Developing integrated CAM services in Primary Care Organisations

To explore policy development and the provision of integrated NHS CAM therapy services following the reorganisation of UK primary care services in 1999.

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.

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 prioritize services and the need to direct funding towards meeting national and local health objectives.

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.