WHAT IS FITNESS TO PRACTISE?
There has, especially in recent years, been a general consensus of opinion that complementary medicine is a fairly ‘safe’ method of treating disorders as opposed to treatment via conventional means. This is not necessarily true and, unfortunately, this may lead to damage to individuals should the practitioner not be fully versed in his/her specialised treatment. Until fairly recently, under common law, it was acceptable for complementary practitioners to carry out their procedures with very few legal restraints.
‘Complementary’ medicine has been used for thousands of years in many different forms; indeed, conventional medicine grew from it, when empirical evidence legitimised certain drug treatments . Its use, however, has been on the increase in recent years due to people seeking an alternative to conventional drug treatments. There is now a vast array of different therapies available and, accordingly, practitioners should now be accountable for their methods and treatments as are traditional medical staff. This should give legitimacy to legitimate practitioners and has been welcomed by many in the field.
The report on Complementary and Alternative Medicine by the House of Lords Select Committee on Science and Technology recommended “only those CAM therapies which are statutorily regulated, or have a powerful mechanism of voluntary self-regulation, should be made available by reference from doctors and other healthcare professionals working in primary, secondary or tertiary care, on the NHS”. (Barnet, p36).
The practitioner should be registered with an organisation that should be reputable and it is often a good idea for the client to check out the credentials of the organisation. Membership of a particular organisation is no guarantee to the worthiness of that organisation. There are some organisations who accept practitioners purely for the registration fee but then fall short on checking the full credentials of each individual.
A good practitioner should always be willing to answer any questions fully before booking an appointment. He/she will be happy to discuss any details of the treatment, or the cost, or the estimated number of sessions – as well as his/her training qualifications and membership of a recognised organization. A legitimate practitioner will also make guarantees of recovery, however conditional. He/she must also be fully covered by professional indemnity insurance. The practitioner will keep confidential any information about his clients and work to a strict ethical code as in traditional medicine.
Some practitioners are trained in more than one type of therapy and will offer a combination of these in the treatments. This is perfectly acceptable, subject to the practitioner being able to show thorough training in each type. Sometimes osteopaths will be trained in homeopathy, for example, and some acupuncturists also practice Chinese herbalism, despite there being no real evidence for the efficacy of any of these treatments
Fitness to practise can be assessed according to the following criteria: adequacy of the practitioners’ training; membership of a thoroughly reputable governing organization; and a good reputation. The practitioner will abide by a strict set of ethical rules and be completely professional in his/her approach to all clients.
IDENTIFY THE RESPONSIBILITIES AND ACCOUNTABILITIES ENCOMPASSED IN CURRENT REGULATORY PROPOSALS FOR PRACTITIONERS OF COMPLEMENTARY HEALTH.
In Britain, recognized herbal medicine dates back to the sixteen and seventeenth centuries and is inherent in the ‘humours’ medical orthodoxy of Shakespeare’s day. Homeopathy became more popular during the nineteenth century, after it was invented in the German-speaking lands, and, more recently, Chinese medicine and acupuncture are being practised more frequently, despite no real peer-reviewed evidence of their efficacy. With the rise in the popularity of the use of the various complementary and alternative medicines (CAM) it has become increasingly important for regulations to be laid down for the safe handling of patients by these professionals. The British Medical Association have very clear cut guidelines for traditional medical caregivers, so it became increasingly important for regulations for CAM specialists.
“The House of Lords Select Committee on Science and Technology identified 29 different therapies in its report into Complementary and Alternative medicine (although this was not exhaustive)” (House of Lords Select Committee on Science and Technology 2000).
It is important to consider the general referral process between GPs and complementary therapists. It is not the policy of the NHS service to allow GPs to refer patients to complementary practitioners – they are able to make referrals to NHS doctors at one the five homeopathic hospitals, and some would say this is a completely irresponsible use of tax-payers’ money as no evidence for efficacy is available. When doctors advise a patient to consult a complementary therapist the doctor must be absolutely sure about the competency of the practitioner, even when he/she knows the ‘treatment’ and ‘cure’ is nothing more than psychological or placebo-affected.
GPs are required by law only to refer patients to CAM practitioners “who are doctors or nurses registered with the GMC or UKCC respectively or osteopaths or chiropractors registered with the General Osteopathic Council or General Chiropractic Council respectively”. (Information pack for primary care groups.)
In this situation therapists will be responsible directly to their regulatory body. The evidence of registration is not necessarily a measure of adequate training and experience. Some therapists will practise with very little training merely on the basis of having membership of an organization, but it is hard to say how this can be prevented. Sometimes non registered therapists can practice under the umbrella of being employed by the practice. These candidates should however be checked for suitable training before being employed by the practice, especially with reference to ‘List 99’: the list of those convicted of offences involving children.
Once the GP has decided that the patient will benefit from a particular complementary therapy he/she may well delegate care, provided the following criteria are met:
The GP should retain responsibility for managing the patients’ care (as stated by the GMC).
The patient must have access to any conventional treatment they require; if the patient insists on seeing a complementary therapist rather than following advice for conventional treatment this should be recorded in the notes. “ (Information pack for primary care groups.)
It is recommended to any practice considering employing a complementary therapist that the following are checked:
- professional status;
- insurance (the therapist needs cover of professional indemnity insurance);
- qualifications and experience;
The British Register of Complementary Practitioners (BRCP) was established in 1989 and its purpose is to ensure that all members are competent to practice either by means of proof of adequate training or by judgment of the BRCP Registration Panel. The BRCP recognises four main groups of qualification:
“ * therapist – providing clinical assessment and services – as mainly used in the Beauty industry
- practitioner – specialist complementary medical diagnosis and treatment offered to assist health issues. Available for self-employed practitioners and clinics.
- advanced practitioner – for teachers and others with higher levels of qualification and specialisation
- fellow – an honorary position awarded to those who have made a significant contribution to CAM” (BRCP, ICNM)
It is widely acknowledged that CAM may well include a wide array of therapies. The UK parliament Science and Technology Sixth Report in November 2000 (House of Lords Select Committee of science and Technology report) places the therapies into three distinct groups. Group one is categorised as ‘professional organised alternative therapies’, chiropractics and osteopathic, herbal medicine and acupuncture; group 2 is categorised as ‘contains therapies that most clearly complement conventional medicine’ aromatherapy, Alexander Technique, massage, stress therapy, reflexology; group three has ‘no convincing research based evidence for efficacy’ and it is subdivided in one group of traditional types of healthcare e.g. Chinese medicine and another group of unproven alternative techniques e.g. crystal therapy and dowsing. The Sixth Report also makes the distinction between alternative therapies which seek to offer a different form of diagnosis and treatment from conventional medical types and complementary therapies which aim to work alongside conventional methods.
The House of Lords report states:
“In Statutory regulation the title of the therapy is protected. Practitioners , by law, have to join the register of the regulatory body otherwise it would be unlawful to practise. Statutory regulation has already been achieved for the disciplines of both osteopathy and chiropractic techniques.
Currently near completion are acupuncture and herbal medicine.” (ICNM)
Other therapies can have voluntary self-regulation and work closely with the Prince’s Foundation for Integrated Health. These include the Aromatherapy Council, the General Council for Massage Therapies, the Reflexology Forum, the British Council for Yoga Therapists to name just a few.
The House of Lords Select Committee Report on CAM, Department of Health (2005) raises issues with consideration to the significant increase in the use of CAM in the United Kingdom and the developed world. The report does not consider the clinical efficacy of particular ‘alternative’ products or therapies – (which is just as well, perhaps, because there is none in most cases) – but rather questions the use, regulation, training, research and NHS provision. These are the issues which relate to the quality of practice offered to individual clients. It is on the basis of the evidence of this report that more stringent attention will be paid to the different CAMs.
Referral by GPs has been discussed earlier in this essay, but many individuals choose to attend a practitioner funded privately by individuals. The majority of consultations with traditional/complementary medicine practitioners are funded privately, but consultations funded by the National Health Service account for less than 10% of all consultations. (Thomas et al, 2001)
This figure is variable between different healthcare trusts. There is also the issue of lack of information on the extent to which private health insurance companies cover complementary services and no wonder: after all, why should any health system invest (waste money) in any treatment for which there is no real evidence?
CAM practitioners, as with other healthcare professionals, have ethical as well as legal duties. They have different therapeutic approaches but they must perform their duties within the same ethical parameters as all other health professionals. They must aim to benefit the client and on no account to cause distress or harm either physically or emotionally, according to the Hippocratic oath which should be followed in spirit by all practitioners.
In conclusion, it could be said that complementary and alternative therapies have an increasingly important role to play with the general healthcare setting, mainly because of public demand. So-called ‘traditional medicines’ have been carefully regulated in terms of practice, drugs administered and general patient care for many years, so now there is a demand for regulation for all practitioners of all health-related treatments. It is now becoming as important, or even essential, to monitor the use of CAM therapies and there is increasing legislation being introduced to make this possible and safeguard again any bad practice.
Barnett, H. (2002). The Which? Guide to Complementary Therapies. London, Which?
Brazier, M (2003). Medicine and the Law. (3rd ed). London, Penguin
Department of Health. (2000). Complementary and alternative medicine: House of Lords Select Committee on Science and Technology. (online). London: Stationary Office. (SN; HL paper, session 1999-2000 12) Available from http://www.doh.gov.uk (accessed 21st February, 2008)
Department of Health. (2006). The regulation of the non-medical healthcare profession: review led by Andrew Foster. (online) London: Stationary Office.
Available from http://www.doh.gov.uk (accessed 23rd February 2008)
Dimond, B. (1998). The Legal aspects of complementary therapy practice: a guide for health care professionals. London, Churchill Livingstone.
Gillon, R. & Lloyd, A. (1994). Principles of health care ethics. Chichester: John Wiley and sons.
Mason, K. & McCall Smith, A & Laurie, G (2002). Law and medical ethics. (6th ed.). London: Butterworths.
Stone, J. (2002). An ethical framework for complementary and alternative therapists. London: Routledge.
Stone, J. and Matthews, J. (1996). Complementary medicine and the law. Oxford University Press.
Complementary Medicine: information pack for primary care groups