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Complementary Therapies within an NHS Clinic

by Adrian Seager(more info)

listed in clinical practice, originally published in issue 21 - August 1997

The therapies offered included homoeopathy, osteopathy, acupuncture and Chinese herbal medicine, reflexology, medical herbalism and the Alexander technique.

All complementary practitioners had appropriate qualifications and their training and previous experience were important factors in their selection by the group. Apart from the initial selection which was done by the team of doctors, subsequent appointments were made by the group as a whole, i.e by both doctors and complementary practitioners working as a team. All the complementary practitioners had thriving individual practices in addition to their work at the Warwick House Medical Centre.

Patients visiting the Centre booked appointments at reception and whilst this was free for the NHS doctors, there was a fee payable directly to the respective complementary therapist. Patients could be registered or not registered with the practice and they could be referred by a doctor or be self-referred to a therapist. So patients had a wide choice. They could either come in off the street, or they could be registered with the practice. In return, each complementary therapist paid a percentage of their total fee per month to the Centre for the use of the room and facilities.

To assess the benefit and relevance of the work of the total team, the practice undertook a research project, in association with the Department of Complementary Medicine, University of Exeter, to evaluate the work being done and to identify any problems encountered in marrying orthodox medical practice with complementary therapies.

This research showed there was some misunderstanding about how each “team” viewed the term ‘referral’. The CPs regarded it in the straightforward way of doctors recommending that patients see one of the CPs. On the other hand, it emerged that the doctors were divided. Some ‘suggested’ rather than referred patients to CPs. The ‘suggested’ method did not have the conviction of a straight referral and maybe this was why some patients did not proceed to have complementary therapy. Furthermore, some of the doctors felt uneasy about recommending the patients – knowing that they would have to pay. They did not have sufficient knowledge and confidence in some of the therapies. Most nurses and some doctors thought primarily in conventional terms and, therefore, did not necessarily think to mention a complementary approach.

Regarding the support staff, the nurses did not feel part of the new approach to patient care, largely because the presence of the complementary practitioners did not affect their way of working. On the other hand, the receptionists were most interested in complementary therapies and wished to know more about them. For each of the first two years the complementary practitioners held evening meetings and discussions specifically for reception staff so that they could attend and listen to brief presentations of therapies. This gave them an insight into the way the therapy worked, the scope and the potential for the various therapies and enabled them to give outline advice to those attending the Centre for the first time.

From the personal experience of working within the practice for over three years, there are some observations which are, in my view, worth sharing.

Generally, communication amongst those within the practice, i.e. the admin and nursing staff, doctors and CPs, was handicapped because many of them worked on a part-time basis, e.g. most of the CPs attended the Centre on one day a week only and many of the nursing, admin and reception staff worked part time. Therefore, the coincidence of those people being at the Centre at the same time was limited. Inevitably, this had an adverse effect on communication and understanding of the overall care of patients. I believe there is a major handicap in combining orthodox medicine with complementary practice in the same premises. It is that the expectation of the general public is for an instant cure and they expect treatment to be free at the point of delivery or, at the very worst, to have only a nominal charge. Departure from this practice comes as a surprise and patients need time and sometimes reassurance and explanation to accept and utilise their increased choice.

This contrasts directly with complementary therapies based upon the body’s ability to heal itself and for which there is a fee. In addition, many expect to experience instant improvement: osteopathy and chiropractic probably come nearest to meeting this desire for an instant ‘cure’ because there is a quick release of pain and of the underlying obstruction to musculo-skeletal mobility.

These improvements are more evident to both patient and practitioner than the slower recovery of constitutional health, which can be somewhat intangible and difficult to quantify to the satisfaction of
scientifically-minded people.

It also raises another issue of major differences between complementary therapies provided in private practice and the care offered within the NHS. The NHS is geared to reacting to health breakdown, i.e. generally, it treats disease and illness. This involves a consequent high cost and it has not proved effective in promoting positive measures to help people avoid breakdown in the first place. Logically, we should take some responsibility for our own health, yet many of us have grown up in an environment of “the NHS will provide”. In short, the NHS might be described as providing  a kind of AA or RAC type of breakdown service.

Whilst this is expressing it in extreme terms, there is some truth in the comment – many of us journey through life without a thought for, or investment in, health maintenance until we break down and have to call for emergency help. Also, our expectations are similar: we expect a prompt, comprehensive and successful repair and, in some cases, replacement parts to get us on our way.

It is with the maintenance of health that many complementary therapies can play a significant part. At present, it remains largely under-utilised. For example, the Warwick House research project revealed that only 40% of the GPs had had direct experience of a complementary therapy treatment. Whilst our enthusiasm remained high, the follow-up of patients referred by a GP was poor, i.e. we complementary therapists were poor at notifying our doctor colleagues of the outcome of patients referred to us. This was a human problem, where enthusiasm, time, effort, personal energy and discipline are all required to make these things happen on a regular basis. It is understandable, therefore, why progress towards an integrated approach, both in practice and in name, proved to be slower than some of us would have wished.

The researchers’ identification of a cost dilemma was over-emphasised by the use of the very word “dilemma”. I do not accept that it was a dilemma. If it was, complementary practitioners would not have run successful private practices and would have gone out of business long ago.

The problem was the close proximity of fee-paying to the provision of health care free of charge at the point of delivery. In other words, it is difficult to marry these two different approaches in the same building where patients have been used to having medical care provided free of charge. It should he possible, however, for GPs and CPs to work together without having to be sited at the same medical centre.

There is another fundamental difference between orthodox general practice and that of complementary practice. It is this: if the therapist fails, it is his or her expertise that has failed, whether this is acupuncture, reflexology, remedial massage or some other form of therapy and the patient may then be dismissive of the complete therapy and of the individual providing that therapy. On the other hand, if the doctor’s initial prescription does not work, or there is an adverse reaction, the prescription can be changed without any loss of face or professional reputation of the prescribing doctor. In other words, it is the prescribed pill or medicine which is seen to fail and not the doctor. Equally, it is not orthodox medical practice that is blamed for any lack of success. Having said that, in recent years there does appear to be a shift of emphasis where members of the public are now beginning to challenge and question the opinion and practices of those within general orthodox medical care.

It is these and similar issues that will occupy our time and energy in the years ahead. Personal experience has highlighted the danger of believing that to safeguard the public, doctors should retain total responsibility such that complementary practitioners will be only allowed to work with people referred to them by a qualified medical physician. The danger lies in failing to recognise the completely different approach taken by a doctor to disease and quality of life for a patient, which contrasts to that taken by many practitioners of complementary therapies.

In short, complementary therapists should be allowed to diagnose and treat within their own competence alongside the competence of the orthodox medical practitioners. It is my personal view that it would be an error to make complementary therapists subservient to orthodox practitioners. Nevertheless, there is great scope for the two to work together, not least, as mentioned earlier, for complementary therapies to do a great deal in maintaining health, thereby not only making the quality of life better for patients but also contributing greatly to reducing costs. These and similar opportunities are exciting and challenging and promise the chance of a cohesive approach that could provide truly comprehensive benefits to patients at a cost that our country can afford to maintain.

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About Adrian Seager

Adrian Seager trained and practised as a chiropodist before becoming a reflexologist. He has been a full time reflexology practitioner for over ten years. For 3½ years he has worked with a group of doctors at a NHS Medical Centre in Somerset and he has a busy private practice in the Bristol area. He can be contacted on Tel: 01275 373359.

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