Managed care vs introductory care agency: what’s the difference?

An introductory care agency puts you in touch with self-employed carers and then steps back: you agree the care directly with the carer and take on day-to-day responsibility. A managed home care service employs its carers, plans and supervises the care, arranges cover, and is registered and inspected by the Care Quality Commission (CQC). When families compare the two, the question that matters most is: who is responsible for the carer?

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There is also a third option: employing a carer yourself. In short: managed care costs more but hands over most of the responsibility; introductory agencies and direct employment can cost less but leave more of the risk and paperwork with the family.

At a glance

• Managed agencies providing personal care must be CQC registered and are inspected.
• Introductory agencies don’t need to register if they have no ongoing role in directing or controlling care.
• Managed agencies in England typically charge £32–£34 an hour in 2026; self-employed carers through introductory services often charge about £18–£25.
• Care from a CQC-registered provider is VAT exempt; introductory fees are standard-rated for VAT.
• With an introductory agency or a carer you engage yourself, you take on more of the duties of an employer or client.

The three models of home care

1. Managed (regulated) home care agency

A managed (or “fully managed”) agency:

• recruits, vets, trains and employs its carers;
• assesses needs and writes the care plan;
• sets rotas and sends replacement carers for sickness and holidays;
• supervises carers and checks quality;
• handles medication records and safeguarding;
• is registered with CQC, which inspects it and publishes a rating, and is accountable for the care.

You have one contract and pay the agency, which pays the carers. Most home care agencies in England work this way.

2. Introductory agency

An introductory agency, sometimes called a care introduction service or platform, matches you with self-employed carers. Typically it:

• vets carers before listing them;
• introduces carers who fit your needs;
• may handle payments between you and the carer;
• charges an introduction or ongoing fee.

You usually pay the carer directly, plus a fee to the agency. The carer then works under your direction: you agree tasks, hours and pay, and you manage the arrangement.

3. Directly employing or engaging a carer

You find a carer yourself — through word of mouth, an advert or an online platform — and pay them directly. The CQC says an individual care worker working for one person or family, with no agency involved and wholly under their direction, does not need to register. That means no inspection and no regulator to go to if things go wrong.

Does an introductory agency need to be CQC registered?

Not if it only introduces carers and has no ongoing role in directing or controlling the care (CQC guidance). CQC says signs of an ongoing role, which would mean the agency should register, include:

• monitoring the care;
• arranging rotas or replacement carers;
• reviewing care plans;
• charging continuing fees;
• requiring uniforms or supervision.

The care itself, from a self-employed carer working under your direction, is not regulated or inspected by CQC. Many introductory services offer some ongoing help, such as finding a replacement if the carer is ill, and some choose to register. Ask each one exactly what it does.

How do the models compare?

As of 2026. Prices vary by region and sources vary; always get a written quote. Introductory and managed prices aren’t directly comparable.

Who is the employer?

This is where families get caught out. Calling a carer “self-employed” does not make them self-employed. Status depends on how the work is actually done: who decides the tasks and hours, whether the carer can send someone else, and whether they work for other clients.

A carer who works set hours for one family, doing what the family asks, may legally be an employee — making the family, or the person receiving care, their employer. If unsure, use HMRC’s Check employment status for tax tool. Getting this wrong can mean unpaid tax and National Insurance, plus claims for holiday pay.

Your responsibilities if you employ a carer

If you are the employer, you have the same legal duties as any other employer. Carers UK lists the main ones:

• Payroll: registering with HMRC if needed and running PAYE.
• Pay and leave: at least the National Minimum or Living Wage, paid holiday, and statutory sick, maternity and paternity pay where they apply.
• Pension: auto-enrolment duties.
• Insurance: employer’s liability and public liability cover; specialist policies exist for people employing their own care workers.
• Checks: right to work, references and a DBS check.
• Health and safety: assessing risks in the home, such as moving and handling.

There is one useful saving: GOV.UK guidance confirms that people who employ a care and support worker for someone with a disability or long-term condition may be able to claim Employment Allowance, which reduces the employer’s National Insurance bill.

If the care is paid for through council direct payments, ask your social care practitioner about support with payroll and employing a personal assistant. Our guide on care agency vs self-employed carer covers employer duties, DBS checks and insurance in more detail.

How the costs compare

A managed agency’s hourly rate covers costs that introductory services don’t carry:

• employing carers (wages, holiday pay, sick pay, pensions, National Insurance);
• paying for travel time between visits;
• training, supervision and quality checks;
• insurance, office staff, out-of-hours cover and CQC registration.

That is why managed care typically costs £32–£34 an hour in England. The Lottie Care Index for Q3 2026 puts the median at £33.49, and the Homecare Association’s minimum sustainable price for 2026/27 is £34.42 an hour.

Introductory and self-employed rates are lower because more of those costs and risks shift to the carer or to you. When you compare, add up:

• the agency’s introduction or weekly fee, and the VAT on it;
• paying for cover when the regular carer is off, often at short notice;
• payroll, insurance and pension costs if you are the employer;
• your own time managing rotas and dealing with problems.

To estimate costs, use our home care cost calculator, and check what financial help is available with our funding checker.

Which model is right for you?

The introductory model’s risks are no CQC inspection, gaps in cover, less oversight of care quality and medication records, and possible employer duties. Changing or high needs can be harder to manage without a supporting team. For stable needs with an engaged family nearby, these risks can be manageable.

A managed agency may suit you if:

• needs include personal care, especially several visits a day, or dementia or complex needs, where it is usually the safest choice;
• family can’t easily step in to cover gaps, live at a distance or work full time;
• you want independent oversight and a clear complaints route.

An introductory agency may suit you if:

• needs are stable and predictable;
• you want more say over who the carer is, and one or two carers for continuity;
• you’re comfortable managing the arrangement and have a plan for when the carer is unavailable;
• budget is the main constraint.

The introductory model is common for live-in care. Employing directly may suit you if you are organised, have a trusted carer in mind, and are ready to take on employer duties — often through direct payments, with support.

Whichever model you choose, do your own checks. See our guide to how carers are vetted, contracts and complaints, and our guides on how to choose a home care agency and choosing a home care agency cover the rest. For an overview of providers, see home care agencies by county.

Frequently asked questions

Is an introductory care agency regulated?

Usually not by CQC, as long as it only introduces carers and has no ongoing role in directing or controlling care. If it monitors care, arranges replacements, reviews care plans or charges continuing fees, it should register. Check the CQC website.

Do I pay VAT on introductory agency fees?

Introduction or placement fees charged by agencies are standard-rated for VAT (HMRC VAT Notice 701/2). Care provided by a CQC-registered agency is exempt. A self-employed carer below the VAT registration threshold won’t charge VAT.

Can I use council direct payments with an introductory agency?

Often yes, but policies vary and the council must agree the arrangement meets the person’s assessed needs. Direct payments can pay a CQC-registered agency or a personal assistant. Speak to your council’s direct payments team before you sign anything.

Who is liable if a self-employed carer has an accident in my home?

It depends on the arrangement and the carer’s own insurance. Ask to see the carer’s public liability insurance, check your home insurance, and take advice if you may be their employer.

Do I need to run payroll for a carer who works a few hours a week?

Possibly. If the carer is legally your employee, you may need to register with HMRC depending on their pay and other circumstances. Check the GOV.UK guidance on becoming an employer or ask a payroll service.

Is managed care better quality?

Not automatically. Managed agencies offer more oversight, cover and accountability, while introductory care can offer strong continuity at lower cost. The right choice depends on needs, budget and how much the family can manage.

Sources

• CQC: personal care, ongoing role, introductory agencies and individual care workers
• CQC: personal care as a regulated activity
• HMRC: VAT Notice 701/2
• HMRC: Check employment status for tax
• GOV.UK: Employment Allowance for employers of care and support workers
• Carers UK: guidance on employing a care worker directly
• Homecare Association: research and reports
• GOV.UK: direct payments
• GOV.UK: employing staff
• PrimeCarers: cost of care (introductory model rates)
• TrustonTap: how much does it cost to have a carer
• Lottie: London home care directory

The Care Panel is an independent publication. We are not a care provider and are not regulated by the Care Quality Commission, because we do not deliver care. Always check a provider’s own CQC registration and inspection report before you commit.

Written and fact-checked by The Care Panel. General information, not financial, legal or medical advice — figures are indicative and subject to change. Last updated September 2026.

This guide is general information about care in England, not legal, medical or financial advice. Rules and rates change; check with your council or an adviser before making decisions.