of relative financial health for the NHS.

“Clinical commissioning groups will be undertaking this challenge in a very different financial context. They are going to have to be brave as they will have to take very difficult decisions.”

She said it was vital new commissioning groups learned lessons from PCTs and made use of existing commissioning tools that had proved useful.

The report says CCGs “do not need to start with a blank sheet of paper”.