About 200 patients with chronic conditions have been allocated budgets under a pilot in North East Lincolnshire PCT.
The patients have been identified by GPs in collaboration with the PCT based on the high cost of their care and high attendance records. They account for 39 per cent of the total local health budget.
Early results suggest that involving the patient in decisions about their care could cut costs by up to 40 per cent.
North East Lincolnshire PCT professional executive committee vice chairman Dr Derek Hopper said patients did not need specific training to take part. They agreed budget decisions with nurses acting as case managers and GPs then chose whether to consent to the decisions.
'The patients' involvement is saying what they feel they need and we feed that information into our budget discussions,' said Dr Hopper.
PCT project director Lance Gardner said: 'It is still in the early stages but after sitting down with the patients and working out the care they should receive over the year, it is coming in at 60 to 75 per cent of the figure we would have spent.'
He said patients were particularly good at spotting overlaps and doubling up of procedures. One patient had had four MRIs.
'Most patients with long-term conditions have an average of six consultants who don't know each other and almost certainly don't talk to each other,' he said.
Most discussions with patients are handled through nurses acting as case managers. GPs are involved in overseeing budget spend on health matters.
Dr Hopper said: 'The types of issues raised, such as depression, combine social care and health.'