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Ask an expert - about acupuncture - NHS & private healthcare

18 questions

Q:  My GP has told me he will allow me to have acupuncture on the NHS for migraines,  but asked me to find out where I can go closest to me. Could you tell me what would be available in Essex

A:We are surprised and delighted to hear that your GP has agreed that you can have acupuncture treatment on the NHS. Although NICE have recommended acupuncture as one of the treatments for cluster headaches, we have seen very few referrals to practitioners outside the NHS itself.  The quickest way to identify a suitable practitioner is to use our online search facility at www.acupuncture.org.uk. On our home page you will see a search box which, if you enter your postcode, will show your the practitioners geographically closest to where you are. We have tried by using your postcode, and it generates a list of ten BAcC members in your area.

We hope that this helps you to find effective treatment for your problem.

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A: We are sorry to say that your chances of getting acupuncture on the NHS, by which we think you probably mean free at the point of delivery, are very slim. From our own experience there are very few people offering traditional acupuncture inside the NHS. Where such services exist they are usually based on some kind of personal knowledge and relationship to individual consultants or GP practices rather than a consequence of open tendering. The current commissioning arrangements have put budgetary power back in the hands of doctors at the cost of a large chunk of their budgets, and for many GPs the main target they try to achieve is saving money.

What provision there is will rest with doctors who also practise acupuncture (there are 2500 members in the British Medical Acupuncture Association) and physiotherapists (there are nearly 6000 members of the Acupuncture Association of Chartered Physiotherapists). The restriction which they face, especially the physios, is that the acupuncture has to be used within the scope of their practice and have a reasonable evidence base. This means that if your problem is musculo-skeletal and you can get a referral to an NHS physio you might, if you are lucky, find that acupuncture is a part of the treatment plan. GPs have slightly more flexibility, but many are reluctant to use acupuncture because the ten minute treatment slot doesn't really give much of a chance to do anything worthwhile.

This all sounds rather doom and gloom, but we think that you shouldn't rule out the possibility of traditional acupuncture. True, our members are highly trained professionals, and the average fees of £35-£50 per session do tend to price treatment out of some people's range. However, many practitioners are willing to offer fee reductions in case of genuine need. This often raises some interesting issues about genuine need; this expert was asked for a fee reduction because the patient's brand new 5-series BMW needed some urgent and costly repairs. Most practitioners are happy to drop fees considerably, though, but tend not to advertise the fact because it is usually people who don't need reductions who barter for a deal.

There is also a growing number of what are called multi-bed clinics which operate with three or more treatment beds in the same large open space. This concept, first used in the USA but highly reminiscent of a great deal of modern Chinese practice, was aimed at making treatment more widely available. Fees of between £10 and £20 a session are not unusual. Details of where these clinics are can be found here: http://acmac.net/acu/clinics

As a general comment, we remain disappointed that the national agencies are so reluctant to fund complementary medicine and especially acupuncture. Although the ancient concept was to stay well and get better, the modern version which sees people getting better and staying well could have immense benefits to the nation's budgets as well as the nation's health. Our day will come!

Q: I have pins and needles in my lower legs and feet.  I am an NHS patient, not covered by private medical insurance.  I have received physiotherapy treatments to strengthen my knee  ligaments. I would be interested in accessing acupuncture for the relief of pain and discomfort. Could my GP practice make a referral ?

We're sorry to say that we think that it is highly unlikely that your GP surgery will be able to make a referral within the NHS. The provision of acupuncture is somewhat random, and depends to a large extent on individual healthcare professionals extending their own personal scope of practice. If you happen to get lucky, and your GP surgery happens to have a partner, salaried GP or locum who has trained in acupuncture you may get a referral within the practice.

To get a referral outside the practice would be difficult for another reason. Generally speaking, GPs have to refer to treatments for which there is a proven evidence base. From a conventional medical perspective this involves testing therapies against a standard which is largely unfeasible for healthcare practices which are not drug-based. As a consequence the number of conditions for which a GP could make a legitimate referral are few and far between.

Leaving aside the problems of getting NHS-funded treatment, we believe that acupuncture treatment can often be very effective for the short term relief of pain and also for the kinds of neuropathic pain from which you appear to be suffering. Mention of your knee, however, makes us wonder whether there has been some sort of structural change or accident which the physiotherapy is aimed at helping, and this would have a significant bearing on what may be achievable.

Normally we would recommend that people visit a BAcC member local to them for advice on whether acupuncture might be beneficial, or whether a treatment which looked at structural issues like osteopathy might not be a good starting point. Clearly our members are not treating free at point of delivery and have to make a living like everyone else, but most are happy to respond to cases of individual hardship and prepared to make concessions. It's just that most of us don't advertise this because it is rarely the people who need them who ask but often the people who don't but like to drive a bargain. Living In South East London gives you a vast range of choices, as you will see if you use the 'find a practitioner' facility on our home page.

You may also find listings for multibed clinics on this website, http://acmac.net/acu/, which is a sub-group of mainly BAcC members committed to making acupuncture more widely available to people who might not otherwise be able to afford it.

The issue of group treatment is a very live one for the
BAcC. We have seen the growth of multibed clinics in the last few years
(several beds in one room) which have been set up to provide members of the
public with a chance to receive treatment in a setting which keeps the
overheads and fees low. We have also been aware for years of group clinics for
detox work in which many of our members work, although of course the ear
acupuncture which they use is very much a modern development and not a part of
the scope of practice of traditional practice.

In general we support the use of acupuncture in these
settings as long as the safety, privacy, dignity and confidentiality of the
patients can be preserved. Safety is a key issue. Maintaining safe practice
procedures while moving from patient to patient is a very difficult proposition
which could mean someone having to wash their hands about two or three hundred
times a day to meet safe practice requirements. The temptation to wander from
patient to patient is great, and although there have been no recorded cases of
cross-infection in these settings, the theoretical possibility exists if
someone is touching needles on patient after patient. The other main issue is
the counting in and out of needles. Having a group of people being needled at
the same creates the possibility of needles being lost or dislodged, and in
group settings, unless there is very clearly a named person in charge of each
patient, it is all too easy for a lost needle to go unremarked and unreported.

We also have our concerns about people's right to privacy
and confidentiality. In China it is not unusual to have twenty people in a room
with relatives crowded in and everyone talking to everyone else. This country
is not the same! Our fear is that important information will go unreported and
people's boundaries about comfort with undress will be breached because they
are too British to say 'no'.

We published an internal consultation document two years ago
highlighting all of the concerns we have about group practice settings, and we
received useful feedback from members involved in multibed provision. We are in
the process of re-drafting all of our Codes, and will now be ensuring that the
rules on all of these issues are updated to reflect the higher levels of
vigilance and respect which these forms of practice necessitate.

Q:  HiI have recently become very interested in acupuncture in terms of becoming one.I have looked into it quite a lot but haven't got all my questions answered. I am 16 , doing my last year of gcses and would like to know where to start after I have completed my gcses. What are the entry requirements of becoming an acupuncturist? What are the costs of courses?

A:We are very pleased to hear that you are considering a career in acupuncture. We have never regretted it as a choice for one moment.

By far the most informative site is that of our sister body, the British Acupuncture Accreditation Board (BAAB). This is the body which
accredits courses whose graduates are automatically eligible to join the BAcC, and the website http://www.baab.co.uk/ has
some very clear sections about what it takes to become a practitioner. The training is set at degree level, and as such the entry requirements are broadly similar.

As far as the cost of training is concerned there has been something of a turnaround in the last few years with the large increases in
university fees. Before then, the costs of training for courses within universities looked like a steal compared with the £4000-£5000 a year fees in independent teaching institutions, especially when the Licenciate in Acupuncture was often accompanied by a BSc degree. However, many universities put courses right at the top of the fee scale, so £9000 a year became the norm. The fact that this is largely deferred until you earn enough to start paying back is not necessarily a pleasant thought; no-one wants £30K of debt waiting around the corner. There has been a resurgence of interest in the independents, and generally speaking training is on the up again, with some courses looking to use modern methods of distance learning, like webinars, to keep the costs down.

All of the courses hold open days, though, and the BAAB site clearly signposts all the courses to contact, so your best bet is to see if
there is a course relatively near to you which you can visit and see for yourself how this might work. You might want to ring a local practitioner and ask a little more, but we can't guarantee what reception you might get - some will be happy to do so, others may not.

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