Personal Maternity Care Budgets (PMCBs)

What is a Personal Maternity Care Budget?

PMCBs will provide a tool for women to choose where they wish to receive their antenatal, intrapartum and postnatal care (in line with NICE guidelines) and may increasingly provide an opportunity to facilitate the flow of money between providers, to support these choices. They will be a mechanism put into women’s hands to actively empower their choices. PMCBs are currently being piloted by Pioneers, in certain geographies, for certain cohorts of women.

A PMCB has several elements that need to work together to support the choice offer to women:

  • choice of service or provider in each stage of the maternity pathway.
  • Access to high quality, meaningful information explaining the choices and providing information to support the choices, including information on the maternity tariff amounts.
  • The woman has a personal care plan, owned by the woman, which records her choices in each stage of maternity care and she feels empowered to make these choices.
  • A woman’s choices are supported by a review and sometimes reshaping of payment mechanisms and transfers between providers to ensure that the tariff and payment flows support a woman’s choices.
  • A woman’s choices are honoured, where possible and where there is a change due to clinical needs, this take place through a new conversation about the new range of choices available to the woman.

Through PMCBs, the Pioneers will increase the visibility of:

  • the choices put in place by CCGs
  • the choices actually offered to women
  • the choices that women exercise
  • how each of these is recorded and acted upon as women progress through their pregnancies.

PMCBs will be a notional budget based on the current maternity pathway payment system and will not provide a direct payment to the woman.  More information about the payment system is provided in the tariff questions below.

CCGs already commission a range of providers, so how are these budgets any different?

CCGs currently have contracts with a range of providers but evidence tells us that the choices available to women vary across many parts of the country and are often limited.  We want CCGs to widen choice across CCG boundaries and deepen choice by providing opportunities for new providers, actively empowering women to understand the options available to them.  Learning from women’s choices will also help CCGs to shape maternity services in response to women’s needs and preferences.  PMCBs are a tool to support the choices that a woman makes from among those providers and services commissioned by her CCG.

Will women be able to use NHS money to pay independent midwives?

Women will be able to choose from a wider range of providers, who must provide maternity care that meets established NHS standards of safety, quality and clinical governance.  This might include independent midwifery practices, some of whom already provide NHS services in some parts of the country.  For a provider to be offered as a choice within a PMCB, that provider must have an NHS contract with the CCG (within a Pioneer area) where the woman lives..

Women will not be able to receive their PMCB as a direct payment and use this to choose a midwife who does not hold an NHS contract.  PMCBs will be notional budgets that support the choices a woman makes from the providers and services commissioned by her CCG.

Can a woman top up her PMCB for more expensive equipment?

No.  A woman is not able to combine the NHS maternity pathway payment with her own funds to purchase more expensive care or equipment.  However, currently women are able to supplement their NHS maternity care with private provision and PMCBs do not change this existing position.

Is this all about privatisation?

No, PMCBs are about empowering women to make choices that better meet their needs and preferences and are still underpinned by core NHS principles – in particular that the NHS should be free at the point of need – and providers will have to be accredited to offer their services for the NHS, working to established NHS standards. Women will only be able to use their PMCBs to access maternity services commissioned by their CCGs.  They will not be able to use them to help ‘buy’ private maternity care.

How can women use their notional budget?

As part of the personalisation of their care, a woman will be able to choose the provider or service that best meets her individual needs and preferences at each stage along the maternity pathway – antenatal, intrapartum and postnatal care. A woman might place particular emphasis on a number of areas, such as a provider who is able to: assure continuity of midwife and team; provide a birthing pool; offer certain pain management options; specialise in teenage, older, or first time mothers; or one who has a good reputation for breastfeeding support.  A woman will also be able to choose the birth setting which most suits her needs and preferences.

Will this not increase health inequalities?

No, this is about empowering women from across society to take control of decisions about the care they receive. By offering women a PMCB and providing them with the information and support that they need to enable them to make the best decisions to meet their needs and preferences, Pioneers will make it easier for women to exercise choice, based on more visible and transparent choice arrangements. The evidence shows that women who are currently most likely to experience poor outcomes may benefit in particular from the ability to choose providers offering more personalised care and continuity of carer. NHS England will work with the Pioneers to support women who are less confident to make choices and access the right services for them.

How many women can access a budget and how frequently?

Pioneers are developing their plans for rollout, with the aim that they will be offered to all pregnant women in their Pioneer area in the next 18 months. Pioneers will test their take up and how well they work in practice. The intention is to learn from this experience in order to inform national developments for improving choice in maternity services.

Will women be able to split up their budgets and choose a number of different providers during each phase of the pregnancy? Will they be able to change their minds if they want to?

A woman could choose one provider for antenatal care, another for intrapartum care and one for postnatal, or opt for the same provider all the way through, based on the services they provide.

Other than for exceptional reasons, women will not normally be able to choose to change from one selected provider to another during a stage of the pathway. But they may change their minds about issues such as where to give birth, or the type of birth they want, as their pregnancy progresses.

When will PMCBs be launched and be available to women?

Pioneers will begin to pilot PMCBs with pregnant women in their localities from December 2016, with all Pioneers having launched by the end of the 2016/17 financial year.  Each Pioneer area has developed an individual piloting approach and details of the women eligible for the pilot in each Pioneer will be available as Pioneers launch their PMCB offer.  Women will be offered a PMCB if they fall within one of the test areas at the start of their antenatal care pathway.