Report from Complementary and Alternative Medicine Seminar organised by the Department of Health, Social Services and Public Safety in County Antrim, Belfast

on Thursday, October 5^th 2006

Reported to be the first Seminar of its kind in Northern Ireland, the day provided an opportunity to discuss current and future developments in CAM. The theme was “Greater integration of CAM within the Health Service” - the barriers we might face in achieving greater integration and how these might be overcome.

The speakers were from the field of Acupuncture, Homeopathy, Chiropractic and Osteopathy with additional presentations from Dr Michael Dixon, Chairman of NHS Alliance; Ian Brownhill, Director of the Prince’s Foundation for Integrated Health and Boo Armstrong of Get Well UK.

Dr Michael Dixon – Chair of NHS Alliance, Trustee of PFIH, Honorary Senior Fellow in Public Policy, HSMC Birmingham University; Visiting Professor at Westminster University, School of Integrated Health

Dr Dixon has been utilising the services of CAM practitioners within his Devon practice since the late 80’s, which started when a healer approached him (who also happened to be the wife of the local Vicar) and he was virtually bullied into it. His presentation included information that 50% of GP’s already provide integrated health in some sense. 20% of practices offer CAM “in house” and 75% of patients want CAM to be available on the NHS. He also reported that from his experience, 50% of patients to not tell their GP’s when they are seeing CAM practitioners.

He discussed the benefits of offering CAM services within his practice in that it had taken pressure off his partners. It is accepted that most GP’s are burnt out; he acknowledged that conventional medicine can not answer all the patient’s problems; CAM offers patients choice; he also emphasised the role of self healing; significant savings; reducing the amount of prescriptions issued; overall improvement in local health/quality of life and more time. GP’s are at liberty to use the savings they make to improve services. He acknowledged that GP’s are “empty handed” when it comes to some conditions e.g., ME and osteo-arthritis, stating that patients arrive with a list of symptoms and “GP’s don’t have a clue where to start”. He appealed to GP’s not to fear CAM and the so-called “dangers” by saying that it has “never happened yet” in his own practice.

Ken Mayne is a registered homeopath, practising in Bangor and Belfast; Director of Studies of the Belfast College of Homeopathy, plus a member of the Belfast Health Initiative, (a registered charity dedicated to health promotion in the community).

Ken discussed the uses of homeopathy in primary care – reminding the audience that the Smallwood Report states, “savings would accrue if GP’s used homeopathy”. He also reiterated Dr Dixon’s point that CAM is most effective in all areas GP’s struggle, for example, chronic conditions. He finished his presentation by stressing that CAM practitioners should be breaking down the barriers, building trust and talking with each other on an ongoing basis. We should be finding ways to come together like this more often to learn how to deliver the best treatments for the public.

Susan Evans is from a nursing background. She has been a Practitioner of Traditional Acupuncture since 1987 and is currently a CPD facilitator for the British Acupuncture Council in Northern Ireland.

Susan discussed issues CAM practitioners are likely to face when working within the NHS. She spoke of barriers like GP lack of knowledge; mistrust and cynicism, and complaints like insufficient evidence, lack of regulation and public confidence. She evidenced that small steps are taking place, resulting in an overview of acupuncture now on the agenda within medical schools, DoH and Government support; academic – with a significant increase in research projects and data published. 5 professors now involved, (previously only 1); 10% of all acupuncture treatments are now being carried out within the NHS.

Nigel Hunt Chiropractor and Director of Health Policy at the College of Chiropractors

Nigel asked a number of questions specifically relating to chiropractic within the NHS but I felt that they could be equally relevant to CAM in general. He felt that we should be focussing on “referral pathways” and in doing so, asking a number of questions like “what conditions do CAM practitioners commonly treat; what are the opportunities for practitioners within the NHS; what are the benefits for patients and NHS and what would be the appropriate referral mechanism? Finally, do CAM practitioners want to get involved?” He pointed out that chiropractic is not just a treatment or manipulation. …. “It is a healthcare profession”. Again, this applies to CAM in general.

Nigel quoted various studies proving efficacy and cost savings in using chiropractic within an NHS setting. He went on to report that 82% of chiropractors want so see patients in their own right. They do not want to be bogged down with the red tape of the NHS but do want to be acknowledged by the medical profession. It was evidenced from the workshop I attended during the afternoon where 2 GP’s were present. When asked if they would refer to CAM practitioners as a result of today, they said they would refer IF they knew how or where to find practitioners they could trust, locally. They seemed unaware that chiropractors and osteopaths are statutorily regulated or the existence of the GOC or GCC!

Nigel also expressed that chiropractors want “proper referral pathways”. Not a delegation of care. Ie GP’s acting as “gatekeepers”. During the workshops in the afternoon – it was my experience that CAM practitioners were all working on the assumption that GP’s will be the gatekeepers.

Martin Pendry – Osteopath. Martin joined the NHS in 2001 to manage and develop an osteopathic service for 2 central London PCT’s. He also represents the NHS on the NCOR (National Council for Osteopathic Research)

Martin made the point that CAM practitioners can do their best work within the area of dysfunction and explained dysfunction as the period between when symptoms first appear and disease takes place.

Martin reiterated Nigel Hunt’s point that, what are required are good disease and referral criteria. In his view “Integrated Health” needs to focus on how to address these problems.

Ian Brownhill – Director of Prince’s Foundation for Integrated Health

Ian gave an overview of the work of the Foundation and it’s achievements since inception and then went on to discuss the aim of the Integrated Health Associates, which is being launched in mid November.

He also discussed “Good Practice in Integrated Health Awards”. Applications will be open from March to June 2007 with judging taking place in November 2007 and the winner announced in December 2007. More information can be gleaned from the Foundation website www.fih.org.uk

Boo Armstrong founder and Managing Director of Get Well UK spoke of the experience of providing complementary medicine for NHS patients in England and the benefits for patients, referring GP’s and commissioners.

Boo began her presentation by quoting Aneurin Bevan: The resources of medical skill and the apparatus of healing shall be placed at the disposal of the patient, without charge, when he or she needs them … preventable pain is a blot on any society”.

Get Well UK was set up to remove inequalities within the NHS and is a not for profit company. Their aim is to bring together patients, GP’s and CAM practitioners. In an independent audit in Haringey from February 2004 – May 2005, 40 GP’s in the area made at least one referral. 124 patients received treatment. 1383 treatments were offered. There was a 90% attendance rate and an 81% documented improvement in patient health. The GP’s reported that the study “reduced the burden on their lives”.

The afternoon required attendance at one of 4 workshops. I was allocated to the CAM Professionals group. Below is an overview of all the groups.

GP’s concluded that there were many obstacles from their perspective including: -

v Lack of understanding of insurance

v Lack of feedback from CAM

v GP ignorance of CAM

v How do they assess the outcome of a patient’s treatment?

v Reports don’t come back after referrals

v Historical myths

v GP’s have no time to learn

v Lack of health strategy to move forward

Solutions discussed

v GP education (starting at medical school)

v Postgraduate courses for GP’s

v Appraisals/evaluations and audits, clinical governance for CAM

v Patient participation groups (feedback)

v Local directory needed so the GP’s know whom to refer. Prefer to know the person they are referring to. Point of contact

v Supervision

v Neutral community centres

v DoH to make funding available for CAM

Administrators

Barriers

v Clear standards – who are or aren’t regulated

v Who can treat what

v Knowing which treatments to refer for best outcomes

v Medical school training – additional expense

v Clear goals from GP’s and patients so that outcomes can be measured

Patients

Barriers

v GP’s don’t know enough

v Conflicts of interest

Solutions

v Education

v Communication

CAM Professionals

Barriers

v Lack of interface between GP’s and CAM professionals

v Inability to make referrals through lack of trust

v Too much info emanating from CAM professionals

Solutions

v Encouraging funding of a nurturing system

v Mutual respect before integration

v Neutral arbitrator

v Well-developed commonality of language to encompass all fields