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Development of Professional Acupuncture in the UK

by Nick Pahl(more info)

listed in acupuncture, originally published in issue 231 - July 2016

The founding of the British Acupuncture Council (BAcC) 20 years ago was a significant moment for professional acupuncture. It helped create a confident, positive profession of around 3000 expert practitioners, that has come to be respected by parliamentarians, government regulators and researchers. Treatment using acupuncture is now increasingly used by the public. Since the BAcC was founded, the UK has seen a huge growth in demand in acupuncture from patients. Research shows that the number of treatments have increased by one third to over 4 million a year in the past decade.  Celebrities have also taken up acupuncture - from Chris Evans to Gwyneth Paltrow. 

Nick Pahl Acupuncture 231 500x500

Acupuncture is now provided in a wide variety of settings within and outside the NHS - from hospices, pain and maternity services - and to specific target groups (such as carers and people with fertility issues). This can be on a 1:1 basis or in bigger ‘multibed’ settings, with treatment provided to a number of patients in a treatment session. The BAcC has also facilitated the development of the acupuncture profession as a career. Being an acupuncturist is rewarding. It is a role where you are in control of your time, and can mix professional work with personal responsibilities. The depth of Chinese Medicine also means a lifetime of personal development. Often people come to acupuncture as a second career, looking for a career option that is ethical and rewarding. If you are interested in becoming an acupuncturist in the UK, there are around a dozen accredited teaching institutions - in centres in London, Bristol York, Reading, Leamington, and Lincoln to East Grinstead.

As BAcC grew, a CEO was recruited in 2000 and one of their first tasks was to represent the BAcC at the House of Lords Select Committee, reporting on complementary therapies.  This recommended statutory regulation of acupuncture. The current Government, however, sees acupuncture as robustly self-regulated, so statutory regulation has not been achieved. This self-regulation is now backed up though by a Government quality mark. Since 2013, the British Acupuncture Council has been regulated by the Professional Standards Authority under its accredited register scheme. The Professional Standards Authority is accountable to parliament and ensures that the BAcC follows best practice in terms of its governance, management of complaints, and protection of the public.

During the last 20 years the evidence base for acupuncture has dramatically increased in terms of clinical trials and mechanism studies. The UK is ranked third out of 59 countries surveyed  publishing acupuncture research between 1991-2009. There are also an increasing number of BAcC members who have obtained their PhD in acupuncture research. This focus on research is reflected in the BAcC’s strategic approach to research. BAcC’s journal, the European Journal of Oriental Medicine, enhances the status and credentials of acupuncture and the BAcC, not just in the UK but internationally. BAcC is also a non-commercial partner of the National Institute of Health Research.

But, there is room for a greater role for acupuncture in health care; only around 10% of people in the UK have ever used acupuncture. It is clear that there are many people whose health would benefit from acupuncture that currently do not do use it.  The research evidence of acupuncture has provided a platform for this to occur - acupuncture has also been recognized for its contribution to long term conditions in a 2014 report by UK parliament’s health committee, is recommended by National Institute of Clinical Excellence - NICE - for low back pain and for headache and migraine and in Scotland is recommended for chronic pain conditions.

In terms of safety there are relatively few complications from using acupuncture which have been reported. The best information about the safety of acupuncture can be found in four published studies. The first two studies, both published in 2001, were conducted at the same time, one by Dr Hugh MacPherson, a senior researcher, to contribute to a prospective survey of adverse incidents, the other by Dr Adrian White. Both were published in the British Medical Journal and both reported extraordinarily similar results for broadly equivalent treatment numbers, 7 minor transient adverse events in each study for over 30,000 treatments. Dr Hugh MacPherson followed up this research with a patient study which reported a slightly higher incidence of adverse events (107 minor transient adverse events per 1000 treatments, mainly tiredness and headaches) but nonetheless still supported a conclusion that acupuncture remains a relatively safe procedure. Dr Adrian White subsequently undertook a study of adverse events across the world published in 2004. The higher incidence reflects the variable standards applied across the globe. The most recent and comprehensive prospective study undertaken by Witt in 2009 in Germany examined the outcomes of over 2.2 million treatments and found an incidence of 8.65 experiencing an adverse event, the most common being headaches, fatigue or bruising. There were two pneumothoraxes, but in general serious adverse events were shown to be very rare.

There is also now a recognized International Standard for needle quality which has been adopted as a British Standard by the British Standards Institute. The reference for this is BS ISO 17218:2014. The importance of this is that supplies from reputable suppliers will meet all of these conditions, especially in terms of the labelling of needle ‘use by’ dates on both primary and secondary packaging. There has been a small resurgence in the direct importation of needles from suppliers in the Far East, and while the vast majority of needles imported in this way will meet these standards, the means of importation sidesteps some of the checks which are essential for the granting of a CE marking. Given that this can easily be marked on packaging without authority, buying needles from legitimate suppliers is the only guarantee that this quality control chain has been followed.

A new website, www.acupuncturesafety.org.uk  has been created by the British Acupuncture Council, the British Medical Acupuncture Society and the Acupuncture Association of Chartered Physiotherapists. This group met in September 2015 to address the safe and legal use of acupuncture as a modality. The group set out some basic principles for practitioners to follow, together with a clear visual safety guide for safe needling, drawn up by the BMAS. This Acupuncture Safety Resource also offers up to date information and content for all healthcare professionals using acupuncture, as well as offering the general public and prospective patients an insight into the sophistication with which the practice of acupuncture is now undertaken in the UK.

Overall, if you decide to visit an acupuncturist, check his or her training and experience.

A future focus of acupuncture research is to:

  • Increase research, whilst honouring the integrity of acupuncture as a traditional system of care;
  • Advance knowledge about acupuncture among the health community at large;
  • Inform the effective integration of acupuncture into healthcare;
  • Strengthen evidence informed practice;
  • Examine trans-disciplinary research.

Examples of future research include research into acupuncture and its impact on the frequency of hot flashes associated with menopause, whether acupuncture can reduce pain and discomfort that may accompany chemotherapy and how acupuncture works. Although the efficacy and physiological mechanism of acupuncture, some aspects can be more challenging for science to study. For example, according to traditional Chinese medicine, acupuncture is based on the idea of Qi, which is envisioned as an energy that circulates through the body in channels. Acupuncture is thought to release blockages in these channels, restoring the flow of Qi through the body. This doesn’t mean that scientific research supports or rejects the use of acupuncture as a medical treatment across the board. On the contrary, it means that science can tell us if, when, and how acupuncture works. Despite these challenges, ongoing scientific research is likely to shed further light on acupuncture therapy.

The profession is now looking to the future and as a start is embracing new forms of communication. It is using social media to inform the public and also create new online communities of practitioners. 

Further Information

To see acupuncture courses and videos from acupuncturists on what it’s like to be a practitioner go to www.baab.co.uk . For more information about the British Acupuncture Council, go to www.acupuncture.org.uk

References

Mcpherson , H The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists BMJ 2001; 323 1 September 2001.

Mcpherson, H Patient reports of adverse events associated with acupuncture treatment: a prospective national survey Qual Saf Health Care 13:349–355. 2004.

White, A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture Acupuncture in Medicine 22(3):122-133. 2004.

Whit, C Safety of Acupuncture: Results of a Prospective Observational Study with 229,230 Patients and Introduction of a Medical Information and Consent Form 16:91–97 Forsch Komplementmed 2009,

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About Nick Pahl

Nick Pahl MSc is CEO of The British Acupuncture Council (BAcC), the leading self-regulatory body for the practice of traditional acupuncture in the UK. Nick graduated with an MSc in Public Health from the London School of Hygiene and Tropical Medicine in 1998, and previously was Assistant Director in a London NHS PCT. He has also held posts as a Director of a national hospice charity and technical adviser to Marie Stopes International. Nick may be contacted on Nick@acupuncture.org.uk    www.acupuncture.org.uk

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