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Q. If I want to set up my own practice and currently not a member of the BACc but have a BSc degree level in acupuncture in the UK what steps do I need to take in able to practice safely within the law..any help would be grateful ..many thanks

A. The first thing that we'd always recommend is that you join a professional body, even if it isn't the BAcC. Our experience is that it can be a lonely world as a practitioner without back-up and regular contact, and we have seen many solo practitioners fall away very quickly, which is a sad waste of the training. If you have other healthcare skills that will help, but being able to turn to fellow professionals in your own trade is vital.

There are a few legal requirements, the main one being that you are registered or licensed with your local authority. In most of the country that will mean a one-off registration under Local Government Miscellaneous Provisions Act 1982. In London it will mean an annual licence unless you belong to an exempt professional body, and in Scotland an annual licence unless you are a statutorily regulated healthcare practitioner. The local authority licensing or environmental health department will sort you out.

You will need to be insured. Indeed, most authorities will want to see this in place as a condition of licensing or registration. Some insist on membership of a professional body, but this is rare. You will also need to set up a contract with a clinical waste disposal agency for removal of sharps boxes and clinic waste.

If you work in an established practice you need to make sure these things are in place. Registration is for every person in every place they work, so anyone telling you that the practice is registered without you being is wring.

If you work from home you need to check that there are no problems with planning - parking is the major issue - and although you are legally entitled to work from home neighbours can object if the parking or volume of business becomes a nuisance. If you work from home you also need to check the situation with business rates; you may become liable for them with an attendant reduction in your council tax being possible. You also need to check whether you mortgage allows this to happen, and also whether running a business from home invalidates your contents insurance.

Aside from that, the main issue is maintaining the currency of your skills by doing relevant CPD and staying in touch with what is happening within the acupuncture world.

More than that, ....... well, that's why our members pay to belong! That is enough to ensure that you stay within the law and suitably protect your patients and the public.

Good luck!

We have generally tended to be quite upbeat about treating shingles, as this sample 'nested' response

shows:As you might imagine we have been asked about this many times over the years, and a recent answer was:
Shingles can be a terribly distressing condition whose after-effects can persist for months or even years. The treatment of post herpetic pain is an area which has been heavily researched in China, as our factsheet

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/herpes.html

says, but the quality of trials is not that great. There is a comprehensive systematic review of all available trials, but this was only announced last year and has not yet been published. We ourselves have treated many cases of shingles, and we have to be honest and say that there has been a significant number of cases where it has been very difficult indeed to reduce the pain, which as we are sure you know can be excruciating.

However, there is no point in being unduly pessimistic. There have been cases of post-herpetic pain where the acupuncture treatment has made significant inroads into the symptoms from a mixture of constitutional treatment to bring balance back to the system as a whole and local treatment to reduce some of the irritation and inflammation. Generally speaking, it is better to start treatment as soon as possible after an attack, just as the use of conventional anti-viral medicines is favoured as early as possible. However, the reality is that most patients present with post-herpetic pain long after they attack and usually because the side-effects of the long-term medication are becoming a problem, so we are used to adopting a slightly different approach from that used in China, where needling often commences with days of an attack starting.

The best advice that we can give is that you visit a BAcC member local to you for a brief face to face assessment. The one caution we always voice in these cases is that if you decide to go ahead with treatment you set review dates for assessing progress and also try to set specific outcome measures, objective evidence that the condition is improving. This can be quite difficult with chronic conditions like this which can still have acute episodes, but it is really important to try to find a marker which can show that there has been progress. We would feel confident, though, that acupuncture treatment might offer some benefit in pain relief and recovery. The only question to resolve is how much and how sustainable the relief is, which is why we are always cautious in setting clear outcomes measures and review periods.

The great strength of Chinese medicine, though, is that each patient is unique and different, even though their symptoms be the same. This means that a skilled practitioner, and all of our members are, would be able to make links that we cannot do at this distance, and may be able to recommend other things that may help alongside acupuncture treatment. We would strongly recommend that you visit a local BAcC member for advice, and hope that it puts you on a path to finding some relief.

We have had a good look through the research databases to see what further evidence is available (the factsheet seems to stop around 2008) and we have found a few which are positively encouraging, such as:

https://www.ncbi.nlm.nih.gov/pubmed/21639941

https://www.ncbi.nlm.nih.gov/pubmed/22502623

but the systematic review proposed in 2014 has still to be completed (at least we can find no trace of a publication by the principal author).
The advice we gave earlier holds good, and that is to visit a local BAcC member for an informal chat about what may be possible. This is by far the best way to get a clear idea of your prospects, and most members are only too happy to see prospective patients in this way.

However, your symptoms seem to us to be particularly severe. This does not mean that it won't be amenable to treatment; there have been many occasions when severe symptoms improve quickly while mild symptoms remain intractable. Common sense dictates, though, that the fact that this has endured for two years probably means that it will require an extended course of treatment to see whether change is possible.

This can often generate problems because whereas we normally say that a practitioner should review progress after four or five sessions, if something might take twenty sessions to deal with there is something of a leap of faith about what can be a quite considerable level of expenditure. Difficult as it is to establish meaningful scales for pain or movement we encourage practitioner and patient to work together at finding an objective measure of improvement which can help both to assess whether there is sustainable progress. Anyone can have good or bad days but objective measures allow a better perspective for making decisions about carrying on.

Q. I have been receiving acupuncture for chronic migraines in the last 6 weeks (twice a week). It has improved a lot but it has been expensive and my acupuncturist is still advising me to attend twice a week. This is something I cannot keep up with financially and I believe she has her own interests in mind with the advice she is giving. I'm asking for some impartial advice on whether I should cut down to once a week at this point? Many thanks.

A. We are all too aware that because the majority of us are in private practice the cost of treatment can sometimes become an issue. Until and unless acupuncture treatment by a properly qualified traditional acupuncturist becomes free at the point of delivery inside the NHS this will remain the case.

We have to say in all sincerity that only on a couple of occasions over the last thirty years have we come across situations where we have had a suspicion that frequency of treatment was driven by the practitioner's need to bump up their income, and in both cases the circumstances were exceptional. When someone asks a person to attend twice a week it is almost always to try to bring a difficult situation under control. This is often the case with acute problems, but can sometimes be the case when someone has a problem which has lasted for years. The body develops a kind of 'habit energy' and it can sometimes take frequent reminders to maintain changes. This is not a problem unique to acupuncture; you will find that many Alexander teachers have to begin with similar levels of frequency to encourage change.

Our advice in these situations will always be to talk to the practitioner about the difficulty of keeping up a twice weekly treatment schedule. If someone told us that we would probably be looking at some form of discount if we felt that continued frequent treatment was going to be of benefit. This can be finessed by making one session the major one and the other one a more brief top-up. We do have sympathy with practitioners who rent space by the hour or day for whom each space must pay for itself, but most people can squeeze a few minutes extra out of a schedule.

If the practitioner doesn't bend or won't discount fees, then it is a hard thing to say but there are usually plenty of others in most areas, and you could well find that someone else will be able to help you at a price you can afford. There are also more multibed clinics which offer treatment in a group setting where you might be able to carry on treatment at greatly reduced fees.

We suspect, though, that after six weeks of bi-weekly treatment it may well be time to step back to once a week sessions, and your practitioner will probably agree. It will only be an issue if as a consequence the migraines return, in which case you might need to have that talk.

We do hope that you continue to make progress and become migraine-free .


We are all too aware that because the majority of us are in private practice the cost of treatment can sometimes become an issue. Until and unless acupuncture treatment by a properly qualified traditional acupuncturist becomes free at the point of delivery inside the NHS this will remain the case.

We have to say in all sincerity that only on a couple of occasions over the last thirty years have we come across situations where we have had a suspicion that frequency of treatment was driven by the practitioner's need to bump up their income, and in both cases the circumstances were exceptional. When someone asks a person to attend twice a week it is almost always to try to bring a difficult situation under control. This is often the case with acute problems, but can sometimes be the case when someone has a problem which has lasted for years. The body develops a kind of 'habit energy' and it can sometimes take frequent reminders to maintain changes. This is not a problem unique to acupuncture; you will find that many Alexander teachers have to begin with similar levels of frequency to encourage change.

Our advice in these situations will always be to talk to the practitioner about the difficulty of keeping up a twice weekly treatment schedule. If someone told us that we would probably be looking at some form of discount if we felt that continued frequent treatment was going to be of benefit. This can be finessed by making one session the major one and the other one a more brief top-up. We do have sympathy with practitioners who rent space by the hour or day for whom each space must pay for itself, but most people can squeeze a few minutes extra out of a schedule.

If the practitioner doesn't bend or won't discount fees, then it is a hard thing to say but there are usually plenty of others in most areas, and you could well find that someone else will be able to help you at a price you can afford. There are also more multibed clinics which offer treatment in a group setting where you might be able to carry on treatment at greatly reduced fees.

We suspect, though, that after six weeks of bi-weekly treatment it may well be time to step back to once a week sessions, and your practitioner will probably agree. It will only be an issue if as a consequence the migraines return, in which case you might need to have that talk.

We do hope that you continue to make progress and become migraine-free .
We have to be honest and say that it is highly unlikely that you will be able to find acupuncture for anxiety within the NHS. The last few years has seen a significant shift away from the funding of all treatments which do not have a strong evidence base (as defined in conventional medical terms) and which are not delivered by existing NHS staff. The very few places where we knew of our members being given carte blanche to treat allcomers have seen an almost complete loss of funding. We attach no blame to anyone; the NHS is horribly under-funded, and we can easily understand why a treatment which takes as long as it takes, possible a dozen sessions or more, without a guarantee would not be a first choice.

However, although we are in private practice, most of us are prepared to reduce fees for people who are in genuine need. We don't always openly advertise this because we find that it encourages bartering by people well able to afford the fees, but as long as there is a genuine case of hardship we do what we can. There are also many members now involved in offering treatment in multi-bed clinics at a significantly reduced fee. They are organised in a specialist group called ACMAC whose details you can find here http://acmac.net/. If there is a clinic in your area this might offer a cost effective option.

We do hope that your daughter manages to find someone. As our factsheet shows

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/anxiety.html

there is some evidence even from studies conducted in a non-optimal way which suggest that treatment can be of benefit, and we certainly see a significant number of people with anxiety as a main presenting problem. From a Chinese medicine perspective this can most often involve a stuck response to situations which can often be interpreted within the diagnostic categories and helped to a degree. We also think that there may be some benefit from some form of talking therapy alongside treatment. Many members have counselling skills, but not all, and this may be worth checking in trying to book in for treatment.

The short answer is 'no'. Traditional Chinese acupuncture has always been a generalist practice, and in that sense every practitioner should in theory be able to treat every person who comes to see them. The reason lies in the fact that each person's energy is unique and different, so somewhat confusingly to the western mind twenty people with the same named western condition might be treated in twenty different ways. Symptoms remain symptoms in all systems of medicine, but the paradigm of Chinese medicine weaves them into a great many more patterns for which other diagnostic signs like the pulse and tongue are the ultimate arbiters of choice. That is not to say it is an exclusively eastern preserve; the great Canadian physician William Osler used to say 'The good physician treats the disease; the great physician treats the patient who has the disease'.


This is particularly important in treating something like PTSD. Not only are there many different ways in which the condition can be expressed by the body, but also the precipitating cause can have an impact on the emotions and deeper aspects of the personality. From a Chinese medicine perspective the body mind and spirit are an indivisible whole, so it is able to make sense of the more subtle impacts of trauma and see the patterns which manifest on all levels.

That said, it can often be good to talk to someone who has experience of working with other patients with similar problems, and although we are in the process of formally recognising only paediatrics and obstetrics we are also aware that complex mental issues can potentially form another area of specialism. So while we would unhesitatingly recommend all of our members to be able to offer you help we suspect there may be one or two in your area who are the 'go to' practitioners for more complex problems, and these will be well known to any local member you call.

Our advice would be to contact one or two BAcC members local to you and see if they are prepared to offer you a few minutes face to face without charge to discuss whether and how they might be able to help you. This is far better than just booking in sight unseen, and will give you a sense of whether the practitioner is someone you can do business with. This may not be the most experienced or skilled, but can often be someone  with whom a prospective patient feels a level of empathy, which can be very helpful in the healing process.

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