Personal health budgets: GP briefing

Gateway reference: 15945

Key points

A personal health budget is an amount of money that is allocated to an individual to allow them to meet their health and wellbeing needs in a way that best suits them
The aim of a personal health budget is to improve outcomes and patient satisfaction by giving people more choice and control over the NHS care they receive. We believe that personal health budgets will be a new tool to effectively meet people’s needs and help reduce unplanned hospital admissions
At the heart of a personal health budget is a care plan. This sets out the individual’s health and social care needs and includes the desired outcomes, the amount of money in the budget and how this will be spent. The care plan is developed in discussion with the patient and the professional or the individual taking the lead, before being checked and signed off by the PCT/GP Consortia
Personal health budgets offer greater integration of health and social care at the level of the individual, and partnership working between the NHS and local authorities
Personal health budgets are at an early stage of development and are currently being piloted in the NHS in England. There are currently over 60 pilot sites involved in the pilot programme, involving around half the PCTs in the country. Other PCTs/GP Consortia can apply to join the programme. An independent evaluation of the pilots will be published in 2012

Dr Greg Rogers, clinical lead for NHS Eastern and Coastal Kent’s pilot programme:

“Personal health budgets bring together the patient’s knowledge of how their health affects them together with clinical knowledge, in a real partnership. It explores how to meet the patient’s health needs in a way which works for them, and is often far more than simply giving them tablets. Knowing how much money is available empowers patients to think about doing things differently, using services not normally considered NHS services to meet individuals’ needs in a holistic and personal way. It offers a real alternative to fund services that lessen or even fix some of the underlying problems people face living with a long term condition.”

The future of personal health budgets

Personal health budgets clearly fit with the future direction of the NHS: an NHS where patients have more control and choice, an NHS that is focused on outcomes and where there is real choice around who provides services
The White Paper Equity and Excellence: Liberating the NHS[1] indicates that personal health budgets are going to be rolled out – with the pilot’s emphasis being how to implement them, and who benefits most. The White Paper indicates that the Government will consider making it a right to have a personal health budget in discrete areas such as NHS continuing health care

FAQs

How is clinical governance maintained?
Personal health budgets are based on a care plan, which sets out how a persona’s health needs and outcomes will be met. This must be agreed by the both the healthcare professional and the individual, but there are several different ways this can be achieved. Pilot sites are looking at different clinical governance processes, which will inform the development of best practice.

How are budgets set?
Setting a budget is one of a number of key practical and operational challenges being explored within the pilot programme. We currently do not have enough information on the cost of NHS services at the level of individuals to say how this should be done. During the pilot, sites are considering different approaches. Budgets could be set through the existing amount spent on the individual, a needs assessment, an outcome-based approach or potentially a combination of these. As part of the pilot, we will be looking at how sites are setting budgets, and how accurate they have been.

Will people use a personal health budget to pay for GP services/time?
As GPs provide a holistic service, we believe it would not be appropriate to include these activities in a personal health budget at this stage: broadly, this means consultation and assessment functions performed by GPs like diagnostic tests, basic medical treatment or vaccinations. However, some services organised and managed by GPs, i.e. physiotherapy, counselling or nursing services, could be included.

Will a personal health budget cover all other NHS care and services that an individual receives?
This will depend on the individual. At this time, we do not envisage personal health budgets being used to pay for unplanned care such as A&E attendance or to buy prescription medication. Nor do we see them being used routinely for elective procedures, where choice can be achieved though other mechanisms.

What can a personal health budget be spent on?
Simply, it can be spent on any services or care that meets an individual’s agreed health and wellbeing needs. The only restrictions set by the Department are that personal health budgets cannot be spent on things that are inappropriate for the State to fund, like alcohol, tobacco, gambling or debt repayment, or anything that is illegal.

Examples of choices people have made include: singing classes instead of physiotherapy to increase lung capacity and control in people with COPD; using traditional care providers but agreeing who comes into the home to provide care.

More information about personal health budgets
Further information is available on the Learning Network www.dh.gov.uk/personalhealthbudgets

Detailed background: www.personalhealthbudgets.dh.gov.uk/About/healthCareProfessionals/faqs/

Patient experiences: www.personalhealthbudgets.dh.gov.uk/About/Stories/

Interim evaluation reports: www.personalhealthbudgets.dh.gov.uk/Topics/index.cfm?tag=personal%20health%20budgets%20pilot%20evaluation

Get involved: www.personalhealthbudgets.dh.gov.uk/About/Contact/

[1] www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353