Access to complementary medicine via general practice

Background: The popularity of complementary medicine continues to be assert ed by the professional associations and umbrella organisations of these the rapies. Within conventional medicine there are also signs that attitudes to wards same of the complementary therapies are changing. Aim: To describe the scale and scape of access to complementary therapies ( acupuncture, chiropractic homoeopathy, hypnotherapy, medical herbalism, and osteopathy) via general practice in England. Design of study: A postal questionnaire sent to 1226 individual general pra ctitioners (GPs) in a random cluster sample of GP partnerships in England. GPs received up to three reminders. Setting: One in eight (1226) GP partnerships in England in 1995. Method: Postal questionnaire to assess estimates of the number of practices offering 'in-house' access to a range of complementary therapies or making National Health Service (NHS) referrals outside the practice; sources of f unding for provision and variations by practice characteristics. Results: A total of 964 GPs replied (78.69%). Of these, 760 provided detail ed information. An estimated 39.5% (95% CI = 35%-43%) of GP partnerships in England provided access to same form of complementary therapy for their NH S patients. If all non-responding partnerships are assumed to be non-provid ers, the lowest possible estimate is 30.3%. An estimated 21.4% (95% Ct = 19 %-24%) were offering access via the provision of treatment by a member of t he primary health care team, 6.1% (95% CI = 2%-10%) employed an 'independen t' complementary therapist, and an estimated 24.6% of partnerships (95% CI = 21%-28%) had made NHS referrals for complementary therapies. The reported volume of provision within any individual service tended to be low. Acupun cture and homoeopathy were the most commonly available therapies. Patients made some payment for 25% of practice-based provision. Former fundholding p ractices were significantly more likely to offer complementary therapies th an non-fundholding practices, (45% versus 36%, P = 0.02). Fundholding did n or affect the range of therapies offered, and patients from former fundhold ing practices were no more likely to pay for treatment. Conclusion: Access to complementary health care for NHS patients was widesp read in English general practices in 1995. This data suggests that a limite d range of complementary therapies were acceptable to a large proportion of GPs. Fundholding clearly provided a mechanism for the provision of complem entary therapies in primary care. Patterns of provision are likely to alter with the demise of fundholding and existing provision may significantly re duce unless the Primary Care Groups or Primary Care Trusts are prepared to support the 'levelling up' of some services.