CONTINUING THE PHILOSOPHY OF REGINALD O. KAPP

9.14 PCT POLICY ON COMPLEMENTARY THERAPY DRAFT

by     JOHN KAPP

22, Saxon Rd, Hove BN3 4LE, East Sussex   johnkapp@btinternet.com   Tel: 01273 417997



Purpose
The purpose of this complementary therapy policy is:
a)   To inform GPs and other healthcare practitioners on how to answer when asked by their patients about complementary therapies. (It is a Government standard that ‘good information’ be given.)
b)   To dispel the fear among patients that they will incur disapproval or discrimination if they admit to their doctor that they have self-referred for complementary therapy.
c)   To dispel the fear among doctors of being reported to the General Medical Council for putting their patient in jeopardy and being struck off the register if they refer them for complementary therapy (the Victorian notion of ‘quack remedies practiced by charlatans’ no longer applies).
d)   To aid the integration of the most cost-effective complementary therapies into the NHS to create a better service and reduce waiting lists (eg the 14,000 waiting locally and 6 million nationally for talking therapy instead of anti-depressants)

Definition of complementary therapy
‘Complementary therapy’ covers a wide range of gentle, non-invasive interventions which are widely available in the market, where they are normally accessed by self-referral. They are used either:
a)   In addition to conventional medicine (‘complementary’ mode) to relieve side effects, improve quality of life and heal, meaning to reharmonise body, mind and spirit when they have fallen apart, or,
b)   In stand alone (‘alternative’ mode) to enhance wellness, prevent illness, relieve symptoms, and heal

Examples of complementary therapy
The complementary therapies most commonly available in the market include the following:

Touching: osteopathy, chiropractic, cranio-sacral therapy, Bowen technique, Alexander technique, massage, aromatherapy, acupuncture, reflexology, shiatsu, colonic hydrotherapy

Talking: homeopathy, hypnotherapy, naturopathy, nutritional therapy, counselling, life coaching, Eye Movement Desensitisation and Reprocessing (EMDR), Emotional Freedom Technique (EFT), astrology

Healing: spiritual healing, reiki,
      Group: yoga, pilates, tai chi, chi gung, meditation.

Evidence base of efficacy
The evidence that complementary therapy works is demonstrated by the growing market for it, despite playing uphill against free NHS treatment. Funding for clinical research trials has been scarce, but is growing. (see 10 below) The National Institute for Clinical Excellence (NICE) has approved some complementary therapies: eg EMDR, Mindfulness meditation as a talking therapy alternative to anti-depressants.

Contra-indications
There are generally no contra-indications for complementary therapy with conventional medicine, with the exception of a few herbal remedies, which should not be taken with a few prescription drugs (eg St John’s Wort is contra-indicated with anti-depressants.)

Adverse reactions
There are generally no adverse reactions with complementary therapy. The worst recorded incident was an infected wound resulting from an unsterilised acupuncture needle.

Doctors’ recommendation for complementary therapy for payment by the patient
Doctors may recommend their patients to try any complementary therapy that they think would be beneficial to their care plan or pathway which the patient can find in the market and pay for themselves.

Doctors’ referral for complementary therapy for payment by the PCT
Doctors may refer their patients for any complementary therapy that they think would be beneficial to the patient’s care plan or pathway, for payment by the PCT, provided that:
a)   Under Payment By Results (PBR) they hold the budget for that patient.
b)   Under Practice Based Commissioning (PBC) their PCT has signed a Service Level Agreements.(SLA) with an Alternative Provider of Medical Services (APMS) who provides that complementary therapy
c)   The complementary therapy is approved by NICE, or both doctor and patient believes that it is essential to their care plan or pathway.
d)   Adequate clinical governance arrangements are in place (see below)

Clinical governance
Clinical governance protects the patient’s safety against adverse reactions. This is not as important as it is in conventional medicine, as complementary therapy is not as invasive so the risks are less. Nevertheless, Alternative Providers of Medical Services (APMS) should make best efforts to apply sound clinical governance procedures by employing complementary therapists who are ‘kite marked’ by being members of their appropriate professional body which is regulated by a Government recognised regulating body, and carry professional indemnity insurance.

In some complementary therapies Government recognised regulation is already in place (such as in physiotherapy, osteopathy, chiropractic, accupunture).

A further twelve complementary therapy professions are seeking Government recognition by joining together in a federal structure for voluntary self-regulation, which is hoped to be in operation by the end of 2007 (Alexander technique, aromatharapy, Bowen technique, craniosacral therapy, homeopathy, massage, naturopathy, nutritional therapy, reflexology, reiki, shiatsu, yoga).

In other professions strenuous efforts are being made to unite members into one regulatory body which can be recognised by Government. ( such as ’UK Healers’ which represents 15,000 healers who are members of about 30 organisations)

The absence of a Government recognised regulating body does not prohibit a therapy from being funded by the PCT provided that the patient is informed about the position and accepts the risk of being treated by a therapist who is less strictly regulated.

Post code lottery of provision of free complementary therapy
It is accepted that initially there will not be uniformity of provision of complementary therapy by all GPs and practices, which may lead to pressure by some patients to switch GPs or practices to improve their choice of treatment.

Co-operation in trials of new complementary therapies
The PCT and GPs will collaborate with researchers to refer patients to take part in clinical trials of complementary therapies which show promise of cost-effective benefit when introduced into the NHS.


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