At a time when GPs are being encouraged to provide more services to patients in-house, one area to consider is complementary medicine.
More than 50 per cent of GPs already provide some form of complementary care, or refer their patients to complementary practitioners. Also, a survey has revealed that 71 per cent of patients want to receive more information about complementary medicine from their GP.
Look at effectiveness gaps
Many GPs feel that they are not in a position to deal effectively with musculoskeletal pain, stress-related problems, moderate depression, skin problems and inflammatory bowel syndrome. Although very common in general practice, these conditions can be difficult to treat and the drug therapies involved might be unacceptable to patients. There is a range of complementary therapies to address such conditions.
Back pain causes an enormous amount of job absenteeism and is a continuing problem for GPs. So if your practice is considering complementary care, a starting point might be musculoskeletal pain services for people with persistent back pain. These services could include acupuncture, osteopathy and physiotherapy.
Other services that GPs could provide in-house are herbal medicine, homoeopathy, nutritional medicine, massage therapy and chiropractic.
Find registered practitioners
You will need to check that practitioners are registered with the regulatory or professional body for their discipline. Chiropractors and osteopaths are statutorily regulated, while acupuncturists and herbalists will face this requirement in 2007/8.
Other complementary professions are developing voluntary self-regulation.
For a list of the professional and regulatory bodies, go to The Prince of Wales's Foundation for Integrated Health (www.fihealth.org.uk). These organisations can advise on training requirements and help with recruitment.
Negotiate with your PCO
Complementary services can be delivered as local enhanced services (LESs), or they can be funded through practice-based commissioning (PBC).
While it might prove difficult to prise LES funding for these services from your primary care organisation (PCO), there are now opportunities for GPs in England to set up services under PBC. Present your bid for providing complementary therapies in terms of decreasing referrals to secondary care.
Audit the service
PCOs are most likely to be persuaded by the idea of services that will divert care away from secondary care providers.
It is important to show that the service you want to provide can be clinically effective and cost-effective. When the in-house service is up and running, keep a record of the number of secondary care referrals that have been avoided.
With the government keen to show that the NHS is patient-led, surveys confirming patient satisfaction will also help.
Rent space at the practice
If providing an NHS complementary service is not a viable option for your practice, you could look at the possibility of renting out surgery space to private complementary therapists instead. The rooms that you provide for these therapists must be comfortable and suitably furnished.
Most importantly, make sure that the relevant health-and-safety requirements will be met, particularly if sharps are going to be used by any of the complementary therapists.
Network with other GPs
The Prince of Wales's Foundation for Integrated Health has established a network of 155 GPs with an interest in complementary medicine. For details, call Clare Isaac on (020) 3119 3114 or email firstname.lastname@example.org.
There is also a conference on 30 March at the Royal College of Obstetricians and Gynaecologists, about business opportunities for GPs and others interested in providing complementary services for patients. For more information about the conference, visit the events section at www.westfocus.org.uk.
CASE STUDY - From GP to complementary therapist
Professor David Peters, clinical director of the School of Integrated Health at the University of Westminster, was formerly a GP at Marylebone Health Centre in London. It was there that, with a research grant, he set up a complementary medicine service in the mid-1980s. Professor Peters is a registered osteopath and a member of the Faculty of Homeopathy.
Now concentrating full-time on complementary medicine, he says: 'I enjoyed being a GP because I had such a range of skills. I could do some osteopathy, some acupuncture, some homoeopathy, some nutritional medicine and a bit of hypnotherapy.' Professor Peters adds that this is a very satisfying way to work in primary care. Though currently on sabbatical leave, he still works one day a week at his former practice, where a massage practitioner, homoeopath, acupuncturist and osteopath also work part-time. The GPs refer patients to the practitioners based on a list of problems where a therapy is appropriate. Patients are offered four NHS massage treatments or six other NHS therapy treatments in a year.
'It's a limited service, because otherwise we'd be overstretched by waiting lists,' he says.