Developing integrated CAM services in Primary Care Organisations

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Abstract

Objectives: To explore policy development and the provision of integrated NHS CAM therapy services following the reorganisation of UK primary care services in 1999. Design: Structured survey interviews with Chairpersons in a stratified random sample of 72 Primary Care Organisations (PCOs) in England in 1999 and 2000; semi-structured telephone interviews with purposive samples of (i) providers of primary care CAM services (mostly General Practitioners), and (ii) Commissioners of primary care services in two purposive sub-samples of PCOs involved in positive policy formation in relation to CAM. Results: By the end of 2000, it is estimated that 85% of PCOs in England (95% CI 78–91%) had discussed CAM at board level, and 37% (95% CI 26–48%) had at least one CAM policy in place. The dominant strategy that emerged was a policy of ‘provide and review’, particularly in practices that had managed their own budgets under the previous fundholding system. We found that a small number of PCOs were developing area-wide services. Positive influences or ‘drivers’ for CAM policy formation were identified as: existing services, local enthusiasm and expertise, patient demand, a willingness to consider the wider evidence-base for CAM, and a perception that complementary therapies could help the PCOs to meet national NHS targets. Negative influences included: the cost of ensuring equitable access to services, a perception that CAM lacks the credibility required for public funding, the need to prioritise services and the need to direct funding towards meeting national and local health objectives. Conclusions: Opportunities for development of integrated NHS services are most likely to occur where CAM provision is seen as a potential solution to an NHS problem. Locality-based, integrated CAM services that are responsive to NHS priorities may offer a model for the future development of CAMs in primary care.

Section snippets

BACKGROUND

There is good evidence of substantial use by the general population of the different types of therapy contained within the umbrella term ‘Complementary and Alternative Medicines’ (CAMs).1 This, and the recommendation for increased provision of CAM therapies for NHS patients from the House of Lords’ enquiry in 2001,2 raised important policy research questions regarding the provision and commissioning of CAM therapies within the NHS. The series of investigations reported here was undertaken

STUDY AIMS

The overall aim of the studies reported here was to understand how the reorganisation of primary care services in 1999 impacted on policy development and the provision of NHS CAM therapy services. Each of the component studies provides a different perspective on the processes underpinning the reconfiguration of CAM services under PCOs and the very early emergence of Primary Care Trusts (PCTs).

The research has current relevance because it also provides an insight into the way some PCOs

METHODS

Qualitative and quantitative data were collected between October 1999 and February 2001. These comprised:

  • 1.

    Semi-structured telephone interviews with providers of nine primary care CAM services (mostly GPs), identified through case studies conducted in 1997/1998 (Box 1).

  • 2.

    Questions about CAM services and commissioning (Box 2) were added to the longitudinal National Tracker Survey, using structured interviews with Chairpersons in a stratified random sample of 72 PCOs in England.6., 7. A ‘core’ set of

Tracker Survey data

In 1999 an estimated 44% of PCOs (95% CI 34–56%) had discussed CAM at Board level, or expected to do so in the next 12 months. However, CAM provision was rated a ‘low’ or ‘very low’ priority by most PCOs in the sample (57 and 35%, respectively), and none rated its priority higher than ‘medium’ on a 5-point scale. Policy development in those PCOs that had already discussed CAM varied. The majority of PCOs had postponed making a decision regarding CAM by opting to continue funding in the

CONCLUSIONS

The combined results of this series of studies suggest a pattern of gradual increase in the numbers of PCOs providing limited access to CAM therapy services for NHS patients. The main factors shaping policy development relating to CAM services in these PCOs were funding, local advocacy and competing priorities. Unified PCO budgets may create opportunities for the development of integrated CAM services, especially where such services converge with National Service Framework priorities and local

Acknowledgements

We would like to thank the participating GPs and PCO staff who contributed to the data for this report, and Professor David Wilkin and colleagues in Manchester for allowing us to add questions to the Primary Care Groups and Trusts Tracker Surveys. This work was supported by the Department of Health. The views expressed are, however, those of the authors alone.

Kate J. Thomas MA, Deputy Director, Senior Lecturer in Health Services Research, Medical Care Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. Tel.: +44 (0) 114 222 0753; Fax: +44 (0) 114 222 0749; E-mail: [email protected]

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Kate J. Thomas MA, Deputy Director, Senior Lecturer in Health Services Research, Medical Care Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. Tel.: +44 (0) 114 222 0753; Fax: +44 (0) 114 222 0749; E-mail: [email protected]

Funding The Department of Health provides core support to the MCRU. These studies were conducted within the recurring grant.

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