Dr Nigel Bird is both a registered pharmacist and a homoeopath. He studied pharmacy and pharmacology at Bradford and Nottingham universities then later became interested in complementary medicine. He passed he diploma of the British Institute of Homoeopathy in 1992. In 1994 he obtained a doctorate in homoeopathic medicine and was made Fellow of the Institute. He offers full homoeopathic services from clinics in the Manchester area.
In theory homoeopathy has always been available on the NHS, mainly through the few medical homoeopaths in general practice and in the five UK homoeopathic hospitals. However, for non-medical homoeopaths like myself, the amount of NHS work has been minute, amounting to the odd referral from occasional open-minded GPs and if the local primary care trust (PCT) would fund it. This source of NHS work dried up in 1997 when the present Government came to power and fund-holding GP practices were abolished. It then became impossible for non-medical homoeopaths to have any NHS work, as there was no funding.
During 2004 there appeared to be a change in Government policy with the Department of Health recognising the therapeutic value of the Group 1 Complementary Therapies where there is evidence for their effectiveness. Five therapies are now recognised: acupuncture, Western herbal medicine, osteopathy, chiropractic and homoeopathy.
All these therapies have been regulated or are about to be regulated, or are regulated voluntarily (in the case of homoeopathy) so that the practitioners can be admitted to a register, have a code of ethics and a disciplinary committee, and undergo continuing professional development – all to ensure professional good conduct and best practice. By the end of 2005 it was a professional requirement to be properly trained by an accredited college of homoeopathy and registered with the appropriate professional body (Common Register in the case of non-medical homoeopaths). This will be essential to work in the NHS.
Pilot projects
Another step forward happened in early 2005 when a number of pilot projects for homoeopathy in the NHS were established nationally. I was asked to manage one in Greater Manchester, established jointly by Rochdale, and Middleton and Heywood PCTs, which gave an initial grant of £1,500. Patients I had treated privately from these PCT areas, either self-referred or referred through their GPs, were eligible to join.
The scheme started in summer 2005 and eventually included 15 patients – a good cross-section in the PCT areas. Unfortunately the initial grant was far too small and restricted patient numbers and duration of treatment. Also there were conditions attached: - Precise patient records to be kept and full details of progress, patients’ GP, remedies and potencies, expected outcomes etc.;
- Patients’ GPs to be kept informed of progress, remedies etc., at six monthly intervals;
- Interim (every six months) and final (at 12 months) reports to be sent to both the patient’s GP and to the two PCTs involved.
I was informed that if the outcome results and studies were satisfactory, then the pilots would be considerably expanded in 2005. I hope and believe that this will start to happen during 2006–07, as a lifetime ambition. I have spent the last five years or so lobbying Parliament for more homoeopathy in the NHS with mixed results – lots of promises but no action!
Ideally, I would like to see a homoeopathic service within the NHS for all who might require it and staffed by both non-medical and medical homoeopaths on an equal footing and running in parallel with conventional medical services. Or even as integrated medicine – as Prince Charles would call it – being the best of both allopathic and homoeopathic medicine, in general and hospital practice equally.
Ideally we should be able to provide a 24-hour, seven days a week homoeopathic service as in conventional medicine, which at present we do not. Homoeopaths would have to come together in partnerships or groups in a similar way to GPs, perhaps working from existing or modified clinics or practices.
No need for aggression
I would reserve conventional medicine for life-threatening and/or acute conditions where it has saved many lives, and use homoeopathy once the patient is stabilised and for everyday problems and chronic conditions, remembering that 70 per cent of all illness is self-limiting and the aggressive, invasive approach of conventional medicine is just not necessary. Much money would be saved by a lower drugs bill and by diverting patients to homoeopathic treatment, which would be much cheaper than sending patients to expensive consultants and hospitals.
Monies would have to be reorganised, but long-term savings would easily outweigh the initial costs. The pharmaceutical industry would undoubtedly complain, but again their place would be in accident and emergency departments rather than in the treatment of long-term chronic conditions. There would still be plenty of scope in research and development around this remit for conventional doctors and pharmacologists.
The amount of money spent on homoeopathic research and development is small compared with that spent on conventional research and development. With increased use of homoeopathy in the UK, more money could be found for proving new remedies. The homoeopathic colleges, such as the British Institute of Homoeopathy (BIH), could be given much larger grants for badly-needed research and development. Homoeopathic research could also be established in our homoeopathic and teaching hospitals alongside conventional medical research, to the benefit of patients.
NHS situation
Homoeopathy and other approved forms of Complementary and Alternative Medicine (CAM) have been available from 1 April 2006 by GP referral. GPs have indicative budgets for further services so patients an access CAM and, in effect, have their professional fees paid by the NHS. Approved practitioners must be trained by an accredited college of homoeopathy and registered with a professional body such as the Alliance of Registered Homeopaths (ARH). They must appear in the NHS Directory of CAM as recognised practitioners. I would commend any pharmacist with a demand for CAM to study homoeopathy using one of the colleges recognised by both the Department of Education and the Department of Health.
Much of the work is done by distance learning and therefore suitable for busy community pharmacists as there is no pressure to complete the courses by a given time and date. Fees are competitive. A 30 per cent discount is given to NPA members using BIH courses to qualify from First Diploma onwards. Once the pharmacist has qualified, has registered with a suitable professional body and with the NHS Directory of CAM, then they can work in the NHS as well as privately.
You should write to your local PCT director of commissioning, enclosing a copy of your NHS Directory of CAM certificate (essential before any PCT will recognise you). You should also have malpractice insurance. At the time of writing (summer 2006) the NHS Trusts Association anticipated that the whole system would be up and running by December 2006, including practice-based commissioning by GPs or groups of GPs. Dilatory PCTs refusing to fund CAM on the grounds of principle will be reported to the Secretary for Health.
Patients requesting homoeopathic treatment on the NHS will be able to approach their GP for a referral. GPs and groups of GPs will be able to commission homoeopathic services from approved practitioner/providers who fulfil conditions as above. Practitioners will be paid their professional fees and costs of remedies (where appropriate) either by the GP’s indicative budget, or initially by the PCT until GPs gain more experience and skill in managing their own budgets. Full details were not available at the time of writing.
As some GPs may be hostile and not grant a referral, there is a procedure through each PCT to ensure every patient who requires CAM has access to it, as a right. Further information can be obtained either from me or through the NHS Trusts Association (see “Further Information” for contact details).
Sadly, many GPs are unaware of homoeopathy, especially the more mature ones, having no experience of it as medical students. More recently qualified GPs (in the last five years or so) have had some basic knowledge at undergraduate level. PCTs will need to do some basic training for GPs, nurses and other health professionals, so at least they are aware of homoeopathy.
Practitioners could come together in CAM clinics to provide ‘alternative’ services in parallel to conventional primary care services. They would be multidisciplinary and offer a daily service similar to the centres recently suggested by the Department of Health for conventional medicine.
Most of the above can be offered in the community pharmacy environment, especially if there is a demand from the public. A pharmacist who is qualified, registered and on the NHS Directory of CAM for homoeopathy could eventually become a fully-fledged homoeopathic practitioner and devote a separate room to consultations. Professional fees would be paid by either the GP practice or by the PCT. By maintaining close liaison with local GPs who may also be homoeopaths, patients’ prescriptions could be issued for dispensing and paid for in the usual way.
There is no reason why any pharmacist should not capitalise on the demand for homoeopathy. It is a growing market and the margins are excellent. While conventional OTC medicines give about 20–25 per cent profit on return (POR), homoeopathic remedies give about 40–45 per cent POR. The enthusiastic, committed homoeopathic pharmacist could exploit these opportunities in every way, working up the customer/patient base to gain a niche market.
Co-operation with local homoeopathic GPs would increase the market by dispensing homoeopathic prescriptions. Every remedy is prescribable and allowable as a zero discount (ZD) item. Supplies are obtainable from manufacturers such as Freemans in Scotland, Nelsons and Weleda in England. Remedies can also be made in the pharmacy from stock solutions but this can be time-consuming in the busy pharmacy, and requires space and apparatus.
Job satisfaction comes from offering an alternative where a conventional product has either failed to work or the customer/patient is suffering from unwanted and unnecessary side-effects. No one has died from homoeopathy in the 200 or so years it has been around! Many PCTs will ask for evidence for homoeopathy; in 2000 Parliament accepted evidence dating back to the1930s and there are ongoing randomised control trials producing favourable results.
My ‘buzz’ is getting patients better where conventional methods have failed and, of course, a belief resulting from the fact that I have seen homoeopathy work. The homoeopathic pharmacist and patient become a team and there is close empathy between practitioner and patient, not seen nearly enough in our ‘instant’ society. Dr Samuel Hahnemann, who discovered homoeopathy, recommended always listening to and observing closely any patient. This is as true today as it was then.
The only drawback I can see is the dichotomy of the opposing philosophies between the two approaches of the conventional (allopathic = the ‘other’) and the homoeopathic (the ‘same’). Integrated medicine uses the best approaches of both. Conventional medicine has become impersonal, with little consideration for the recipient. In homoeopathy, as with other natural therapies, the care and dedication of the therapist must be combined with close co-operation of the patient, so that the two work as a team. Homoeopathy is not instant, but the aim is complete cure with steady progress over a period of time and not the masking or suppression of symptoms by chemicals that are foreign to the body and hence cause side-effects and interactions.
Further information
Space does not permit any further discussion of this (to my mind) fascinating subject, but I would be prepared to enter into further correspondence. Please contact Nigel Bird, 29 Hereford Drive, Prestwich, Manchester M25 0AG, tel: 0161 798 7358.
The NHS Trusts Association can be contacted at PO Box 45734, London SW16 5WJ.
|
