Developing integrated CAM services in Primary Care Organisations.

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 prioritize 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.