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Half of general practices offer patients complementary medicine

BMJ 2003; 327 doi: (Published 27 November 2003) Cite this as: BMJ 2003;327:1250
  1. Roger Dobson
  1. Abergavenny

    Half of general practices in England now offer patients some access to complementary or alternative medicines.

    New research shows that there has been a substantial increase in provision since 1995, when a similar study by the same authors found that 40% of practices were offering complementary or alternative medicines.

    “Increased provision by the primary health care team, coupled with its use for priority patient groups, suggests that CAM [complementary or alternative medicine] is regarded by many GPs as having a role to play in patient management,” says a report of the study in Family Practice (2003:20:575-7). The growth in services has been made possible partly by asking patients to pay for the services, the report says.

    In the study, a postal questionnaire was sent to one in eight GP partnerships in England, and 870 took part. The survey in 1995, which also sampled one in eight partnerships, had found that 40% were offering access to complementary or alternative medicines, and the authors, from the Medical Care Research Unit, at the University of Sheffield, wanted to see if there had been any changes.

    They estimate that almost half the general practices in England (49%) were providing some access to complementary or alternative therapies in 2001. One or more members of the primary healthcare team–GPs, nurses, and others–provided the therapies in an estimated 30% of practices; independent practitioners worked in 12% of practices; and 27% of practices made NHS referrals to external providers.

    The proportion of practices offering therapies and whose primary healthcare team provides the therapies had increased by 38% since 1995, and acupuncture and homoeopathy are the therapies most frequently provided in this way, says the report. Involvement of an independent practitioner working at the practice has doubled since 1995, and these practitioners most often provide manipulative therapies. The percentage of practices making NHS referrals for complementary or alternative therapies has changed little. The proportion of services supported by full or partial payments by patients rose from 26% to 42% between 1995 and 2001.

    In 2001, complementary or alternative therapies were being used to provide support or care for each of the NHS priority groups. Eleven per cent of practices used the therapies for cancer patients; 10% for elderly patients; 9% for mental health patients; and 5% each for patients with diabetes or coronary heart disease.

    The report says that the increase in the proportion of practices with an independent practitioner in complementary or alternative medicine is surprising, given the known difficulties in sustaining funding for such services: “This growth appears to have been facilitated in part by requesting patient payments. Assuming that these services are provided according to perceived patient need, the reported growth in patient payment for these services has clear equity implications.”

    It adds, “To meet acceptable standards of clinical governance, more evidence is needed regarding the CAM qualifications and training of all those providing this type of care to NHS primary care patients.”