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Q: I had acupuncture before for my MS and depression but it was never regular like once a week. As I am very poorly at the moment I need to find an affordable acupuncturist near me central London. I can even be a volunteer in a teaching class. I can only afford £10 for a week at the moment.
A: It is an unfortunate consequence of the fact that most acupuncture treatment is offered in private practice that its practitioners have to charge the market rate to make a living. This has sometimes led to the accusation that it remains a middle class option. However, money was not the driving force which made the majority of BAcCv members train to become acupuncturists, and many are prepared to negotiate discounts if someone would really benefit from having treatment. The balance that many of us seek is to see enough patients at our normal fee rates to pay the bills to be able to offer treatment to those who cannot afford it at the normal rate. This is very much a personal choice and commitment by the individual practitioner; we do not interfere in this at all. There are a number of members who are committed to a model of practice called the multi-bed clinic which has its origins in the United States. This is a clinic which houses several treatment couches in a large open space, and while it does not afford the privacy of usual practice it is how acupuncture is offered in much of China and the Far East. There is an organisation called ACMAC which is a forum for all providers of this form of treatment in the UK, and logging onto their site at acmac.net will offer you a drop down list of clinics in or near your area. Finally there are a number of teaching institutions which sometimes have student clinics in which the fees are heavily reduced. Although the practitioners are in the process of qualifying they are under the supervision of some of the most experienced practitioners around, and this can be a very fruitful option. Contact details for all of the teaching institutions whose graduates are automatically eligible to join the BAcC can be found here http://baab.co.uk/study-acupuncture/accredited-courses.html.
Q: Is Rother District Council (East Sussex) linked in anyway to the Acupuncture Association? I ask as I have been told that most London Councils are affiliated and accept the rule of the society.
A: We think what you are alluding to here is the difference between the registration of acupuncturists in the UK outside London and the licensing of acupuncturists in Greater London. Outside London, local authorities grant a one-off registration to a practitioner under the Local Government Miscellaneous Provisions Act 1982. This registers the premises and the practitioner, and often if the premises have already been registered by someone working there, any new practitioners joining their set-up pay a lower fee. There are no affiliations or exemptions granted to any organisations or members of organisations, unless the practitioner is a doctor or dentist in which cae they do not have to register. In London, however, most local authorities have adopted the London Local Authorities Act 1991 which requires the annual licensing of 'special treatments' of which acupuncture is regarded to be one. There are, however, provisions within the Act to exempt practitioners registered with statutory bodies, such as physiotherapists or osteopaths, and also members of professional organisations which can demonstrate that they have all of the necessary codes of conduct, registers and disciplinary processes to protect the public interest. A list is maintained of these associations, and a recent version can be found on Westminster's website at: http://transact.westminster.gov.uk/publications/publications_detail.cfm?ID=4401 In all cases a practitioner belonging to one of these bodies is required to make themselves known to the local authority if they set up business in a borough, and the local environmental health officers have the power to inspect premises and require standards to be met on penalty of refusing to accept the exemption and requiring a licence subject to conditions.
Q: What are the legal implications and requirements for an acupuncturist when treating a patient who refuses to register with a GP?
A: There are no legal requirements of which we are aware about treating patients who are not registered with a GP. Registration with a GP through the NHS is entirely a matter of choice for a patient, and if someone exercises their choice not to register it does not mean that we cannot treat them or are not legally allowed to treat them. However, there are circumstances where it may be essential to refer a patient on to orthodox or conventional medical services. Indeed, this is taken seriously by many regulatory bodies, and the Advertising Standards Authority has a long and very exhaustive list of named conditions which it believes put a patient at risk if someone who is not suitably medically qualified promotes their treatment instead of referring to orthodox care or fails to ensure that someone is receiving orthodox care. This might present something of an ethical dilemma for a BAcC member. If the practitioner believes that the patient should consult an orthodox medical practitioner and the patient refuses, the question would be whether offering some treatment 'blind', so to speak, is better than refusing to treat and running the risk that the patient will have no treatment of any kind. In circumstances like this our members would almost certainly seek advice from our experts in the field of insurance, conventional medicine and law. The BAcC has all of these expert facilities in place, and if there is any perceived risk to either patent or practitioner, we advise and encourage our members to contact us. This will always remain a troublesome area, however. Even if someone is registered with a GP they may refuse consent for a practitioner to contact the GP or may listen to the practitioner's advice and ignore it. Breaching confidentiality by disclosing details to a third party, even in the patient's best interests, is also a minefield, and the legal advice we have been given is that only in exceptional circumstances can disclosures without consent be made, and only where there is a real risk to the general public. Essentially we would deal with each case on its own merits, given that some medical needs are more pressing than other. It would be true to say, though, that such instances are quite rare, and we hear of very few people who opt out of registration with a GP.
Q: I recently watched a programme on television in which it was stated that acupuncture can be obtained free or at a greatly reduced cost if you volunteer to be a guinea pig for students to practice on. I have had acupuncture in the past for allergic rhinitis and found it to be very helpful but just could not afford to keep the treatments up. I enquired at my GP if I could have the treatment on the NHS but they only provide it for tennis elbow.
A: The short answer is, we're afraid to say, 'no'. The list of training institutions which are in a formal relationship with the Accreditation Board can be found here:http://baab.co.uk/study-acupuncture/accredited-courses.html and you will see that none is particularly close. In most cases the cost of travel would exceed the cost of treatment. However, it would be fair to say that the great majority of our members are not driven by money, although clearly they have to pay bills and eat just like everybody else. Many members are willing to discount fees for patients who are genuinely hard up, and it may well be worthwhile asking the practitioners close to where you live whether they would be prepared to reduce fees. However, this can get into some interesting discussions about what counts as hardship, and all of us have been 'burned' at least once in the early stages of our career by people pleading hardship when the patient's definition has extended to 'down to the last million and the Rolls has a puncture.' This particular expert let someone have treatment for £5 per session over several weeks on pleas of poverty, and was surprised, when asking whether the patient was booking in next week, to be told, 'oh no, dear, can't do that, we're off to Barbados for six weeks.' The vast majority of people who seek reductions are bona fide, however, and if you happen to live near BAcC members whose primary concern is helping people to get better, all shall be well.
A: A great deal depends on which type of diabetes you are asking about. Type-1 diabetes, the insulin dependent variety, is not likely to be amenable to acupuncture treatment. In nearly all cases there is no residual pancreatic function, and the sufferer will have to take insulin by injection for life. There may be a case to be made for using acupuncture to enhance the whole system in an attempt to reduce the long-term impact of circulatory problems which tend to develop in later years, but there is no evidence to back up claims that treatment can do this. Anecdotally we hear of patients who believe that some of the numbness, or neuropathic pain or erectile dysfunction which accompanies the condition has been resolved to a degree, but the evidence is not plentiful. The situation with Type-2 diabetes, non-insulin dependent diabetes, is not a great deal more positive as our factsheet http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/type-2-diabetes.html shows. There is very little research on which to base positive recommendations, although the paper does say that acupuncture can be a valuable part of an overall strategy to bring all aspects of long term care - diet, exercise, etc - together. We have heard of occasional cases where there has been some residual pancreatic function which has responded well to treatment, and many practitioners warn NIDDM patients to taske care in the days after a first session in case a sudden revitalising of the insulin-producing cells causes an renewed production which in turn could cause a hypoglycaemic coma, but we have never heard of this happening.
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