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CCGs 'spending £1,500 a year per patient' on personal health budget administration

Exclusive Commissioners are spending as much as £1,500 every year to third party organisations for administrating a single patient’s personal health budget, it has emerged.

The head of commissioning at NHS Shared Business Services told delegates at the Health + Care conference in London yesterday that the organisation has heard of brokers charging these fees, which only includes administrative support. 

Benjamin Damazer said that the high costs involved mean that using a third party is hard to justify,even though many patients may not be able to manage a budget for themselves.

CCGs are currently under huge pressure to ramp up the number of patients adopting personal health budgets, as part of NHS England’s ‘personalisation agenda’.

NHS England wants CCGs to give patients direct payments so they can spend the budget as they choose, but many CCGs are using third party organisations to administer the budget on their behalf.

Mr Damazer said that CCGs are finding brokers ‘an expensive option’.

He added: ‘We are aware of one broker that charges the CCG £1,500 per patient per year to act as the broker and intermediary and for that the patient doesn’t get support beyond the admin. Whether it comes off the patient’s budget or not, it’s still the CCG and the taxpayer they are charging. So it is a difficult model to justify financially.'

Around 5,000 patients have personal budgets currently, but NHS chiefs are pushing to increase this to around 100,000 in the next few years, so they are used by a much wider range of patients with long-term conditions - despite concerns from GP leaders and other experts that they do not offer clear health benefits and could destabilise existing NHS services.

CCGs can give patients a direct payment, use a third party, also known as a ‘broker’, or give them a ‘notional budget’ - where the patient’s care team still have control over the budget.

NHS England says that evidence shows patients do best when they receive a direct payment for their budget.

But Mr Damazer explained that direct payments were also causing CCGs considerable administrative burden.

He said: ‘We’ve seen examples of patients coming into CCGs with carrier bags of receipts and some poor junior administrator is left to deal with all those receipts, sort them out and put them in some sort of order and explain why the value of the receipts is not the same as the value of the budget, and account for that through to audit committees.'

An NHS England spokesperson said: 'NHS England is committed to working with CCGs to ensure that personal health budgets are cost-effective, whilst ensuring that patients receive high quality and personalised care. Evaluation of personal health budgets has indicated that personal health budgets are cost-effective compared with conventional health services.

'Third party brokers who support the delivery of personal health budgets can offer a range of services besides administration, including care planning and employment support and advice. CCGs have a responsibility to ensure that all third party support services represent genuine value for money for the service being provided.'

Personal health budgets under scrutiny

Travel - beach - SQUARE

CCGs are currently being pushed to expand access to personal health budgets for a range of patients, including those with long-term conditions.

NHS chiefs have set a target to have 100,000 people using the budgets by 2020, and Simon Stevens has also gone on record calling for ‘north of five million’ NHS patients with long-term conditions to be using a combined personal budget – covering both health and social care needs – within two years.

The plans are based on Department of Health pilots of personal health budgets, after an evaluation concluded that they could save the NHS money and improve patients’ quality of life.

However, the pilots caused controversy when Pulse revealed that patients had used their budgets to pay for items such as frozen ready meals and theatre tickets. A separate independent evaluation subsequently concluded that the budgets offered no overall health improvements and only benefited patients who spent considerably more than usual on their care.

CCG leaders have expressed doubts about whether the schemes offer value for money, especially for the wider population of patients with chronic conditions that NHS chiefs want to reach, while critics also argue they risk destabilising existing NHS services and serve as a precursor for private medical insurance care packages. Pulse discovered that a day centre in one area had been axed so the CCG could put money into offering the budgets to some patients with mental health problems.

More recently the BMA called for a review of personal health budgets and NICE said they should be evaluated further, after a Pulse investigation revealed the budgets were being used on non-evidence based treatments such as holidays, summer houses, reflexology and pedalo boat rides.

Readers' comments (9)

  • This is the direction that the NHS is moving. At the moment patients can overspend and the CCG picks this up. If patients continue to overspend their right to hold a budget can be taken away. However patients can top up their budgets themselves. So think of a future NHS where patients have personal budgets for all of their care. In essence this will be similar to private health insurance where patients have limits on what insurance will pay for. Now imagine these budgets being controlled by insurance companies, which in effect is what these 'brokers' are. It is very easy for these 'brokers' to sell patients top up health insurance packages. Future Governments can then gradually reduce the money paid for personal budgets, transferring the cost for what would now be 'essential' top ups to patients.

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  • 'Third party providers'- and shady deals flourish. Certainly, all member Practices are aware of this expenditure. Carry on CCGs !

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  • Where's Optimus?

    Administratum: A Chemical Analysis


    Physicists at Harwell have discovered the heaviest element
    known to science, named Administratum. The new element has no
    protons or electrons, and has an atomic number of zero.
    However, it does have one neutron, eight assistant neutrons,
    ten executive neutrons, 35 vice neutrons and 258 assistant
    vice neutrons.

    Administratum has an atomic mass of 311=, since the neutron
    is only detectable half of the time. Its 312 particles are
    held together by a force which involves the continuous
    exchange of meson-like particles, called morons.

    Since it has no electrons, Administratum is completely inert.
    Nevertheless, its presence can be detected because it impedes
    every reaction with which it comes into contact. One
    experiment, which should have lasted only a few days, is
    still running after 2= years due to the addition of just one
    milligramme of Administratum.

    It is weakly active, and has a normal half-life of
    approximately six months. After this time, it does not
    actually decay, but undergoes a metamorphosis in which
    assistant neutrons, executive neutrons, vice neutrons and
    assistant vice neutrons exchange places. This almost
    invariably leads to an increase in atomic weight, hence it is

    Although it occurs widely, Administratum tends to concentrate
    around large corporations, research laboratories and
    government departments. It can especially be found in
    recently re-organised sites, and there is reason to believe
    that it is heavily involved in the processes of deforestation
    and global warming.

    It should be remembered that Administratum is known to be
    toxic at all concentrations, and can easily destroy any
    productive reactions where it is allowed to accumulate.
    Numerous attempts have been made to determine how
    Administratum can be controlled to prevent irreversible
    damage, but results to date are not promising.

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  • And we get £134 per patient per year to do anything and everything. Total p#ss take.

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  • Time for gps to negotiate new rates for administration of patient meds and patient letters and patient investigation results .. 1500 per patient should cover it

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  • We will do the admin and the health stuff for 1499.00. I might even do it for 500.
    This whole thing is a joke and the joke is on us. There you are, Chaand, just ask for 1500 for admin and health. Simple.

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  • Wow £134 per patient, I only get £77! The moment I see them I have made a loss! CQC clearly shows the link between funding and success. Failing practices all have low funding. NHS England made them fail. It will be interesting to see how much virgin gets.

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  • 9:44 - We are taking legal action against nhse; if you have a problems with low payments and wish to share info, email
    Some Practices had data skewed manually and it's worthwhile exploring why

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  • SBS are looking to move into this market with a IT solution so this headline is clearly to drum up business for themselves!

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