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PHB: referrals

Please use the form below to refer someone to our PHB service.

If you have referred this person before and their personal information hasn’t changed, please complete their name and NHS number, then go straight to the referral section.

To make a referral to the PHB service you will need to:

  • Complete the referral form.
  • Include the service user’s PHB support plan, here is a template if you need it.
  • Have authorisation to make the referral at the appropriate level.

If you’ve got any questions, email or call 020 8106 1488.

Personal Health budget referral

  • About the service user

  • Date Format: DD slash MM slash YYYY
  • Communication observations and needs
  • If so, please specify
  • Referral details

  • Date Format: DD slash MM slash YYYY
  • Supporting recovery goals

  • Items to be purchased - include product code and website link, Activities for a course- include as much information about the provider and a website links if possible.
  • Which recovery goals will this purchase support?
  • Please provide details of how the PHB will support the recovery
  • How will the recovery continue once the PHB has finished
  • Purchases

  • Notional payments are used where the CCG already fund the service and no further payment to the provider is needed.

    Direct payment purchases are used where:

  • a service or support is not already funded by the CCG;
  • is not freely available in the borough; or
  • if the purchase of a particular item is required.
  • If 'Bank Account’ is selected the service user will need to open a new separate bank account for the PHB Direct payment. For more information, you can contact our PHB Advisor.

    Please detail each purchase separately, for example, product/service 1 could be for a course, product/service 2 might be for essential equipment to attend the course.

  • Quantity times the unit cost
  • Quantity times the unit cost
  • Quantity times the unit cost
  • Approval

  • Please note the approval values:

    £0 – £250 Direct Payment – Approval by assessing Clinician

    £250 – £750 Direct Payment – Approval by Team Manager

    £750 – £1000 (or greater by exception) Direct Payment – Approval by Team Manager and then sent to the CCG for final budget spend approval.

  • If required
  • Total costs

  • The total cost of all activity and purchases
  • Additional information

  • Are there any risks that need to be considered and how will these be managed?
  • Please supply any additional information you think will be useful
  • Support plan

  • If you have permission to share the person’s Dialog+ or EPC recovery care plan to make this referral, please complete and attach the short PHB Support Plan.

  • If you are not submitting the person's Dialog+ or EPC recovery care plan, please complete and attach the full PHB support plan.

    Please make sure you complete all sections.

  • ReQoL monitoring

    Please use the ReQoL monitoring questions at the following stages; referral, review, and closure to measure the impact. Answer the questions in relation to last week.
  • You will receive a confirmation email if the referral has been submitted successfully