Focus on Alternative and Complementary Therapies
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Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2003; 8: 134
To provide a ‘snapshot’ of the main ‘triggers’ and ‘barriers’ influencing provision of complementary and alternative medicine (CAM) through primary care groups/trusts (PCG/Ts) in England, 1 year following a major reorganisation of primary care services.
Tape-recorded telephone interviews using a semistructured schedule were conducted with key personnel responsible for commissioning or developing services, in ten PCG/Ts. The sample was selected purposively from responses to a previous survey indicating active engagement in CAM policy formation in November 1999. The interviews were mapped, abstracted and coded thematically using WinMAX software. The data were interpreted according to the principles of framework analysis for applied qualitative research.
Nine interviews were completed. Each formed the basis of a case study of current provision and policy development. Two PCGs were not providing CAM, but one was reviewing that decision against the potential of CAM to reduce secondary referrals for orthopaedics. The previous practice-based services of another PCG were unchanged. In six cases, practice-based services, provided mostly by general practice (GP)-practitioners, had been extended PCG-wide. The most usual development was the extension of individual practice-based CAM services to the entire primary care group, although this was sometimes achieved by ‘levelling down’ provision to achieve equity. There was diversity in how CAM was available to patients, the most usual model being the ‘GP-practitioner’. All provision was time limited and subject to review. A number of ‘brakes’ and ‘drivers’ were identified, including building on existing services, local enthusiasm, ensuring equitable access to services, available evidence, patient demand and competing funding priorities.
Opportunities exist for the development of CAM services where national policy directives and local health priorities intersect. Locality-based integrated CAM services that are responsive to NHS priorities offer a model for the future development of CAM in NHS primary care.
