Debate: is it possible to practise integrated health on the NHS?
Dr Roy Welford is a partner in an integrated GP practice in Glastonbury. He argues that it is possible to offer good integrated care on the NHS. Agree? Disagree? Leave your comments at the bottom of the page.
Yes
My answer is a certain and definite ‘Yes’.
I think one of the difficulties that we could encounter in practising integrated medicine is in trying to be all things to all people.
Practising integrated medicine to me is about engaging and empathising with our patients at all levels of their health – physical and emotional, maybe even spiritual, advising them about their health choices and supporting them appropriately in their decisions regarding their health; and if we can, providing a wider range of treatments, including complementary therapies.
I am sure that Julia practices holistically, and holistic or integrated (I don't really think they are different) medicine is achievable throughout the NHS. Integrated medicine is as much about the attitude and open-mindedness of the practitioner – what is brought to the consultation - as it is about therapies.
Julia is rightly concerned that a thorough integrated consultation takes time and I agree that throughout most of the NHS, time is pressured. Fortunately, as GPs we are in the privileged position of being able to get to know our patients over a time period, rather than all at once, and also to stretch consultations if we need, even offering occasional lengthier consultations where required. There are limits though and we do have to juggle time continuously.
Despite these time pressures, we do find that within the confines of the NHS, many practitioners are practising integrated medicine - the British Medical Acupuncture Society has 2700 members, the Acupuncture Association of Chartered Physiotherapists has 2600, the Faculty of Homeopathy has 1400 Members (and also many associated members) - many of whom are working in the NHS. There are 5 NHS homeopathic hospitals in the UK, and at the Bristol Homeopathic Hospital we are able to offer new patients 60 minutes per consultation. An increasing number of GPs practice acupuncture or homeopathy, and acupuncture in particular is becoming widely available in pain clinics as well as physio departments.
These therapies are offering a limited or partially integrated service – although for some patients it is all that is required to trigger their self-healing response, and generate recovery.
For sure, at the moment the NHS is encountering a surfeit of narrow-minded diatribes by the academics who are quick to condemn complementary therapies; all the while these self-styled (usually remote and ivory-towered) experts do not encounter the therapeutic dilemmas proffered to us every day by our patients - those patients who cannot tolerate or do not respond to conventional medication, or perhaps have a healthy scepticism to some of the claims of so called evidence-based medicine. Luckily patients do not pay them much attention or credence.
I do believe as well that there is potential within primary care for expanding integrated services – at Glastonbury we have been able to offer access to the five main complementary therapies within the practice – and demonstrate cost-savings and cost-effectiveness as a result. The main beneficiaries have been the patients and in the future it will be patient demand that persuades PCTs to fund greater access to integrated care, despite their reservations on cost grounds. If practice-based commissioning is going to mean anything at all in the future then it will have to incorporate greater patient choice and that will include access to integrated care.
I am not starry-eyed about the difficulties for many patients and practitioners when it comes to accessing and delivering integrated care within the NHS, but realistically most patients have nowhere else to go, and integrated care that happens outside the NHS is always in danger of fragmentation. It is imperative that we make integration work in the NHS, including drawing on the expertise from the private sector – and I still retain the optimism that comprehensive integrated NHS care will become a reality.
Comments
Dr. Olga Dreeben, United States
January 21, 2008
Integrated health is extremely important for the future of medical care all over the world. I believe that the illness-based thinking process should be changing to a risk-based one that involves the patient as a collaborator and partner of care, sharing responsibilities for their health with the health care provider. In this context, the primary role of the health care provider is being the educator and supporter to better help the patient progress and effect the change. Health professionals should be encouraged to involve patients in treatment decisions, recognizing patients as experts with a unique knowledge of their own health and their preferences for treatments, health states, and outcomes.
P.Jeffery
January 15, 2008
I personally think that we should integrate CAMS into the NHS. Without generating another complex debate; could it not be argued that current EBM/NICE criteria wrongly focuses on outcomes such as numbers needed to treat etc but ignores the possible benefit to the individual of a treatment that doesn’t lend itself to EBM scrutiny? If we can get beyond the need to meet evidence based criteria (based on demographic data and regressed to the individual) and build a framework for exploring and funding alternative treatments based on individual outcome we might achieve integration. I acknowledge the need for EBM and understand the reasons for only funding proven tx's but not at the cost of losing potentially potent interventions esp. for chronic conditions poorly managed by modern medication.
Sarah Baker
January 05, 2008
CAM can be practiced in the NHS, CAM saved my family when the NHS wouldn't. My husband had had mygrains all his life, my eldest son was 2 years below at school with 75% attendance. after some blood tests they were both suffering from a huge lack of mineral and vitamin deficiancy all because of a food intolerance. My youngest son had neonatal sepsis at 6 weeks old. Still so poorly I thought he was going to die. CAM found he had a food intolerance, as I was feeding him the difference was notied in 48 hours, as with my asthma an hayfever that I had experienced for over 20 years, I too think this caused my two cases of pre-eclampsia. Our many visits to the NHS has cost in excess of 60 oppointments, incl speacalist; 40 years of prescriptions; hospital care. Time of work lots and lots!