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78 questions

Q:  Are there any acupuncturists specifically trained in non-surgical "face-lifts" who are members of BAcC and if so, are there any in Oxfordshire?
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A:  We find ourselves a little bit conflicted when we receive questions like this. There are a number of areas where are developing standards of expert practice. This in turn might lead to qualifications which would enable us to recommend specific groups of practitioners. However, at the moment the focus is on paediatrics and obstetrics, so although we are aware of a number of courses which offer postgraduate training in facial or cosmetic acupuncture, we have not yet agreed the standards against which they should be measured.
 
However, it is widely recognised by many of the trainers in this area that using facial acupuncture techniques without also attending to the underlying patterns of energy is not as effective. We always recommend, therefore, that if someone is conducting their own search for a practitioner they should ensure that the person is a fully trained professional acupuncturist, not someone who has learned a few specific techniques as an adjunct to beauty therapy. There are also some safety concerns about being treated by someone who is not a professional acupuncturist. There is no difference in health and safety terms between someone who uses ten needles a year and someone who uses ten thousand. The same scrupulous attention to hygienic practice is essential. We have some reservations about very short coirses which offer the technique and all of the safe practice essentials in a very time.
 
If you undertake a google search under 'facial acupuncture oxford' you will find a number of BAcC members whose standards you can trust and who have undertaken additional training in this area of work   
 

Q  I am setting up some rooms for acupucturists in cancer treatment centres.  Could you please tell me if it is acceptable to have carpet in those room or does it have to be hard flooring? If it has to be hard flooring; could we put a mat over the carpet in the area under the couch? Do we have to provide a sink in the room where acupuncture treatment is taking place? nd finally: could we put an ad on your website when we are recruiting?

A:The legislation under which the majority of premises in the UK outside Greater London and Scotland (Local Government Miscellaneous Provisions 1982 Act) could not be more specific:
The requirement in paragraph 2(3) that the floor of the treatment area be provided with a smooth impervious surface applies to tattooing, semi-permanent skin-colouring and cosmetic piercing but not to acupuncture or electrolysis or ear-piercing or nose-piercing using a hygienic piercing instrument.
The same rules tend to apply in London, although each borough which operates under the auspices of the London Local Authorities Act 1991 has a set of guidelines which are broadly consistent with the BAcC's own Code of Safe Practice in which we say that premises should have 'smooth, impervious flooring or short pile (not looped) commercial carpeting'.
We supplement this with further information in the Guide to Safe Practice, an internal document for members in which we say:


FLOORING

Impervious floor surfaces must be washed daily with appropriate cleansers. All carpets in the areas adjacent to treatment surfaces must be vacuum cleaned daily and steam cleaned annually.

The requirement for vacuum cleaning is primarily not so much about cross-infection as about general cleanliness in the clinic environment. Best practice would be to use vacuum cleaners with HEPA filters to avoid the process spreading dust particles and bacteria throughout the entire treatment room.

The requirement for steam cleaning is essential if short pile carpeting is to remain acceptable within the Code. The BAcC will continue to investigate any commercially available techniques for disinfecting carpet.

Flooring must be smooth and impervious, or short pile (not looped) commercial carpeting.

The acceptable type of flooring continues to be an area of considerable debate. The Barbour Index, the main reference guide used by environmental health officers (EHO), requires that flooring be 'smooth and impervious' and the previous BAcC Code of Safe Practice required that premises be 'clean and capable of being kept clean', ie that surfaces can be washed. Local authority byelaws have always allowed for short pile commercial carpeting as long as it is 'clean and capable of being kept clean'; there is, for example, no mention of impervious flooring in the Health and Safety Executive's Guidance on Blood-borne Viruses in the Workplace (HSE, 2001). The Barbour Index recommendations are mainly intended to apply to treatment rooms in GP surgeries and outpatient clinics where minor surgical procedures may be performed.

Given that the reported incidents of major blood and body fluid spillage are rare, and that many practitioners are not able to insist on the use of smooth impervious floor coverings in the clinics where they work, the BAcC has decided to allow the continued use of non-looped short pile carpet as long as you have the appropriate means to clean and disinfect any soiled areas in the event of spillage.

If a carpet in rented premises does not match the above criteria, rubber matting which can be cleaned easily must be laid around the treatment area.

This last provision is one which a number of members have had to apply after dealing with intractable Environmental Health Officers. We have on occasion taken on EHOs who in our view are writing their own laws, but since it is the member, not us, who will suffer if things become too adversarial, we have advised several members to do as you suggest and have rubber matting directly adjacent to the treatment couch.

As far as sinks are concerned, we allow for the possibility that someone may have a sink immediately adjacent to their treatment space, but we recognise that this may cause problems and prefer members to have running hot and cold water in the treatment space itself. The law says:
suitable and sufficient washing facilities appropriately located for the sole use of operators, including an adequate and constant supply of clean hot and cold water, soap or detergent
and we have made our provision in the Code:

You must have a washbasin with a clean running hot water supply, preferably wrist, arm or foot operated and for your and other practitioners' sole use. This must be located in or in the near vicinity (ie not necessitating opening and closing of doors with your hands) of the treatment room. You must also have: dispenser liquid soap; disposable paper towels; and an adequately sized bin, pedal operated if lidded, situated close to the basin.

supplemented with the following information in the Guide:


HAND WASHING FACILITIES

Best practice is for there to be a washbasin with a clean running hot and cold water supply in the treatment room.

However, for some practitioners working from home or for many existing clinics and centres this is not feasible. Acupuncturists working in these circumstances are advised to ensure that they do not compromise their hygiene standards when re-entering the room after using a basin in an adjoining room. It is also permissible to install a portable washbasin with a hot water supply in the treatment room.

The washbasin must be for the sole use of the practitioner(s).

There have been some problems with local authorities enforcing general skin piercing regulations, ie body and cosmetic piercing alongside acupuncture. For the more invasive techniques there is usually a requirement for two basins, one for hand washing and for the sole use of the practitioner, and a second for the cleansing of equipment prior to sterilisation. The only pieces of equipment frequently used by acupuncturists which might necessitate this are cups. All other equipment is either disposable or washable without sterilisation. In most cases the BAcC has been able to negotiate away the need for a second basin, but if your local authority stands its ground on this, then that is what you must arrange.

Dispenser liquid soap is required.

Solid soap is not acceptable, whether anti-bacterial or not. Disposable paper towels must be provided. The use of antibacterial hand gels does not substitute the need for proper hand washing with soap and water.

In our experience most EHOs are very supportive and negotiable. We only have problems where someone hasn't really understood what acupuncture entails and how good a safety record acupuncture has in the UK. If this becomes a problem for you we shall be happy to lend our support.

Finally we are very happy to forward your request on to the staff member who deals with our internal advertising, and she will be in touch with you in due course.

Q:  i wonder if ther is  any data on this website about guidance for the acupuncture graduates and how to open their own business and what are the next steps after graduation? Also. is there any data available about employability of  acupuncture graduates in UK? For example what percentages of graduates stay in business after graduation?  

A: There is information about what to do when setting up a business and when dealing with the transition from study to practice, but this is one of the benefits of student membership for which someone needs to be studying at a British Acupuncture Accreditation Board accredited teaching institution. We produced a very helpful booklet called Bridging the Gap and have placed a great deal more information on the student website. If you are a student at a BAAB course, then this material will be made available to you. In certain exceptional circumstances students at other courses are allowed to become student affiliates which allows them access to the same materials. This is granted at the discretion of the Student Services Officer and the Admissions Manager.
 
As far as statistics about people remaining in practice is concerned, we have undertaken a few rudimentary surveys over the last few years to determine whether the recession is causing a greater dropout rate than previously. We were always concerned that teaching institutions were giving a slightly over-optimistic picture of how easy it was to establish a practice, and we reckoned that two years was probably the minimum time necessary to become free-standing. We have found that there has been a slight but not very significant increase in the dropout rate from membership, but of course this means only that someone ceases to belong to the BAcC. We have no idea, for example, how many people find even the heavily discounted subscriptions of the first two years something of a luxury after the cost of training, and leave the BAcC to save money. This is probably more common than leaving practice entirely, especially since the average student has spent or committed themselves to £20K or more to become a practitioner.
 
There is no more data than that. However, many of the teaching institutions, who can be found on the main BAAB site, maintain alumni groups for cohorts of graduates, and you may find that they can give you a better view. Of course, it may not be in their interests to tell you if the drop out rate is high.....!
 
As for employability, the majority of UK practice is self-employed business, so the successful transition to business is very much in the hands of the individual. There are a small number of employment opportunities in the NHS, but too few to merit anything.

Q:  How well regulated and safe are practitioners licensed under ATCM? Do practitioners generally have both registration under ATCM and the BAcC or is only one required for legality?

A:   The members of the ATCM (Association of Traditional Chinese Medicine) are all well trained and qualified. The majority of its members trained in China, and often have a five or even seven year training which in may cases includes a training in western medicine to degree level and beyond. You can be reassured that ATCM members are competent and safe. The ATCM also has regulatory systems very similar to those developed by the BAcC, and holds its members to account for their standards.
 
There is actually nothing in law which requires a practitioner to belong to any professional association. We have argued for many years that professions such as ours should be regulated by statute, but we have been deemed relatively low risk and very efficiently self-regulating, so the immediate prospect of legal registration is remote. The best guarantee that a prospective patient has of their interests being protected is only to visit a practitioner who belongs to a body like the BAcC or ATCM, both of which take their role of protecting the public interest very seriously.
 
As for joining both, this would be unnecessary. Each provides similar benefits for its members, and to join both would be to add cost without gain. That said, there are an increasing number of practitioners who do join both, and we are engaged in high level talks with the ATCM about working more closely together for our mutual benefit and for the benefit of our members.  
 

A:  There are no 'rules' as such about self-needling by practitioners. The advice most acupuncturists were given in their initial training was that a practitioner could not have sufficient objectivity to make an effective diagnosis of themselves and to make the acupuncture as efficacious as possible. However, there are some short term emergency situations, like acute toothache, where there are commonly agreed pain relieving points which can buy a few hours of relief until emergency dental treatment. There is no reason why someone should not needle themselves in this kind of situation.

Self-needling by patients is a more contentious issue. We are aware of two or three highly successful programmes where patients undergoing chemotherapy for cancer are using a well-tried and tested point to reduce the nausea this can induce. Although we have some reservations about this, as long as the patients are trained in safe needling and the safe disposal of clinical waste, we accept that this is likely to be a part of mainstream care in the future.

Our major concern with self-needling is not knowing what to do but knowing what to do when/if something goes wrong. The true test of expertise is being able to react to unpredicted responses. If someone is only able to perform one task with one expected outcome then it is difficult to expect them to be able to react if they get an adverse reaction, like bruising or fainting. The same applies, in terms of reacting, to both practitioner and patient alike with self-needling; fainting is rare but putting a needle in onself and keeling over is not a great option.

With nearly 3000 BAcC members in practice, it isn't as though there weren't enough practitioners around!

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