Chiropractic on the NHS
Patient choice for low back pain
Chiropractic available on the NHS?
Now is the time to have your say. Ask your GP for evidence based treatment for back pain recommended by NICE.
NICE (National Institute for Health and Clinical Excellence) has recommended that GPs refer to chiropractic, osteopathy and acupuncture on the NHS. The guideline is for the care and treatment for people with persistent non-specific low back pain in England and Wales to help them manage their pain.
The actual guidelines can be found here http://guidance.nice.org.uk/CG88 These are relevant not only for the GP or practitioner to read, but also useful for the general public, patient and their carers. If you read what the findings actually are rather than just the newspaper reports you will have a better understanding of the recommendations and what you may be entitled to under the NHS. http://guidance.nice.org.uk/CG88
The recommendations, aimed at GPs, include:
- Provide people with advice and information to promote self-management of their low back pain.
- Consider offering a course of manual therapy including spinal manipulation of up to 9 sessions over up to 12 weeks
- Consider offering a course of acupuncture needling comprising up to 10 sessions over a period of up to 12 weeks
- Consider offering a structured exercise programme tailored to the individual.
- If the first option is unsuccessful consider offering one of the other above options.
- When choosing a therapy consider the patient's expectations and preferences
I am not sure how long it will take for this guidance to be implemented, however if you fall into the category described by this guideline from NICE and wish to undertake one of the treatments described above it is worthwhile asking your GP. To be considered as a referral under the NHS this guideline states that you will have persistent non-specific low back pain for more than 6 weeks but not more than a year.
Up until recently in the UK Primary Care Trusts who have managed NHS budgets have been slow to implement these guidelines. With the recent NHS reforms, set out in the Government's Health and Social Care Bill 2011, things should change. The Department of Health believes that the implementation of the Bill will empower patients and improve patient care.
Chiropractic available in your area on the NHS?
As well as deciding what health services are available in your local community and providing funding for them, your local Primary Care Trust (PCT) will decide if chiropractic is available on the NHS in your area. Any member of the public who is encountering difficulties in obtaining chiropractic or other complementary therapy via the NHS and who would like to bring this problem to the notice of their Primary Care Trust, should write to the Patient Advice and Liaison Co-ordinator (PAL) at the Primary Care Trust. If many people write to the PCT they may become aware that a particular service is required and therefore fund it where they haven't done so previously. http://www.nhsdirectory.org/default.aspx?page=public Although "Since 2002, the NHS has been legally obliged to provide funding and resources in England and Wales for medicines and treatments that are recommended by NICE" http://www.nhs.uk/chq/Pages/1317.aspx However, this does not replace the GP's clinical decision as to whether you will benefit from a particular treatment.
The voice of the patient is paramount as GPs will listen to patient demand. Ask your GP if the new Consortia are considering contracting chiropractors to provide manual therapy in a back pain pathway. You should quote the NICE guidelines saying that these recommend a course of up to 9 sessions of manual therapy, which is one of the best treatments for perisitent back pain and there is evidence to show its effectiveness and cost savings. For more information, a patient leaflet and face sheet see http://www.nice.org.uk/CG88
Can I see a chiropractor anyway?
Yes of course you can. Most patients do come to a chiropractor privately, you do not need to see your GP first or have a referral letter.
What about health insurance? Will it pay for my chiropractic treatment?
Most health insurance companies will reimburse your chiropractic fees. As each policy and company is different it is best to check with yours first to see how much you are covered and which forms you need.
How often do I have to go to the chiropractor?
Each treatment is individualized to you the patient. It therefore depends on the severity of the problem, how long you've had it and are there any other factors such as your medical history and lifestyle. Any follow up appointments are made one visit at a time and that with your express agreement.
Are chiropractors regulated?
By law in the UK to be a chiropractor you must be registered with the General Chiropractic Council (GCC). To be registered you must show that you have the relevant training, qualifications and be fully insured to practice. Check to see if your chiropractor is registered with the GCC http://www.gcc-uk.org/chiro_search.cfm