Provision of medical acupuncture service in general practice under practice-based commissioning.

Acupuncture involves inserting small needles into various points in the body; the needles are normally stimulated by manual rotation or electrically. Western acupuncture uses the same needling technique as traditional Chinese acupuncture but is based on affecting nerve impulses and the central nervous system. A Western medical acupuncturist makes a medical clinical diagnosis in the conventional way, and uses acupuncture as a form of analgesia along with other drugs and other appropriate interventions, including surgery. Myofascial pain is an extremely common presenting complaint, and general practitioners (GPs) are normally the fi rst point of contact. Studies have indicated that acupuncture helps in different musculoskeletal pain1–3 and migraine,4 and NICE has recommended the use of acupuncture in the management of low back pain. Acupuncture may be most effective in primary care to treat patients early and prevent deterioration in the patients’ condition while on a waiting list. Charlton medical practice started to provide Western medical acupuncture for NHS patients registered with the practice in November 2008. The practice is situated in Telford, West Midlands with about 10 600 registered patients. Pain management is taken very seriously in our practice. Acupuncture provision in the practice aims at improving patients’ symptoms and reducing re-consultations, prescriptions, and referrals to a physiotherapist, secondary care and pain clinic (reducing waiting times and costs). Improved pain control helps to improve patients’ functional status, decreases times off work and prevents comorbidity (for example, depression with pain). Practice-based commissioning (PBC) enables GPs and other primary healthcare professionals to commission and, thereby improve, local services for their patients. Initially, the acupuncture service treated only one patient a week. Funding for acupuncture clinics in general practice has been very diffi cult, but resources available under PBC offered an opportunity and I presented a business plan to the PBC commissioning team describing the benefi ts of acupuncture, including reduced referrals to secondary care. We also discussed monitoring the clinic. As a result, a weekly acupuncture clinic was funded using the available PBC resources; this will be reviewed in due course and the Primary Care Trust agreed to fund the service for another year under PBC. The reception manager deals with the waiting list and appointments, and ensures smooth running of the clinics. We discussed in our clinical meeting which patients might be suitable for acupuncture and my GP colleagues have been given the referral criteria. The manager is informed about these patients and puts them on the waiting list. During the fi rst session, I assess the patient’s suitability for Western medical acupuncture and would decline to use acupuncture for