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Ask an expert - general
Q: What is the VAT status of treatments made by an acupuncturist? Exempt or standard rated?
A: There are no exemptions from VAT for acupuncture treatment because we are a healthcare profession. This only applies to the statutorily regulated professions like osteopathy. The full list, taken from the HMRC site, is:
Item 1 of Group 7 of Schedule 9 to the VAT Act 1994 exempts:
The supply of services by a person registered or enrolled in any of the following –
(a) the register of medical practitioners or the register of medical practitioners with limited registration;
(b) either of the registers of ophthalmic opticians or the register of dispensing opticians kept under the Opticians Act 1989 or either of the lists kept under section 9 of that Act of bodies corporate carrying on business as ophthalmic opticians or as dispensing opticians;
(c) the register kept under the Health Professions Order 2001;
(ca) the register of osteopaths maintained in accordance with the provisions of the Osteopaths Act 1993;
(cb) the register of chiropractors maintained in accordance with the provisions of the Chiropractors Act 1994;
(d) the register of qualified nurses and midwives maintained under article 5 of the Nursing and Midwifery Order 2001;
(e) the register of dispensers of hearing aids or the register of persons employing such dispensers maintained under section 2 of the Hearing Aid Council Act 1968
Health Professions Order 2001
Professions which have registers kept under the Health Professions Order 2001 are:
podiatrists and chiropodists (Chiropody: the examination, diagnosis, treatment and prevention of diseases and malfunctions of the foot and its related structures);
dieticians (Dietetics: the application of nutritional science to the maintenance or restoration of health);
occupational therapists (Occupational therapy: treatment aimed at enabling people disabled by physical illness or a serious accident to relearn muscular control and co-ordination, to cope with everyday tasks, such as dressing, and when possible to resume employment);
orthoptists (Orthoptics: a technique used to measure and evaluate squint, mainly in children. It includes assessment of monocular and binocular vision, eye exercises and measures to combat lazy eye);
physiotherapists (Physiotherapy: treatment of disorders or injuries with physical methods or agents);
prosthetists and orthoptists;
radiographers (Radiography: the use of radiation to obtain images of parts of the body. Radiotherapists are included in this register);
speech and language therapists; and
operating department practitioners
Q: I am due to have surgery can I ask for acupunture instead of conventional medicine?
A: A great deal depends on what you mean. If you are referring to the anaesthetics for the operation, or any of the pre-meds which people may have to take, then we would strongly advise someone not to do this. Although acupuncture has been used for anaesthesia, mainly in mainland China, it has fallen into disuse because on most occasions it is more reliable to use conventional methods, and these have to be in place and ready anyway in case the acupuncture anaesthesia ceases to work. One of our members wrote a fascinating account of being asked by a patient to use acupuncture anaesthesia for nasal surgery, mainly because the patient could not have conventional anaesthetic. The patient bled less and recovered more quickly than the other patients, but he found it too stressful to do it again, even when asked by the consultant.
As far as post-surgery is concerned, again this depends on what kind of surgery we are talking about. There are a number of conditions for which acupuncture treatment may be offered as pain relief in place of or in addition to conventional medication, and there is some very well documented and proven research for the use of acupuncture to reduce the nausea from which people suffer after a general anaesthetic. Our factsheets on the main homepage under 'research' give all the references to both of these. However, there are few other areas where we would be comfortable that someone used acupuncture as an alternatibe unless it was with the express permission of the surgeon or consultant and did not increase the operative or post-operative risks.
To give clearer advice, though, we would need to know what kind of surgery you are going to have.
Q: I am a Health and Social Care student researching into acupuncture. I am looking for information on regulation of acupuncturist and requirements they must have to be a registered practitioner. I haven't been able to find any information on your website if any practitioner must have any CRB checks, professional indemnity insurance or annual renewal of registration. Is there any in place for practitioners governed by the BAcC
A: All of our practitioners are covered by a bloc professional idemnity policy through Royal Sun Alliance which is a full 'claims occurring' policy with a £5million limit of cover. The only practitioners whom we do not insure are those working full time in the NHS, for whom NHS cover applies.
We do not routinely seek CRB checks for practitioners. The vast majority of the membership intake is from accredited teaching institutions, some of whom seek CRB checks when students enrol. The BAcC took advice from the Health Professions Council some years ago when acupuncture was about to be statutorily regulated on whether we should introduce mandatory CRB checks. We were advised that self-declaration was adequate, although we did investigate which of several agencies would be most appropriate for mass checking. The BAcC's Code of Professional Conduct requires that members do not work unsupervised in a number of situations where CRB checks would be essential. However, we do regard ourselves as exempt from the provisons of the Rehabilitation of Offenders Act 1974 insofar as we require members to disclose all convictions, including spent ones, because of the potential for working with vulnerable adults and undertaking home visits.
There is an annual renewal of registration process which requires members to make a number of declarations about their continuing fitness to practise, and any relevant issues to do with criminal or civil actions, or insurance claims. This process is under review and will be upgraded for the 2014 renewal process.
Q: I have persistent pain in my chest just under my left nipple. I have had heart scan, X Ray, endoscopy all to find everything is ok. Would acupuncture be worth a try?
A: When someone has had a battery of conventional medical tests to assess a pain they have, the first thing we say to them is that this should be reassuring - it has ruled out most, if not all, of the serious possibilities. We tend to 'inherit' a great many patients in your situation, and working in a different paradigm of medicine can sometimes offer new treatment possibilities.
Chinese medicine is based on an entirely different understanding of the way in which the body mind and spirit work as an interconnected system of energy called 'qi', a term which is virtually untranslatable. An understanding of the flow, rhythms and balance of this energy is integral to understanding the concept of disease in Chinese medicine, and the practitioner will be looking at excesses, deficiencies or blockages to try to establish what is causing the pain. This might lead to local treatment to clear a blockage, or could involve systemic treatment if the problem is the tip of a larger iceberg. Usually there is an element of both involved, with underlying patterns allowing local patterns to develop. A practitioner would probably ask you the same kinds of question you have already been asked - nature, frequency, onset, duration, etc etc - in order to refine their diagnosis.
The best advice we can give you is to visit a BAcC member local to you and seek a brief face to face assessment. This will enable someone to give you a much better idea of how treatable the problem is. Our experience is that these kinds of pains clear quickly with acupuncture treatment or not at all, and you should, if you decide to have treatment, set measurable outcomes and a set review point to avoid a sequence of treatment extending a long time without discernible improvement.
Q: I have had four sessions so far but my practitioner also prescrobes herbal medicine Jin ui Shen Qui Wan and another capsule which has no name on the packaging - when questioned about what they are for she simply said they are herbal and wont do me any harm. Is it normal to have to take tablets alongside acupuncture?
A: Chinese medicine includes acupuncture, herbal medicine, tui na (a form of massage), moxibustion (burning a warming herb) and cupping, as well as dietary advice and exercise (tai chi and qi gong). It is quite possible, therefore, to have chinese herbal medicine alongside acupuncture, and the BAcC has about 300 members who are also members of the Register of Chinese Herbal Medicine and use herbs regularly, as well as a further 250 trained to use ready made herbal formulae.
Where a herbal product comes in a ready made form it is required by law to list the contents. If the formula is made up by the practitioner, then there is no need to list the contents, and in most cases the patient would be none the wiser if they did - we certainly wouldn't! However, if we had a list, it would mean that we could check if we wanted to, and that is the important thing. In the days of the internet it is possible to find out just about anything, and the patient has a right to know what they are being given.
We are sure that there are good reasons why the practitioner has not told you what they are giving you, probably to do with the rather obscure names of the contents, but a responsible practitioner will certainly accede to your request for a list of the contents. If that is not forthcoming, then you would be entitled to take that up with the professional association the practitioner belonged to, especially if it comes in packaged form and does not list what it contains. Capsules can be made by the practitioners, so this does not count as packaging, but industrially produced boxes would seem to indicate ready-made herbs whose contents should be listed.