OUR INITIATIVE


Our complementary medicine project began in 1992. Our aim is to establish a model of integrated primary health care which is clinically effective, cost-effective and transferable to other GP practices.

Our project is established within a conventional 3-partner NHS practice in Glastonbury, Somerset. Dr Welford was the prime instigator, who in 1992 had a vision of integrated health care which could overcome the boundaries between conventional and complementary medicine and offer a more complete range of treatment and care to the practice patients. Homoeopathy was already a well-used therapy within the practice and all the partners were comfortable and open-minded in their views of complementary care. Perhaps living and working in Glastonbury with its New-Age associations fostered that approach, although the plethora of complementary health practitioners in Glastonbury - some well trained and professional and others poorly trained and of limited experience - only served to emphasise the need for communication and bridge-building between conventional and complementary care. This would enable more co-ordinated patient care, as well as safer patient care.


Programme outline

We offer up to 3 hours of treatment (usually 4-6 appointments) in the main specialities of Complementary Medicine. These are: Acupuncture, Herbal medicine, Homoeopathy, Massage Therapy, Osteopathy.

These therapies have been chosen as they as they comprise 70% of complementary medicine consultations in the UK, and they are the most-validated specialities with accredited professional standards. Osteopathic practice is now subject to registration by the General Osteopathic Council, with acupuncture and herbal medicine due for registration by Act of Parliament in the near future.

Patients are GP-referred, and evaluated before and after their course of treatment.

The aims of the Trust are to support the integration of complementary medicine and conventional medicine within NHS Primary Care.

At first, our programme was funded by Somerset Health Authority as part of the Health Promotion Initiative, and then subsequently funded as a Health Authority research programme. Health Authority funding ceased in 1997 when research funding was redirected to the NHS Research Directorate. Since 1997, our project has been funded through a practice-based charitable Trust, the Somerset Trust for Integrated Health Care (Charity number 1065943). Since 2001 we have received funding from Mendip PCT.

Our project now has two 'arms'. Since 2003:

• we have an osteopathy/acupuncture service, now operating out of two Glastonbury practices, which is fully funded by Mendip PCT;
• we have one ongoing herbal medicine and massage service, part-funded by patient donation of up to £10 per treatment, and part-funded with a grant from Mendip PCT.

Intended outcomes

• To improve health and well-being by the appropriate and safe use of Complementary Medicine.
• To provide access to Complementary Medicine independent of ability to pay.

We believe an integrated approach is vital to the success of the project as complementary medicine and primary care have a lot in common:

• Primary Care is concerned very much with long-term care of patients rather than cure; this is very similar to the majority of complementary medicine interventions.
• 30% of complementary medicine consultations are made by patients before seeing their GP - that is, complementary medicine is already providing a primary care service.
• Delegation of care by the GP is much easier within a primary care setting - providing opportunities for discussion and sharing of care.
• By working together we can learn and develop our joint expertise - the complementary medicine practitioners and the doctors meet regularly to discuss and plan the programme development.

Our successes, and patient benefits

Our project continues to consolidate, develop and grow. We have secured NHS funding for the service, which has enabled us to extend provision into a neighbouring medical practice.

Evaluation of our service is vital, and we have consistently been able to demonstrate:

• patient benefits in terms of clinical improvement and access to complementary therapies;
• NHS benefit in terms of cost-effective care.

Our administrative costs run at about three hours per week - we have incurred no capital costs and overheads are minimal and mainly absorbed into the daily-running of the practice.


Between 1994 and 1997 we conducted an in-depth evaluation of our complementary medicine service.

The evaluation addressed four questions:

1. What contribution can complementary medicine make to primary health care?
2. Which patients can benefit from complementary medicine?
3. What are the advantages and disadvantages for the practice of having a complementary medicine service?
4. Can such a service be cost-effective?

The evaluation was based on data from different sources including:

• Referral forms completed by GPs at the time of referral and by the practitioners during and on completion of treatment. The forms described the patient, their illness, their treatment and an outcome assessment.
• Questionnaires completed by the patient at the time of referral, on completion of treatment and 6 months after referral. The questionnaires we used were:
      - SF-36 for overall well-being
      - Beck’s depression Inventory - for psycho-social well-being
      - FLP Index for pain assessment
      - Patient satisfaction forms
      - Questions addressing patients health attitudes.
• Interviews with a sample of patients, and with practitioners and doctors and other health service staff.

We did not set out to conduct a trial of complementary therapy - our evaluation was to examine the potential for such therapy in general practice.


Outcome summary

1. More than 600 patients were referred for treatment during the evaluation period (approx 17% of practice population). Most were for chronic health problems, especially problems relating to muscles and joints. 34% of patients were referred because their problem had failed to respond to conventional treatments.
2. 85% of patients reported improvement in their illness following treatment, which most ascribed to the treatment itself. This was statistically confirmed on SF-36 assessment. 85% of patients were satisfied with their treatment.
3. Complementary therapy seemed to be most effective for people with more severe symptoms, people with musculo-skeletal problems, people with problems of shorter duration and it also proved helpful for people with psycho-social distress.
4. A cost benefit study of a sub-sample of patients with long-term health problems demonstrated that their utilisation of health services changed after treatment. Savings were made in the overall care of these patients which paralleled the cost of providing the complementary medicine service.

In effect, patients were experiencing improvement in their health at no extra cost.

Further extrapolation of our practice costs indicated that during the evaluation period more widespread savings were being made in overall practice expenditure - particularly in reduction of referral to secondary care. We did not have the data to explore this change more thoroughly although it was reasonable to ascribe some of the change to the impact of the complementary medicine service.

In essence, our evaluation showed our service was significantly helping people with a variety of problems, especially painful problems, with high patient satisfaction and with the potential for releasing cost-savings which could even fund the cost of the treatment.

Full details of the evaluation and results are available in our published report.

A more recent evaluation of our musculo-skeletal service, established in 2003, confirms patient improvement and cost-effectiveness.


Further developments

We are all excited by the contribution complementary medicine has made to our patients and our practice and yet we know there is considerable potential still to be realised. We need to develop and consolidate our existing model of care as well as focussing more effectively on those areas where complementary medicine is likely to be most effective. This requires the incorporation of evidence-based practice in complementary medicine - an increasingly realistic option as evidence about complementary medicine is gradually accumulating.

Our major aim is to continue to incorporate our model of care into a full NHS-funded service, and to extend this to more local practices where there is the demand. To achieve this we need to:

1. Continue to provide access to our integrated complementary medicine service.
2. Conduct a further investigations into the cost-effectiveness of our model of care.
3. Network with other complementary medicine providers in NHS primary care to share our experiences.
4. Liase with and lobby our Primary Care Trust and other decision-making bodies to ensure further funding.

Somerset Trust for Integrated Health Care is committed to facilitate these developments.

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