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David Oliver: What’s the verdict on personal health budgets?

BMJ 2019; 366 doi: (Published 21 August 2019) Cite this as: BMJ 2019;366:l5138

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Re: David Oliver: What’s the verdict on personal health budgets?


I thank Woody Caan and Andrew Bamji for their comments

The issue of personal health and budgets is one on which I have no clear personal view, hence my setting out the arguments on both sides and leaving the conclusions open ended.

With regard to doctors learning advocacy and asset mapping, I suspect General Practitioners would be the ones leading the way on working with patients on developing personal care and support plans. The GP training curriculum is already shorter than that for specialist medicine, despite the pivotal role of GPs as true expert generalists meaning they probably need a broader range of knowledge and skill than their hospital counterparts. And there are constant calls for them to "Know more about" or "have more skills in" X Y or Z. I wonder if the solution might be in Advanced Practitioners or Care Co-ordinators or a smaller group of GPs specifically trained in these skills. However, there is a wider focus on shared care, supported self management, care planning (including advance care planning for End of Life) in health policy and to deliver these in any kind of mainstream way both GPs, primary and community care nurses and their secondary care and mental health counterparts would need relevant skils either embdedded in standard training or more feasibly, built into to specialised training beyond that.

With regard to Andrew Bamji, I think the considerable movement led by health advocacy groups, patient charities, some practitioners and now embedded in the NHS 10 year plan, towards care planning in partnership with patients and families would say that the "experts" and expertise are with the patients with regard to their own condition, their own lives, their own priorities and that expertise should be given parity with that of the professionals. Paternalism and pedestals are Passe in this narrative.

However, as he re-iterated, every decision to spend a pound of public money on one intervention, support, potentially deprives another patient If you read the detailed guidance from NHS England on what Personal Health Budgets can be used for, they explicitly exclude medications, operations, procedures, GP appointments and urgent care. To my mind this is perhaps their biggest limitation. If you are living with one or more long term conditions which mean all of these things may be necessary then a personal budget cannot in reality cover all that person's needs even if it can allow some more personalised support.

David Oliver

Competing interests: No competing interests

26 August 2019
David Oliver
Consultant Physician