Personal Maternity Care Budgets (PMCBs)

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 a CCG in a Pioneer area.

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.