The idea behind PHBs (personal health budgets) is that patients with certain long term conditions are allocated a pot of money to spend on their individual needs. The patient works with their local NHS team to agree a care plan, setting out how the budget will be spent.

The BMA's position

Whilst supportive of patients having more control over their care, the evidence shows that although quality of life may improve, personal health budgets do not directly result in better clinical outcomes for patients.

The BMA is also concerned that NHS funds, which are already stretched to the limit, are being spent on non-traditional treatments and non-NHS services that may not be clinically effective.

There is also the potential for inequity for patients, with those in receipt of personal health budgets being able to access treatments that others may not. Until these issues can be resolved satisfactorily, the BMA will remain unconvinced of the benefit of personal health budgets.

Helping patients decide

Not every patient who is eligible will know about personal health budgets or understand their benefits and drawbacks. Some may need more help in decision-making than others.

To help you best advise your patient:

• if necessary, help eligible patients to understand personal health budgets to enable them to make the right decision
• if it isn't practical to do this yourself, you can advise your patient to speak to a personal health budget broker, or another knowledgeable member of the NHS team involved in their care
• check what has been agreed locally about the differing roles of the team of staff supporting patients with personal health budgets
• become familiar with alternative options to help patients access more personalised care
• be clear that social care personal budgets are a different thing altogether.

Practical steps

Once a patient has decided they would like to pursue holding a personal health budget, they should be referred to a broker.

If agreed, a personal health care plan is drafted and at this stage input from the patient's GP and other doctors is required.

We recommend you ask to be regularly updated on the patient's progress.

Concerns

In some cases, patients may wish to use their budget to pay for something which is not evidence-based.

The RCGP's advice is to note that there is a difference between approving a care plan that you know is unsafe, and approving a non-traditional service that has no clinical evidence to say it will help but which you know is not harmful.

As a clinician, any concerns you have will be taken into account in discussions between the broker and the patient, and the personal health budget plan amended as necessary.