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The Challenge of Working and Learning Together

by Dr David Peters(more info)

listed in complementary medicine, originally published in issue 53 - June 2000

Complementary medicine is a relative newcomer to the NHS. CM works better for some problems (and for certain kinds of people) than it does for others and is most effective in the hands of practitioners with real knowledge and skill.

Although CM has taken root in the mainstream over the past few years, it is still a long way from thriving in the way counselling has.

Those of us working towards an integrated holistic NHS hope that in time most NHS health centres will offer complementary therapies (CTs), just as until recently, they did counselling. I put it that way because as the NHS 'modernizes' it looks as if some parts of the UK are becoming less inclined to include either complementary therapists or counsellors. Let's hope this is a temporary glitch and not a U-turn in the ten-year trend for more and more general practices to incorporate high-touch and listening therapies. Maybe it's just because the new Primary Care Groups are tightening their belts and setting priorities. Having to spend limited budgets efficiently, what else are they to do, faced on the one hand by an ever wider array of high-tech treatment options, and on the other by an increasingly long-lived population with ever higher expectations of healthcare? Small wonder the Chancellor was applauded for putting new money into the NHS, albeit for high-tech cancer services and more heart operations.

Life-saving relief of catastrophic end-stage disease calls for big money and that raises important questions about the kind of health care we really want the public sector to provide. High-tech rescue may be the 'meat' in the sandwich but it is not enough; we have to find ways of building up national resources for prevention, health promotion and mind-body medicine too. With funds capped, how can the NHS ensure the high-tech 'meat' is properly contained in a package of skilled nursing, counselling and (yes I think so) complementary therapies?

Apparently sixty percent of GPs have tried to do this in their own way, by including counselling and complementary therapies; either by using their own CT skills, employing nurses who provide them or delegating treatment to complementary therapists. Several surveys confirm this trend, so it's safe to assume a lot of GPs believe this improves on conventional treatment. Whatever the explanation, CTs have focused aspirations for more acceptable or more effective health care, which is (ironically?) also what the NHS modernization project intends to achieve. Whether or not 'modernization' allows the voices of poorly met needs to be heard, it will surely take more than just high-tech medicine to satisfy them. So if too few nurses, physios, health educators, counsellors (and osteopaths, homoeopaths, herbalists, acupuncturists and massage practitioners) are working in the NHS, then it looks like bad news for holistic care. Will the new NHS money make a difference? It ought to, because the Government's health policy is supposed to be about empowerment, diversity and equity; a levelling up of standards. It's the job of the new Groups and Trusts to commission the local resources needed to make this happen, and on these bodies the GPs hold sway. British general practice at its best has pioneered an holistic approach since the 1950s: healthcare for people as minds and bodies, coping with their families and jobs and culture. Its great strength and a measure of its success has been a capacity for comprehensive, continuous, long-term care that reflects local need.

Which is why, given the resources, GPs should be best placed to encourage more integrated holistic care, including access to CAM.

But so far access has been haphazard and far from equitable, yet with calls for evidence-based medicine getting louder, the lack of evidence for CT cost-effectiveness has often been used to justify cutting back the NHS' embryonic CT services. The obvious question is: should we expect a levelling up or a levelling down as the NHS modernizes and equity takes centre stage? It's sad but true that research and therefore the available evidence still clusters round high-tech treatments rather than counselling and CT; that, after all, is where the research grants are. But wouldn't it be ridiculous if the case for holism and humanity – highly desirable aspects of a health service – had to be made by randomized controlled trials and cost-effective studies in order for them to survive!

I think the reason they will not go under is that too many doctors and nurses value job satisfaction and know it largely depends on having good enough relationships with patients. Truth is, when the gap between people's health beliefs and perceived needs and health professionals' ideas, abilities and willingness to meet them gets too wide, then relationships strain and eventually fracture. That's why successful integration of CAM with mainstream approaches will only partly depend on the evidence base. It has as much to do with how we learn to share ideas and hear what our clients and colleagues can tell us about the direction health and healthcare needs and wants might be going. In my experience this kind of open-ness is what makes dialogue between experienced GPs and experienced complementary practitioners so creative and (ultimately) positive. Doctors drawn to the subject already have a sense of biomedicine's incompleteness; I speak as one who had to find out the hard way that it takes more than a prescription pad and a referral letter to deal with everyday anguish. For doctors seeking ways of working more holistically, CTs may not be the final destination, but they can often be an important signpost on this journey.

As you can imagine, scouts at the collaborative frontier all too easily plummet into an attitude- and paradigm-gap. Even those who don't fall over the edge suffer from time to time, a sort of inter-disciplinary vertigo that vexes communication. But real co-operation between conventional and complementary practitioners means tolerating this discomfort for the sake of exploring our rich potential for working together. Integration? No-one told us it would be easy.

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About Dr David Peters

Prof David Peters is Chair of the British Holistic Medical Association (BHMA.org), an open association for everyone concerned to develop medicine as if people matter. David is the Clinical Director and Professor of Integrated Healthcare at the University of Westminster (U of W), is on the Board of Directors of the U of W Institute of Health and Wellbeing, a transdisciplinary research and training group exploring biopsychosocial approaches to health creation and treatment. He may be contacted via petersd@westminster.ac.uk

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