(2001; 200 pages)
United Kingdom of Great Britain and Northern Ireland
Successive governments have ensured that as long as patients require complementary/alternative treatment, access to it will be guaranteed. As a result, the United Kingdom is the only country in the European Union with public-sector hospitals for complementary/alternative medicine. Indeed, there are National Health Service homeopathic hospitals in London, Glasgow, Liverpool, Bristol, and Tunbridge Wells (53). At Saint Mary's Hospital, where relaxation, dietetic, yoga, and meditation therapies are available, allopathic physicians work closely with non-physicians. Homeopathy provided by allopathic physicians is included in the National Health Service (86).
Complementary/alternative medications, homeopathic products, and other natural remedies are becoming increasingly popular and are now widely available in health food stores and pharmacies (172).
In response to the increased use of complementary/alternative medicine by the public and the Government's concern over its effectiveness, the British Research Council on Complementary Medicines was formed in 1982. Among other things, it noticed the major role of complementary/alternative medicine in reducing the costs of the health care system (172).
In general, in order to become a member of a professional organization, non-allopathic practitioners must be covered by insurance and adhere to the Code of Professional Ethics (172).
During the past 20 years, interest in complementary/alternative medicine has increased (172). Seventy per cent of the public is in favour of complementary/alternative medicine becoming widely available in the National Health Service - particularly osteopathy, acupuncture, chiropractic, and homeopathy.
One-eighth of the British population has tried complementary/alternative medicine, and 90% of these people are ready to use it again. Complementary/alternative medicine is most popular with middle-aged, middle-class women. The complementary/alternative therapies most used are herbal medicines, osteopathy, homeopathy, acupuncture, hypnotherapy, and spiritual healing. Much complementary/alternative medical practice centres on treating chronic diseases. Most patients of complementary/alternative medicine are also patients of allopathic medicine (172).
Complementary/alternative practitioners without an academic degree provide the largest proportion of complementary/alternative medicine. In 1987, there were about 2000 non-allopathic medical practitioners. In 1999, there were 50 000 complementary/alternative medical providers. Approximately 10 000 of these are officially registered health professionals. In 1998, up to five million patients consulted a complementary/alternative practitioner. Patients spend about 1.6 billion pounds sterling each year on complementary/alternative medicine (183).
There are approximately 1300 chiropractors practising in the United Kingdom (45). There are several professional associations of complementary/alternative practitioners.
Although complementary/alternative medical practitioners without an allopathic medical degree are tolerated by law, only medical providers holding a university degree in allopathic medicine are officially recognized (172): to practise medicine as a physician, a person must posses a certificate or qualification from the faculty of medicine of a university and complete one year of general clinical training. During the clinical training period, a physician candidate has provisional registration. After satisfactorily completing the training, the candidate may obtain full registration. Being a registered medical practitioner confers privileges and responsibilities, including the right to use the title or describe oneself as a registered practitioner, to be recognized by law as a physician or surgeon, to recover fees for medical attendance or advice in a court of law, to hold specific posts, to provide general medical services in the National Health Service, and to give some statutory certificates. The General Medical Council, a statutory body that regulates the medical profession, maintains the register of qualified allopathic doctors.
Although registration, for which specific training is required, provides certain privileges to non-allopathic practitioners as well, the right to practise medicine without formal recognition is established in British Common Law (172). This right protects an individual's freedom to carry out medical activities not specifically prohibited by an act of Parliament. As a result, given some restrictions and provided they do not breach the Medical Act of 1983, non-allopathic providers can practise medicine regardless of their training. In principle, non-registered persons are even allowed to perform surgical acts with the consent of patients. If such acts result in maltreatment, however, non-allopathic practitioners may be prosecuted under the penal law and the tort-based common law of negligence. And if a patient dies, the practitioner may be prosecuted for involuntary homicide. Registered physicians cannot be so prosecuted.
Under the terms of the Venereal Disease Act of 1917 and Section 4 of the Cancer Act of 1939 (172), there are some limitations on the rights of non-allopathic practitioners. Non-allopathic practitioners may not perform certain medical acts, practice specific professions, or use particular titles. Only registered allopathic doctors may treat cancer, diabetes, epilepsy, glaucoma, and tuberculosis; prescribe controlled drugs; perform specific medical acts such as abortion; or treat venereal diseases. Unqualified practitioners may not claim to be or practise as pharmacists, midwives, or dentists, or imply that they are State-registered allopathic practitioners whose legal status is regulated by the Professions Supplementary to Medicine Act of 1960. This Act regulates dieticians, medical laboratory technicians, occupational therapists, physiotherapists, radiographers, and orthopaedists. Further, commercial use of the term "health care centre" in relation to any premises where no allopathic doctors and nurses are employed is prohibited.
Allopathic physicians referring patients to non-allopathic practitioners for treatment retain clinical responsibility for their patients. The Medical Act of 1983 (172) does not regulate which forms of therapy may be practised by registered physicians. Thus, there is no restriction on registered allopathic physicians using complementary/alternative medicine if they have the requisite skills and/or qualifications. Further, the agreement of 1 April 1990 between allopathic general practitioners and the Family Health Service Authorities does not define the staff that may work with an allopathic physician. Thus, a physician's staff may include physiotherapists, chiropractors, and dieticians.
In 1950, the Government gave official recognition to homeopathy in the Faculty of Homeopathy Act. The Government regulates osteopathy and chiropractic through the quite similar Osteopath and Chiropractor Acts of 1993 and 1994 (172). While registered practitioners of these two professions have special rights, including title protection, they, like other non-allopathic practitioners, are not recognized as official health care providers and may not work in National Health Service hospitals. Nonetheless, these two acts are considered to be important developments in complementary/alternative medicine. Other practitioners, including acupuncturists, homeopaths, and herbalists, are now pursuing the same level of recognition.
The regulation of chiropractors and osteopaths, as with all health care professionals, is based upon a register. The right to use the title of "Chiropractor" or "Osteopath" is restricted to registered chiropractors and osteopaths, and registration depends on having recognized qualifications, although there are transitional provisions for experienced practitioners.
The General Chiropractic Council, which includes a significant number of non-chiropractors, is publishing its own Code of Professional Ethics. Under the Osteopath and Chiropractor Acts of 1993 and 1994, the principal criteria for disciplinary action are professional incompetence, conduct that falls short of the standards required of a registered osteopath or chiropractor, conviction of a criminal offence, and serious health impairment affecting the ability to work as an osteopath or chiropractor. Under this Code, practitioners facing disciplinary action from the Committee may be admonished, suspended, or dismissed. The right to practise is initially granted for a period of up to three years, then for periods of two to three years. However, this is not yet in effect.
Homeopathic and other natural remedies are sold by many independent pharmacies. The European Directive on Homeopathic Products regulates the making and marketing of homeopathic products in the United Kingdom (172), The licensing of other medicines is regulated by the Medicines Act of 1968 (172). Applications for drug registration must be accompanied by details of relevant research and clinical trials. Requirements are less stringent if the medicines do not contain a new chemical substance or if they are herbal preparations.
The Health Act of 1999 (183) provides two options for achieving statutory regulation for a profession or therapy. The first option allows associations representing a profession to apply for statutory regulation. The second option allows professions to join the Health Professions Council; membership in the Council confers title protection.
Education and training
The British Medical Association recommends incorporating complementary/alternative medicine into the undergraduate curriculum of medical schools and making accredited postgraduate training available (172).
While most non-allopathic practitioners have good training, the quality of complementary/alternative medical programmes varies. The Institute of Complementary/Alternative Medicines is working with the Training Desk to establish national standards of training acceptable to both the public and the Government (172).
There are 54 professional associations representing complementary/alternative practitioners and offering comprehensive full-time courses in anthroposophy, chiropractic, homeopathy, phytotherapy, naturopathy, and osteopathy, lasting for a minimum of three years (172).
The Faculty of Homeopathy Act empowers the Faculty of Homeopathy to train, examine, and confer diplomas in homeopathy to allopathic physicians and other statutorily recognized health professionals (172). There are four schools of chiropractic in the United Kingdom (65).
With some exceptions, fees for complementary/alternative therapies are not reimbursed by the social security system (172). Exceptions are made for treatments available within National Health Service hospitals, which are provided free of charge, and occasionally for acupuncture, osteopathy, and chiropractic treatments. An allopathic general practitioner may claim reimbursement for a wide range of staff, including physiotherapists, chiropractors, and dieticians; however, the authorities have the freedom to reimburse all, part, or none of these costs.
Some private insurance programmes (172) reimburse the five most popular forms of complementary/alternative therapy - homeopathy, osteopathy, herbalism, acupuncture, and naturopathy - when they are provided by allopathic physicians.
The services of chiropractors and osteopaths are reimbursed by trade bodies and by several associations, such as industrial and veterans' associations.