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Independents' Day

Patients to take control of personal budgets as pilots get underway

By Ian Quinn

Thousands of GPs will have to start helping patients decide what NHS treatments they can afford as a Government plan giving people with long term conditions control over their own budgets is launched in pilots across the country.

The Government has named 20 PCTs which will carry out a three-year evaluation of the controversial personal health budget scheme.

The Department of Heath hopes the trial, which in some areas will involve every GP practice, will give more power over their care.

But it also hopes to save the NHS money, on the back of research suggesting patients will not spend all their budgets when they see for themselves just how much their care is costing.

However, the scheme has provoked fears among GPs that they will face a big new workload dealing with potentially fraught discussions over what treatments patients - including those who are dying, have mental health problems or are drug misusers - can afford.

The pilots cover a raft of long-term care categories, including end-of-life care, mental health and continuing care. Some PCTs' schemes cover a string of clinical areas such as COPD, CHD and diabetes.

Derek Hoddinott, interim commissioning manager at Medway PCT, which is to hand personal budgets to a trial group of patients all with 12 months or less to live, said it expected to provide the service to between 70-100 ‘clients' over the three years and estimates that up to 40 GP practices could be involved in the course of the trial.

He said the PCT would be measuring the success of the scheme based on improvements in palliative care outcomes, patient feedback on qualitative outcomes and whether it saved the PCT money.

A control group will be used, without personal budgets, to see if the new system gets better results.

He added: ‘I don't think this will bring a significant extra workload for GPs. What it will bring is a different style of work, working in partnership with patients. It's a change of culture.'

Medway's scheme envisages giving around one in 10 dying patients in the area control over their end-of-life care budget but in other areas up to 10,000 patients at a time are expected to be considered for a part in one of the pilots.

Dr Andrew Mimnagh, a GP in Sefton, which along with other PCTS in Liverpool will be piloting personal healthcare budgets for patients with mental health problems, said the system risked ‘opening a Pandora's box.'

He said: ‘I'm worried that we could end up with patients claiming that they are being denied treatment because of how much it costs.'

‘I also think many of my colleagues will be insulted at the idea that working in partnership with patients is a new idea and I can't see how this scheme can fail to increase our workload.'

Dr Andrew Mimnagh: 'I can't see how this scheme can fail to increase out workload' Dr Andrew Mimnagh: 'I can't see how this scheme can fail to increase out workload' Personal budget pilot sites

Bedfordshire - Long term neurological conditions
Eastern and Coastal Kent - Carers; end of life care; maternity; mental health
Norfolk - dementia; learning disabilities; mental health
Stoke-on-Trent - Learning disabilities; COPD, coronary heart disease, diabetes); mental health; tele-care
Nottingham City - Carers; COPD dementia; end of life care; heart failure; MND, Parkinson's disease
Medway - End of life care; COPD, heart and lung conditions; long term neurological conditions Huntington's disease, motor neurone disease, multiple sclerosis, Parkinson's disease)
Northamptonshire Teaching - mental health
Oxfordshire - NHS continuing healthcare; end of life care; learning disabilities; mental health (adults and older people); older people; physical disabilities; young people in transition
Birmingham East and North - Cystic fibrosis; epilepsy; chronic obstructive pulmonary disease
Hartlepool and Stockton - NHS continuing healthcare; long term conditions
Merseyside (Sefton, Liverpool and Knowsley) -Early intervention in mental health
Manchester - TBC
Doncaster - NHS continuing healthcare; mental health rehabilitation; obesity
Hull Teaching - End of life care;
Avon, Gloucestershire, Wiltshire and Somerset - Cardiac and Stroke
Dorset - including multiple sclerosis, Parkinson's disease, spinal injury and traumatic brain injury
Torbay Care Trust - NHS continuing healthcare; mental health; motor neurone disease; multiple sclerosis; preventative services; young people in transition
West London (Hammersmith & Fulham, Kensington & Chelsea and Westminster) - dementia; learning disabilities; long term conditions; older people with disabilities; physical disabilities
Barking and Dagenham - COPD, CHD, diabetes
Havering - dementia; end of life care; COPD, coronary heart disease, diabetes, stroke; tele-care

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