Positive Health Online

In April 2003, Hazel Blears, then the Public Health Minister, announced1 that her Department will be spending £1.3 million researching Complementary Medicine to develop “a solid evidence base for complementary and alternative medicine” with a view to making it available on the NHS, possibly through GP Surgeries. This would overcome the problem of equality of access currently existing in relation to NHS provision of Complementary Medicine.

This sum is an initial investment by the Department of Health in a five-year programme of research into complementary medicine.2 The Minister further commented upon this research investment as follows:
“I anticipate it will underpin the future integration of all forms of therapy towards improving the nation’s health.”

Mr Gordon Brown, the Complementary Medicine representative at the Department of Health, advises that his Department is working closely with the Prince of Wales’s Foundation for Integrated Health and selected Universities regarding the Department of Health’s research.

The Research Council for Complementary Medicine (RCCM) is carrying out a systematic review of literature for selected Complementary Therapies in the area of key NHS priorities, namely cancer, coronary heart disease, mental health and chronic conditions. This three-year project is just starting and is also funded by the Department of Health.3

It is apparent that this is a time of considerable transition for the practice and medical status of Complementary Medicine, particularly in view of the Department of Health’s initiatives. Recent reports indicate that the demand for Complementary Medicine is expected to rise by 45% over the next five years. This follows a 60% growth over the past five years.4 Up to 20% of the population use complementary medicine.5 A survey by the University of Sheffield’s Medical Care Research Unit in 1998 revealed patient expenditure on complementary medicine over the previous year as being £540 million.6

The future would appear to be the provision of Integrated Healthcare combining the respective attributes of complementary medicine and conventional medicine. Such a combination will require both complementary and conventional medical practitioners to adapt, not least, in their training and practice methods. Cost implications will inevitably result. Complementary Medicine Practitioners need to start planning now for changes. Whilst some practitioners will, naturally, be reluctant to adapt to the changes necessary to bring about integration, few would deny that this will result in enormous healthcare benefits for those in need, many of whom, often for financial reasons or due to conventional medical ethical prejudice, are currently excluded from receiving complementary medicine.

Sensible and sympathetic integration should also introduce Practitioners to a new and diverse client base offering many professional opportunities.

It might be argued that complementary medicine will never be integrated into the State healthcare system as this would burden the National Health Service with additional cost. This may not be the case. An evaluation undertaken

by the Glastonbury Health Centre Complementary Medicine Service between 1994 and 1997 concluded that the cost of providing a complementary medicine service was approximately equal to the savings made. Patients were thus experiencing an improvement in their health at no additional cost to the Health Service.7

Similarly, the provision of a Homoeopathic service at the St Margaret’s Surgery NHS general practice during February 1993 to June 1995 resulted in a significant saving in GP consultation time generally demonstrated by there being no consultations needed with a GP in the year following Homeopathic treatment.

At a conference organized by the Royal London Homoeopathic Hospital (RLHH) in April 2003, three major research papers were presented from different European research teams demonstrating that better medical results can be obtained with homeopathy at no greater cost than conventional medicine.8
Arguably, the provision of complementary medicine services can be cost effective and viably integrated into the State healthcare system.

The recent research investment by the Department of Health indicates that it, too, believes that this could be the case.

Practitioners need to prepare for anticipated challenges including:

1. Increased statutory regulation of practice areas. This is likely to result in higher annual professional registration fees and increased requirements for continuing practice development courses;
2. Competition from Complementary Medicine Practitioners employed by and working in GP’s surgeries, NHS Hospital Trusts, Primary Healthcare Groups and ‘Healthy Living Centres’ sponsored by Primary Care Trusts;
3. Increased regulation of professional fees, practice ethics and procedures by Government Funded Organizations (e.g. NHS and Primary Care Trusts) as they take on an increasing role in the provision (and therefore control) of Complementary Medicine services;
4. The continuing intervention of European Union Institutions requiring the UK to harmonize its complementary medicine healthcare services with those existing in other member states. Practitioners will already be aware of the effects of recent EU Directives relating to Food Supplements and Traditional Herbal Medicine Products.9

Proactive Suggestions for Practitioners

• Liaise with your respective professional organizations as to what arrangements are being made by them to deal with these changes;
• Review practising procedures to be ready for a new and more ‘evidence-based’ practising environment.
• For instance, one possibility would be to prepare and use a Client Evaluation Form. In Complementary Medicine, as in conventional medicine, measuring a client’s satisfaction with a treatment is important. Evaluating a holistic treatment approach requires client-related outcome measures, assessing, for example, ‘quality of life’ and the ingredient of ‘care’ from the client’s perspective. See box above:
• Compile a dossier of evidenced-based research information as resource material and for inspection by clients and the public.
• As with the Client Evaluation Form, such a research dossier would also be useful when practitioners engage in competitive tendering for a contract to provide complementary medicine services.

There are a number of websites dealing with research on specified treatments.

• The Research Council for Complementary Medicine (RCCM): www.rccm.org.uk  
• Positive Health Magazine: www.positivehealth.com  
• Journal of Alternative and Complementary Medicine: www.liebertpub.com
• British Medical Journal: www.bmj.com
• Centre for Complementary Health Studies, University of Exeter:  www.ex.ac.uk/chs
• The Cochrane Collaboration: www.update-software.com/ccweb/cochrane/cc-broch.htm  
• Bandolier: www.ebandolier.com
• National Center for Complementary and Alternative Health:  www.nccam.nih.gov
• The Research Centre for Alternative Medicine: www.rcamonline.com
• Interesting and Successful Primary Care projects involving Complementary Medicine have been undertaken by:
• The Glastonbury Health Centre: Tel: 01458 834100: www.integratedhealth.org.uk  
• The Marylebone Health Centre, 17a Marylebone Road, London NW1 5LT (Dr Sue Morrison, Tel 020 7935 6328).
• Prepare and keep updated a comprehensive Curriculum Vitae (CV) and selection of case studies/articles you have had published, for use when promoting your practice;
• Undertake regularly and keep a record of continuing Professional Development courses;
• Complete appropriate accredited First Aid courses;
• Register with the Criminal Records Bureau; The Department of Health advises on its website (www.nhs.uk/nhsupdate) that checks on healthcare workers will be
• introduced from November 2003. Tel: 01507 524379 www.care1st.org; care1st@hotmail.com 
• Check whether you are required to be registered at the Data Protection Registry (Tel: 01625 545745);
• Use your existing ‘client list’ to introduce your past clients to your new practising initiatives and encourage them to network on your behalf to gain new clients for your practice;
• Review the amount of time and money you are putting in to marketing your practice. Write a ‘Complementary Health’ column for your local newspaper or take a slot on a local radio station. Review the content and format of your professional literature.
• Discuss with your Accountant whether you would obtain any income tax advantage by incorporating your practice as a private limited company;
• Consider joining, free, the ‘Health Voice Network Forum’ to keep up-to-date on contentious areas of change in Health Services.  www.healthvoice-uk.net;  info@healthvoice-uk.net;
• Consider the implications for your practice for the future Become a member of the Prince of Wales’s Foundation for Integrated Health (£25 per annum), Tel: 020-7619 6140, e-mail: inquiries@fimed.org, website:  www.fimed.org;11
• Read up-to-date research literature, for instance, Integrated Complementary Therapy in Primary Care, Setting the Agenda for the Future (May 2003) available free from the Prince of Wales’s Foundation for Integrated Health and Positive Health magazine;12
• Contact the Health Improvement Manager or the Health Promotion Manager of your local Primary Care Trust;
• Develop and promote a speciality within your practice to deal with key NHS treatment priorities which are the subject of the ‘review of literature’ currently being carried out by the Research Council for Complementary Medicine (see above);
• Check that the premises from which you practise comply with the Disability Discrimination Act 1995.
• ‘A Practical Guide for Small Service Providers’ is available free from the Disability Rights Commission
• (Tel: 08457 622633; www.drc-gb.org).

The Advantages of Working Together

The many Complementary Practitioners who practise alone may feel that it is time to investigate either forming or joining a Complementary Health Centre. A well-run centre should provide a practitioner with a managed administrative structure within which he or she may develop their practice to meet the challenges of change whilst, at the same time, retaining professional autonomy.

Additional benefits include the day-to-day opportunity to interact with fellow professionals, thereby enhancing your understanding of other types of treatment, and benefiting from a culture of mutual client referrals between practitioners with a view to providing a client with a truly holistic healthcare service. At the end of the day, it is the client who is of paramount importance.

Almost certainly, some of the changes anticipated may result in attempts to reduce the quality of client care – for example, by pressuring the practitioner to reduce treatment time in order to save costs. We owe it to our clients to make sure that this does not happen.

The Department of Health has declared its stated aim as being:
“…the future integration of all forms of therapy…”

The message to complementary and alternative medicine practitioners is clear – prepare now for the future.

References

1.     Department of Health Press Release 2003/0169 dated 17th April 2003. Gordon Brown Tel: 020-7210 4850.
2.     The Prince of Wales’s Foundation for Integrated Health. Setting the Agenda for the Future. 2003.
3.     The Research Council for Complementary Medicine. Newsletter. 2003.
4.    The Independent Newspaper. 22 April 2003. Research on Alternative Medicine gets £1.3 million.
5.     The Prince of Wales’s Foundation for Integrated Health. Alternative Medicine: The Consumer Perspective. April 2003.
6.     Thomas KJ, Nicholl JP and Coleman P. Use and Expenditure on Complementary Medicine in England: A Population based survey. Complementary Therapies in Medicine 2001 9: 2-11.
7.     Russo H. Integrated Healthcare: A Guide to Good Practice. The Foundation for Integrated Medicine. 2000.
8.     Joan Marinin, Royal London Homeopathic Hospital 1003. Tel: 020-7391 8864. rlhhconference@uclh.org
9.    Fullerton H Dr. EU Directives – Health Protection Double Speak. Positive Health Magazine. Issue 89. June 2003.
10.     Peters D, Chaitow L, Harris G and Morrison S. Integrating Complementary Therapy In Primary Care. Churchill Livingstone. 2002.
11.    The Prince of Wales’s Foundation for Integrated Health. 12 Chillingworth Road, London N7 8QJ. Tel: 020-7619 6140; enquiries@fimed.org; www.fimed.org
12.    Positive Health Publications Ltd. Tel: 0183 85114;  admin@positivehealth.com; www.positivehealth.com