Family Practice Vol. 20, No. 5, 575-577
© Oxford University Press 2003
Health Services Research |
Trends in access to complementary or alternative medicines via primary care in England: 1995–2001 Results from a follow-up national survey
Medical Care Research Unit, ScHARR, University of Sheffield, Sheffield, UK.
Correspondence to KJ Thomas; E-mail: K.J.Thomas{at}sheffield.ac.uk
Thomas KJ, Coleman P, Nicholl JP. Trends in access to complementary or alternative medicines via primary care in England: 1995–2001. Results from a follow-up national survey. Family Practice 2003; 20: 575–577.
Received 20 December 2002; Accepted 19 May 2003.
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Abstract |
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 Top Abstract IntroductionMethodResultsDiscussionReferences |
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A prior national survey of one in eight randomly selected general practices in England estimated that 39% of general practices [95% confidence interval (CI) 35–43%] provided some access to complementary or alternative medicine (CAM) therapies in 1995. A repeat survey, conducted in 2001, estimated that one in two practices in England now offer their patients some access to CAMs (95% CI 46–52%). The change was due to increased provision in-house; the proportion of practices making NHS referrals remained unchanged. The proportion of services supported by patient payments rose from 26 to 42%.
Keywords. Complementary and alternative medicines, England, primary care, survey.
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Introduction |
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TopAbstractIntroductionMethodResultsDiscussionReferences |
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In a 1995 national survey, we estimated that 39.5% of general practices in England were offering patients access to complementary and alternative medicines (CAMs).1 Further national research estimated that 10.6% of adults visited a CAM practitioner in 1998,2 and a Government enquiry in 2001 recommended the increased provision of CAMs in the NHS where there is evidence of patient demand and effectiveness.3
NHS CAM provision tends to expand when policy changes favour innovative service developments. In the past, GP fundholding offered an opportunity for practice-based CAM services to develop.4 Since 1995, major changes in NHS organization have included the reconfiguration of primary care services into Primary Care Groups (PCGs) and latterly Primary Care Trusts (PCTs), bringing new commissioning powers for GPs.5 The impact of these changes on the provision of CAM services is not known. We therefore repeated our 1995 survey in 2001 (2 years following the reorganization) to generate new national estimates of the provision of CAMs in NHS primary care in England, and to describe any changes that have occurred in patterns of patient access over time.
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Method |
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TopAbstractIntroductionMethodResultsDiscussionReferences |
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Data collection using methods employed in 19951 was repeated in 2001. A postal questionnaire and up to two reminders were sent to 1203 randomly selected GPs in a stratified random cluster sample of one in eight GP partnerships in England. A fourth mailing asked non-responders to complete a subset of three ‘core’ questions. The data were processed and analysed used SPSS, and 95% confidence intervals (CIs) were calculated for all key estimates.
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Results |
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TopAbstractIntroductionMethodResultsDiscussionReferences |
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A response rate of 72.3% (870/1203) was achieved. This was similar to the 78.6% obtained in 1995,1 and was representative of the sample frame for known practice characteristics. A total of 700 responders gave detailed information on the services provided in 2001.
It is estimated that almost half the general practices in England (49.4%, CI 46–52%) were providing some access to CAM therapies in 2001. One or more members of the primary health care team (GPs, nurses and others) provided therapies in an estimated 29.5% of practices; independent CAM practitioners worked in 12.2% of practices, and 26.8% of practices made NHS referrals to external CAMs providers (Table 1
).
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The proportion of practices with CAMs provided by the primary health care team has increased 38% since 1995. As in 1995,1 acupuncture and homeopathy are the therapies most frequently provided in this way. CAM services involving an independent practitioner working at the practice have doubled since 1995. These services most frequently provide manipulative therapies. Little change is evident in the percentage of practices making NHS referrals for CAMs (Table 1
). The proportion of services supported by full or partial patient payments rose from 26 to 42% between 1995 and 2001. In 2001, CAM therapies were being used to provide support or care for each of the NHS priority groups.5 Eleven percent (95% CI 9–13%) of practices reported current use of CAMs for cancer patients; 10% (95% CI 8–12%) for elderly patients; 9% (95% CI 7–11%) for mental health patients; and 5% each (95% CI 4–7%) for diabetes and for coronary heart disease patients.
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Discussion |
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TopAbstractIntroductionMethodResultsDiscussionReferences |
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Over 800 GPs participated in this representative national survey. The results show a substantial increase in the ‘in-house’ provision of CAMs in UK primary care over the past 6 years. The increase in the proportion of practices with an independent CAM practitioner is surprising given the known difficulties experienced in sustaining funding for such services.4 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. No change was found in the proportion of practices making NHS referrals for CAMs. This may reflect restricted resources at practice level, and the strong culture of evidence-based purchasing operating in the wider NHS.
Increased provision by the primary health care team, coupled with its use for priority patient groups, suggests that CAM is regarded by many GPs as having a role to play in patient management. 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.
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Acknowledgments |
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We would like to thank the participating GPs who contributed to the data for this study. This work is supported by the Department of Health. The views expressed are, however, those of the authors alone.
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References |
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1 Thomas KJ, Nicholl JP, Fall M. Access to complementary medicine via general practice. Br J Gen Pract 2001; 51: 25–30.[Medline]
2 Thomas KJ, Nicholl J, Coleman P. Use and expenditure on complementary medicine in England—a population-based survey. Complementary Ther Med 2001; 9: 1–11.[CrossRef][ISI][Medline]
3 Complementary and Alternative Medicine. Report of the House of Lords Select Committee on Science and Technology; Session 1999–2000: HL Paper 123. London: The Stationery Office; 2000.
4 Luff D, Thomas KJ. Sustaining complementary therapy provision in primary care: lessons from existing services. Complementary Ther Med 2000; 8: 174–179.
5 Department of Health. The NHS Plan. A Plan for Investment. A Plan for Reform. London: Department of Health; 2000.
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