How to start a care introduction agency – what you need to know

There are two main types of care agency you may be considering setting up: a managed agency and an introduction agency. A managed agency is probably the form of care agency that most people are familiar with. The agency employs a number of carers directly and sends them out to service users to perform required tasks. The agency is the employer and responsible for the carer, and the service user will pay for the services of a carer through the agency itself.A care introduction agency is a little different. It acts as a middleman, matching self-employed paid carers to service users who wish to contract with a carer to meet their needs. For a paid carer, working with an introduction service can be a useful way to make contact with service users and build a client base, paying a fee to the agency to be on their books. Paid carers can join as many agencies as they wish to help find new clients. Introduction agencies may specialise in one type of care, for example, regular homecare services or live-in care. Service users are usually charged a one-off introduction fee when they are matched with a carer.If you’re considering setting up a care introduction agency, there are some important considerations you need to make. This guide will cover some of the key points. 

Do you need to register your agency with CQC?

One of the main legal differences between a managed care agency and a care introduction agency is down to CQC regulation – introduction agencies don’t always need to be regulated. The CQC website says:You should not register if you provide carers in the role of an employment or introductory agency:

• to another organisation who will then be responsible for direct provision of the care, or
• to an individual who will then wholly take responsibility for the provision of their own care under a personal budget or private arrangement

The most important distinction to make is that the introduction agency does not provide any form of regulated activity themselves; the regulated activity is carried out by an individual who is solely responsible for their own actions or by a provider to whom staff has been supplied. The agency should not provide any ‘ongoing direction or control of the service’ being provided, if they wish to remain unregulated.[ADS]On one hand, not having to be regulated does save you time and money; it’s a simpler business structure. But on the other hand, you may have to work harder to earn the trust of service users for who regulation is a seal of approval.However, it is not as clear-cut as it seems and often depends on the interpretation of the regulations and the role your care introduction company plays after a carer has been placed in a setting. Guidance was released in 2012 specifically to look at the how ‘ongoing direction or control of the service’ should be defined. If you’re looking to set up your own care introduction service, it is worth being familiar with this. If you are planning on providing any form of ‘ongoing role’, then you may need to be registered after all. 

What is an ongoing role?

The ‘ongoing role’ may apply if you monitor the service the carer you have placed is giving and take any responsibility for replacing the carer as a result of the monitoring; you act as an advocate or actively ask for the views of the service user and it results in changes to the activity of the carer you have placed; you arrange a rota of carers to meet an individual’s needs; you levy any charge for the carer to the service user on an ongoing basis outside of an introduction fee; you agree to organise cover for sickness or leave; or you review or change a care plan given to the service user. If you have no further involvement after the initial introduction, you should not need to register. There are also other permitted ongoing roles you may play without registration, but these are limited. For example, you might arrange to introduce an additional or replacement carer at the specific request of the service user (not through monitoring the initial carer’s work); you can provide good practice guidance and procedures to the carer, but the implementation of these is not monitored; you can assess the needs of a service user to help introduce the right kind of carer, but this should not form a care plan; you can charge a one-off introduction fee, which can be paid in instalments; and you can contact the service user for feedback on the introduction, but not as a way of monitoring the care services being provided. Once you have got together a business plan and know what kind of introduction agency you want to set up, you should get further professional or legal advice to clarify whether you would need to be regulated or not, or you can contact CQC directly for advice. 

The client-carer relationship

When you act as an introduction agency, you are not responsible for managing the carer you have placed. The carer will be a self-employed paid carer, responsible for their own tax affairs and are not bound to any one introduction agency.The service user will enter into a contract directly with the carer, and not with the agency, when it comes to the provision of care. The service user is responsible for paying the carer themselves, which could be using personal funds or a Personal Budget. However, in the guidance referenced above, there is provision to provide a payroll service for your service users, but this needs to be completely separate to the introduction aspect of your business and have no influence on the service being provided.It is the carer themselves who is responsible for the day-to-day management of the care they provide to their clients, and they should work with family members, social care representatives and any relevant health professionals to form a care plan. These are not tasks that are performed by a care introduction agency. What you can do is direct carers on your books towards tools that can help them set up a working relationship with their new client. For example, you could point them to the YtB Shop, which has template contracts, risk assessment guidance and tools to assess care needs.While you are not responsible for the care that is provided, whether good or bad, you should have a system in place to ensure that the carers on your books meet your standards. If they fail to meet these standards, they should be removed from your booking system. As such, you will need to have a contract drawn up between you and the carers using your introduction services, which outlines your terms and conditions, as well as any fees. 

Other important information

When setting up your care introduction agency, you should have a clear set of terms and conditions that define the role that you play. Part of this will be to explain that service users are using your agency entirely at their own risk – which limits your liability for the carer’s actions.However, you should also take out a high-value public liability insurance for peace of mind. In most cases, any excess is paid by the service user themselves when making a claim against you.