Now you know what you want to deliver, you need to work out what you can realistically achieve. You need to identify the parameters within which you are working as it is unlikely you will be able to do everything you would like.

Look at where you need to ensure you are covering certain initiatives such as QIPP, CQUIN and QOF - and where these can act as levers for service delivery. You can also use programme budgeting to identify what changes in costs and benefits are possible when resources in programmes are increased, decreased, or deployed in new ways. Programme budgeting allows you to find out if you are spending money wisely and what you are getting for it.

The steering group will need to start working with local procurement advisors (step 7) at this point to get some understanding of how the currencies (tariffs and payment strategies) will affect the cost of what they want to procure. 

At this stage you will also need to make sure you’re building in a robust monitoring process so you can measure the impact on the health of people using the service.

This section describes:

• How the resources that will be needed may be addressed including programme budgets
• Linking with other strategic initiatives to improve efficiency
• Monitoring arrangements and metrics - you need to include a robust monitoring process with specified measures in the SLA to be able to measure the impact on the health of people using the service

These decisions will then be fed directly into the specifications for services from the appropriate providers