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This paper aims to describe a new process for creating points systems – i.e. decision criteria and their point values – for prioritising patients for access to elective health services.

The process was developed in New Zealand from a project the authors were closely involved in, beginning in 2004, to create new points systems, initially for coronary artery bypass graft (CABG) surgery and then successively for other elective services. The objective was to overcome the limitations of earlier methodologies for creating points systems.

The process, supported by internet‐based software, consists of seven steps performed by a working group of clinical leaders for the elective service concerned, in consultation with patient groups and other clinicians. The authors' experience reveals it is acceptable to clinicians and their professional organisations as well as to patient groups.

The process creates points systems that are valid and reproducible and based on a consensus of clinical judgements. The process is explained in a step‐by‐step manner so that it is possible for readers to apply it themselves to create points systems for their own patient‐prioritisation applications.