Virtual Wallet for One-Off PHBS - COPD

This project will test the use of low value OOPHBs for people with COPD, building on their successful application in discharge (part of the UEC Recovery Plan).

The aim is to test and evaluate OOPHBs to increase participation in Pulmonary Rehab (PR) and /or supported self-management. The PHB offer will be targeted specifically at those that experience barriers to access due to health inequalities such as deprivation and/or SMI.

• National commitment to increase referrals to PR and engagement in self-management activity which will likely be included in MCS and MTS (Lung Health @home work is supporting delivery of national objectives)
• Although a highly effective, recommended intervention, conversion rate of referral to uptake of PR can be impacted by health inequalities i.e. SMI /deprivation
• Chronic respiratory disease is a CORE20PLUS5 clinical area. Respiratory disease is strongly associated with social deprivation and is a major contributor to the overall life expectancy gap between the rich and the poor.
• People living with a serious mental illness generally have higher rates of lung conditions. They also die 15 – 20 years earlier than the general population.
• The pandemic has exacerbated wait times for PR – there is a need to support people whilst waiting which could be through SSM, physical activity or community-based provision.
• Clinical support to test this approach from sites and Interim NCD Jonathan Fuld and Personalised Care Clinical Advisor, Mohan Chandan

The PCN should send over a quote on their letterhead to NHS England, this should include the content from the previously shared MOU document, a purchase order number will be raised and sent to the PCN site. The PCN should then send an invoice with the purchase order number included to NHS England via the @home team in order to receive funds.

No, however, it would be advisable to ensure your ICB is aware of this piece of work alongside their involvement in the lung health @home MoU. If PCNs would like to continue offering OO PHBs after any NHS England funding has ended, they would need to ensure ICBs are included so that the direct payment regulations are adhered to.

The PCN funding can be used for project management costs and workforce capacity, it should be used by end of March 2024.

There is no additional funding planned at this time however NHS England will be reviewing the impact and evaluation to support development of future plans and associated funding for scaling up.

The lung health @home test sites are testing approaches to support more people to manage their lung condition through:

1. Improving access to Pulmonary Rehab through case finding and prioritisation and by improving and personalising the pathway
2. Increasing access and participation in supported self-management, education, exercise and other activity

To maximise the opportunity for identification and prioritisation of people for PR the OO PHB proof of concept has been developed in parallel to sites developing their change ideas. All the Lung Health @home sites have been invited to take part, to increase their offer of support to their patients in completing PR for better health outcomes.

NHSE will review and evaluate the data from the digital supplier to understand if the proof of concept has achieved its aims and its suitability to be rolled out as a national model for COPD and within other LTC services

People Places Lives (PPL) have been commissioned to support this project. They have several years experience of providing a full Person Health Budget/Continuing Health Care Budget digital solutions to health and social care organisations. They have recently been involved in supporting the use of OOPHBs to enable earlier patient discharges from hospital.

PPL are compliant with both NHS digital requirements and the wider GDPR requirements regarding the use and protection of personal/patient data.

There will be a local data sharing agreement in place between the referring site and PPL to ensure data process requirements. The compliance is regularly and independently tested.

PPL are also overseen by the UK’s Financial Conduct Authority, which regulates organisations who operate financial services.

The digital system is now up and running, and funding in place for the OO PHB payment, therefore referrals can now be made.

The PCN should follow the guidance available at the top of this page

Referrals are processed Monday to Friday (excluding UK Bank Holidays) inline with the timescales outlined below:

Invoiced Services - When the referral is received before 3pm, it is processed the same working day. Payment will be generated the next working day and will arrive with the provider within 3 working days. 

Physical Vouchers - When the referral is received before 3pm, it is processed and the item ordered on the same working day. Delivery timescales will vary, depending on the supplier. An anticipated delivery date will be confirmed with the referring professional via email when the order is processed.

Digital Vouchers - When the referral is received before 3pm, it is processed and the item ordered on the same working day. The voucher will be emailed to the designated email address within 1 working day.

Cash Payments - When the referral is received before 3pm, it is processed the same working day. Payment will be generated the next working day and will arrive in the designated bank accounts within 3 working days. 

Through a personalised conversation between the HCP in supporting the development of a personalised care and support plan, if:

1. Access to pulmonary rehabilitation, supported self-management, education, exercise or other activities is impacted by barriers to access that a budget will remove.  
2. Payment for goods or service would remove identified barriers to accessing pulmonary rehabilitation, supported self-management, education, exercise and other activities
3. The goods or service cannot be provided via existing commissioned services
4. The goods or service cannot be provided through the voluntary sector or cannot be provided by them without this additional support. 

If the proposed One-off PHB meets one of the above criteria, work through the following criteria: 

A One-off PHB may be appropriate if it meets the following criteria:  

1. The value of a One-Off PHB does not exceed £350 per patient (exceptions can be considered). Integrated Care Boards (ICBs) or delegated PCN must assure the proposed spend clearly represents value for money by ensuring:
2. The good or service must meet an identified need via a personalised care and support planning conversation.
3. Payment for the service will enable access to pulmonary rehabilitation or supported self-management activity or education, exercise or other activities that has been clinically assessed as meeting an agreed health outcome.
4. Spend must be captured and signed off within a personalised care and support plan.
5. The payment is not for an item or service prohibited by the National Health Service (Direct Payments) Regulations 2013

The Let’s talk about PR step by step guide is available to support the conversation to make a shared decision and initiate a referral to PR. The OO PHB could use be used for (but not limited to)

• Transportation to PR/other activity
• Funding physical activity/ gym costs
• Exercise equipment
• Digital equipment/apps
• Homecare if patient is a carer
• Costs for someone to accompany them
• Income replacement for those unable to access paid time off (with close monitoring and support from NHSE to assess/appraise this approach) 

The digital provider, PPL, will provide this information to NHS England, however, the PCN should update their own patient records. Including identifying and recording the barrier/proposed solution within the personalised care and support plan.

You will not be asked to send receipts to PPL but we would expect there to be some form of follow up discussion with the patient as part of the usual care which would include a discussion on what the outcome of receiving the OO PHB was, e.g. did they go to PR?  Did they complete etc?

This will depend on the overall budget remaining for this proof of concept. During project update meetings the number of referrals/budget remaining for the OO PHBs will be discussed and monitored.

If the HCP is confident the referral meets the criteria the patient will receive the payment. If you are unsure if the criteria are met, please contact england.home@nhs.net or Kerrie Weston kerrie.weston@nhs.net for support.

Sites can decide who is best placed to make the referral for the OO PHB to PPL, however, a list of names should be provided to PPL asap. If there are any changes, please contact PPL to amend and update.

Currently, the following individuals are able to approve and submit referrals:

Feel free reach out to each other for support, learning and advice through the closed discussion forum. You can also contact the england.home@nhs.net mailbox or Kerrie Weston kerrie.weston@nhs.net for any questions you may have that are not covered in these FAQs.