The real difference
If you have a Direct Payment or a personal health budget, you generally have a choice about how the agreed support is delivered. Broadly, two routes:
- Employ one or more Personal Assistants directly. You choose them, they work for you, and you are their employer.
- Commission a registered care provider. They employ the staff, they arrange the rota, and you are their customer.
Everything else follows from that one structural difference. It is not really a choice between two services; it is a choice about who holds the responsibility. More control comes with more responsibility, in almost exact proportion.
Neither answer is more grown-up than the other. Plenty of capable, organised people choose a provider because they want their energy to go somewhere other than payroll. Plenty of people who found the administration daunting employ PAs because continuity matters more to them than convenience.
Side by side
| Employ a Personal Assistant | Use a registered provider | |
|---|---|---|
| Who chooses the person | You. You interview and appoint | The provider allocates staff |
| Continuity | Usually high — the same person, often for years | Varies with their rota and turnover |
| Flexibility of hours and tasks | High, within what your plan covers | Usually fixed call times and defined tasks |
| Employment responsibility | Yours — contract, pay, PAYE, pension, insurance | Theirs |
| Cover for holiday and sickness | Yours to plan for | Theirs to arrange |
| If it is not working | You address it, using a proper process | You raise it with the provider |
| Regulation | Not a CQC-registered service. Safeguards come from your checks, contract and oversight | Registered with and inspected by the CQC |
| Administration | Payroll, records, training coordination — supportable but yours | Invoices |
| Clinical tasks | Possible with proper training and professional sign-off | Within the scope the provider is registered and staffed for |
| Recruitment when someone leaves | You recruit again | They cover it |
When a PA tends to suit
- Continuity is the priority. Particularly where change is distressing, where communication depends on someone knowing the person well, or where trust took a long time to build.
- The support is about a life, not a task list. Getting to work or college, sport, socialising, travel, being supported in a role rather than at fixed times.
- The hours are irregular or unusual. Early starts, evenings, long single blocks, occasional overnight support — patterns that do not fit a round of calls.
- The person receiving support wants to choose. For many disabled people this is the entire point, and the difference between support that fits and support that is delivered.
- You want to build a relationship rather than manage a service. A good PA arrangement is a long working relationship, and it is usually the thing people value most.
When a provider tends to suit
- You do not want to be an employer. A completely legitimate position, and not a failure of capability.
- The need is unpredictable or escalating. A provider can usually increase or change cover faster than you can recruit.
- The support requires regulated care at scale. Multiple calls a day, two-person visits, or needs that require an organisation's training, supervision and clinical oversight behind them.
- Reliability matters more than familiarity. Where a missed call would be dangerous, a provider carries the duty to cover it. An individual employer with one PA does not have that safety net.
- Nobody is available to manage it. Where the person receiving support cannot manage the arrangement and there is no relative or nominated person able to, the employer route is fragile.
- You want a regulator involved. A registered provider is inspected and rated. Some people find that reassurance decisive, and it is a reasonable thing to weigh.
Doing both
This is the option people least often consider and frequently end up choosing.
A common shape: a PA for the bulk of the week, covering the support where continuity matters most, with a provider covering weekends, holidays or a specific kind of call. Another: a PA for community support and getting out, with a provider for personal care that requires two people. Another: a provider while a PA is recruited, then a gradual handover.
Mixed arrangements need agreement from your funding body about how the budget is split, and they need clarity about who does what so nothing falls between the two. But they can give you the continuity of a PA with the resilience of a provider, and they solve the single biggest weakness of the employer route — what happens when your one PA is unwell.
Cost is not the deciding factor
People often assume employing a PA is cheaper. Sometimes it is, but the comparison is rarely as simple as an hourly rate.
A PA's hourly pay is only part of the cost. On top sit employer's National Insurance, pension contributions, holiday pay, statutory sick pay, insurance, payroll support, training and recruitment when someone leaves. A provider's hourly charge includes all of its equivalents, along with supervision, cover and regulatory overhead.
Compare total cost against total cost, not rate against rate. And then be clear with yourself that the decision is probably not really about money — it is about whether you want control or want the responsibility held elsewhere. Choosing the employer route to save money and then finding the administration unsustainable is the worst of both outcomes.
Questions to ask yourself
- Does the person receiving support want to choose who helps them — and how strongly?
- Is there someone able and willing to manage an employment arrangement, including when it is difficult?
- What happens if the one person supporting you is unwell next week? Is that survivable?
- Is the support mostly at fixed times, or built around a life that does not run to a timetable?
- How much would a change of worker cost you, in practical and emotional terms?
- Does anything in the support require the training, supervision and oversight of an organisation?
- Honestly, how do you feel about paperwork, deadlines and difficult conversations with someone you see every day?
If the answers point in different directions, that is usually a sign that a mixed arrangement is worth exploring rather than a sign that you have not decided.
Where Oakline fits
We support the Personal Assistant route: recruiting and checking PAs, preparing employment documentation, running payroll, coordinating training and keeping records.
We are not a registered care provider. Oakline is not registered with the Care Quality Commission and does not provide regulated personal care, so if the answer for you is a provider, it is not us — and we will say so plainly. Your local authority can tell you who operates in your area, and the CQC register lists registered providers along with their current ratings.
If you are genuinely unsure which route fits, that is a good conversation to have with us. It costs nothing, and an honest "you probably want a provider" is a perfectly normal outcome of it.
General information, not advice.What your funding allows and which options are available depend on your plan and on your local authority or NHS body. Confirm the position with them before making arrangements.
Where this comes from
The rules described here change, sometimes every April. These are the official sources we checked this guide against on 23 September 2026. If you are about to make a decision that turns on a figure or a threshold, check the source rather than trusting our summary of it.
- Employing staff for the first time — GOV.UK The seven things every new employer must do.
- Regulations for service providers — Care Quality Commission What counts as a regulated activity requiring registration.
- Care Quality Commission Check whether any provider is registered, and read their reports.
- Employers' liability insurance — GOV.UK When it is legally required and the penalties for not having it.
- Skills for Care Guidance for individual employers and Personal Assistants.
Rules also vary between England, Scotland, Wales and Northern Ireland, and local authorities apply national rules differently. Where this guide says something is usual, that is not the same as it being the rule where you live.