Introductory agency, managed agency, franchise or platform: the four ways to arrange care, compared

The word doing the most work in that list is regulated activity. It is the legal name for work the Care Quality Commission has to register, and personal care given where somebody lives is one. Personal care means physical help with washing, bathing, dressing, toileting, oral care and the care of skin, hair and nails, or prompting and supervising somebody through those tasks. A company that supplies that care has to be registered. A company that introduces you to a carer who supplies it, and has nothing to do with how the care is run, does not.

Nothing in that comparison makes one route correct. A managed agency costs more and carries more of the responsibility. Choosing the carer yourself costs less and leaves more of the arranging with you. Our own argument for a private carer rather than an agency is on agency or private carer, and private carers compared with agency carers covers the day-to-day difference.

The test in law is not what a company calls itself. It is whether the company directs or controls the care. An introductory agency that starts writing rotas, supervising carers and taking charge of the care plan has stopped introducing and should be registered. That cuts both ways, so an introducer should not be managing your relative's care, and a company that does manage care should be on the register whatever it calls itself.

Registration is worth knowing the value of. A registered provider has to deploy enough suitably qualified, competent, skilled and experienced staff, and give them the training, supervision and appraisal the work needs. It has to satisfy itself that every care worker is of good character, and hold a file on each one containing proof of identity, a criminal record certificate, references covering previous care work, evidence of qualifications and a full employment history. It has to run a complaints system and act on what the complaints show, and the CQC assesses it and publishes what it finds.

About £12 of a £28 agency hour reaches the care worker. The carer keeps about £17 of a £20 hour booked through PrimeCarers. The gap is the management layer, and it buys an employer, a rota, supervision, training and a company that has to answer for the care. Whether that is worth £8 an hour depends on how much of the arranging you can do yourself.

Live-in care splits the same way. A managed agency charges from about £1,400 a week, and through PrimeCarers it starts at £1,050 a week and is typically £1,120. What an hour of care at home costs has the hourly figures in full, and our pricing explains what is inside the rate on a profile.

Two things change the bill. No VAT is added to a self-employed carer's rate, because the VAT exemption for welfare services applies to state-regulated providers and a carer is not one. And on PrimeCarers an optional managed service adds 5% to the rate for monthly reviews and scheduling help, or 10% for live-in care under Fully Managed; neither is required. If a council direct payment is paying for the care, how direct payments work covers what you can spend it on.

1. 1

   The call comes early

   Early

   With a managed agency or a franchised branch, the office rings you or simply sends somebody else. With an introductory agency, a platform or a carer you employ, the carer rings you and the next move is yours.
2. 2

   Ask the carer who they suggest

   Within the hour

   On PrimeCarers the contract lets a carer put a suitably qualified substitute forward, and you can object to that substitute for a good reason such as their experience or their eligibility to work. Ask before you start ringing round yourself.
3. 3

   Tell our team the same morning

   The same day

   Our support team will try to find you vetted cover at short notice. There is no rota behind that, so it is an effort rather than a guarantee, and this is the part where a managed agency does something we do not.
4. 4

   Decide what can wait and what cannot

   That day

   Medication, a hoist transfer and a meal are hard to postpone. Shopping and laundry are easier. Working this out on a calm afternoon is easier than working it out at 7am.
5. 5

   Line up a second carer before you need one

   This month

   A short regular visit from a second carer, even one afternoon a fortnight, means somebody else already knows your relative, the house and the routine. On a route without a rota, that is what makes cover work in practice.

When your carer is ill or on holiday sets out how to plan for this, and how many carers a rota needs helps if cover is needed seven days a week. If your relative cannot safely miss a single visit and nobody in the family could step in, a managed agency is the right answer even though it costs more.

Handling problems with a private carer covers raising something difficult without the arrangement falling apart, and notice periods explains what ending one costs. On PrimeCarers, notice is 48 hours for hourly care and 7 days for live-in once the carer has worked a full week, and a visit you cancel is payable in full unless it is unplanned hospitalisation, illness or a reason the carer agrees. PrimeCarers charges nothing of its own to cancel, and the terms are yours and the carer's rather than ours to set: what a private carer agreement has to cover goes through the twelve things those terms have to settle.

None of that makes direct employment a bad idea. It makes it a job, and one that families do well, particularly where a council direct payment is paying for the care and the council can point you at a payroll service. Employing a private carer: the legal and financial side goes through the paperwork, personal assistants and direct payments covers the usual route into it, and self-employed carer or employee explains how HMRC decides which one you have.