Individual budgets as piloted in social care could be used in healthcare, according to the government's Commissioning framework for health and well being.

The document's vision for the future sets out how commissioning in health should move from primary care trust-level to practice-level, using 'individual budgets wherever possible, to give people more control of their own care and support arrangements'. This would mirror the system of direct payments and individual budgets that has already been piloted in social care.

The document also details plans for joint strategic needs assessment by PCTs and local authorities to look at the health needs of their population and future provision needed.

The framework says a good assessment should be based on joint analysis of current and predicted health and well-being outcomes, an account of what the local community wants and a view of the future.

The document would provide the basis for agreeing longer-term priorities in a community strategy that would be reflected in joint objectives in local area agreements and children and young people's plans. PCTs would be held to account by strategic health authorities based on these agreed objectives.

Announcing the framework, health secretary Patricia Hewitt said: 'Giving people more choice and more control over their lives -creating a truly personalised service - is the first goal of commissioning for health and well-being. The second is to enable people to lead lives that are as healthy, happy and independent as possible, rather than just dealing with the consequences when things go wrong.'

The minimum set of data and analysis that PCTs and local authorities might expect to carry out to inform the assessment are: demography; social and environmental context; current known health status of the population; current met needs of the population; patient/service user voice; public demands; analysis of current inequalities; projection of service use; projection of outcomes value for money and return on investment.

The document sets out a 'flexible approach' to resources, suggesting that practice-based commissioners. should be able to commission social services, such as using carer services to reduce the rise of hospital admissions.

But the Local Government Association expressed some concerns, and said that PCTs should have to do more than seek views from local authority partners - as the document suggests - if they were considering introducing changes.

LGA senior policy consultant Trish O'Flynn commented: 'If GPs start commissioning social care there could be duplication with local services. We would want it to happen as part of a local area agreement as we would rather not have duplication or competition with the local authority.

'Otherwise you could get some GPs commissioning social care and others referring a patient to a local authority where they have to pay for services.'

NHS confederation director of policy Nigel Edwards agreed: 'We must make sure additional resources put into practice-based commissioning are not equal to a withdrawal of resources from social services by local authorities.

'GPs could cut out the middleman by commissioning social care but in using NHS money you need a good partnership with local authorities to ensure that they don't withdraw some of their services.

'It could undermine PCTs allocations, which are based on health needs of a population, if money seeped into social care at the expense of healthcare,' he added.

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