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GPs could take control of the administration of personal health budgets, says think-tank



The Government should consider putting GP practices in charge of the administration of patients’ individual personal health budgets, a leading think-tank has said in a report launched by the care minister overseeing the initiative.

Under proposals suggested by 2020health, which were launched today by health minister Norman Lamb, GPs would be subcontracted by CCGs in certain cases to make ‘small discretionary payments’ to patients as part of the personal health budget scheme, with the practices taking responsibility for the administration of the budgets. In the pilot, the GP role was limited to making referrals and recommendations.

The authors, who looked at the DH’s analysis of the pilot results published last year as well as at data stemming directly from the pilot areas, came out strongly in support of personal budgets for mental health patients and those requiring continuing care. They also said it should in future be rolled out for arthritic patients, for haemodialysis transport and falls prevention.

But GP leaders said that taking on the administration of the scheme - which is due to be rolled out by April 2014 to 56,000 patients receiving continuing care - would add ‘budgetary bureacracy’ to practices at a time when CCGs are allowed to personalise commissioning arrangements without the need of a new initiative.

The report said: ‘We would recommend that where possible, GP practices should issue budgets notionally and undertake the payment of invoices on behalf of patients. The CCG would need full oversight of all GP-issued PHBs, ensuring accountability and transparency - the CCG would after all be effectively subcontracting the work.’

GPs should be enabled to make ‘small discretionary’ payments from funds held by, or immediately accessible to, the practice itself, 2020Health said. It recommended that to avoid fraud or patients overspending, the payments could be made via a prepaid card or a voucher scheme.

Click here to read the full report

But the authors admitted that the rollout would be controversial, saying that scheme would challenge the role of the GP.

They wrote: ‘PHBs undoubtedly challenge the traditional status of GPs and other clinicians, besides uprooting conventional models of healthcare delivery. The culture shift is enormous, but necessary for individuals to become sufficiently informed and empowered, as the pilot evaluators have noted.’

The report also said many GPs are currently ‘ill-informed’ about personal health budgets while those with knowledge of the scheme fear that the rollout will come with widespread fraud and a destabilising of traditional services. They also found that GPs were concerned regarding the financial viability of the scheme to the NHS, as a patient could not be denied care if they spent their personal health budget unwisely.

The authors concluded: ‘It is vital to remember that the NHS is (in theory) not spending any more money than it would do providing traditional services.’

But GPC negotiator Dr Chaand Nagpaul said he was confused by the scheme’s relevance to GPs as it seemed to focus on social rather than medical aspects of care.

He said: ‘That is where I am getting confused. In the pilots I have not seen many actual healthcare budgets being tested. They have not made a sufficient argument for introducing these budgets into the NHS. We are using this term very loosely. What we are talking about are personal budgets for social elements of their care, rather than direct healthcare. We need to be careful before involving GPs, who are already overworked to administer a scheme that will take their time away from patients. They cannot just take on additional work like this.’

‘If GPs were to take on this role then it begs the question if they are personal health budgets or a GP-led scheme in which case why not simply use the current commissioning arrangements but tailor them more for individual patients. GPs already are commissioners of care for their patients and there is nothing to stop the commissioning arrangements to be more personalised, rather than creating a new budgetary bureaucracy.’

The budgets have proved controversial after patients spent NHS funds on complementary therapies, theatre tickets and manicures, and the 2020health report is likely to fuel that fire, making an example of a PCT signing off on parents buying their disabled son a summerhouse.

A DH spokesperson said: ‘Personal health budgets are a good example of how the NHS is now able to give people more choice and control and this report by 2020health highlights some of the challenges that have to be overcome when delivering change. The learning from the pilot programme has been captured and best practice and the other information CCGs will need is available. This covers many of the issues that were raised in the 2020health report such as financial sustainability and equality.’

‘They will also get support from a national delivery team, helping them to make the necessary changes so they can provide personal health budgets well. The key to getting personal health budgets right are pragmatism and flexibility.’

This article was modified at 16:00 on 10 July 2013