Developing health policy: The British perspective

Integrating regulation of practitioners: In the EU there are three main systems for regulating practitioners:

Full legal framework (France and many southern European Countries). Only licensed health-care professionals may practice medicine, including complementary medicine (CM).

Intermediate (Germany). CM practitioners have reduced registration requirements (Heilpraktiker).

Liberal (UK, Netherlands, Ireland, some Nordic countries). The right to practice is not systematically regulated by law. In the UK many legally registered health professionals also integrate CM including homeopathy and acupuncture.

The liberal system is associated with problems including public protection and professional discipline. In the UK there is a gradual process of regulation of CM practitioners: osteopaths and chiropractors became legally regulated in the early 1990s. In June 2008 an official report on the Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine and other Traditional Medicine Systems identified an urgent need for regulation. The main reason is to safeguard the public but also to permit the manufacture of herbal medicines for individual patients after full implementation of the European Traditional Herbal Medicinal Products Directive in 2011. The report recommends that these professions be regulated by Health Professions Council, which already regulates 13 health professions; this integrates the regulatory system for CM practitioners.

In parallel the Complementary and Natural Healthcare Council has recently been launched. It will register other practitioners but is voluntary, and does not involve legal regulation. The governing council is independent and 100% lay; it will provide a more credible regulatory structure for other CM therapists.

Public sector integration: The UK National Health Service (NHS) is being reformed from a classical socialist model to an ‘internal market’ of commissioners who purchase health services from providers. This aims to allow patients free choice, increases the autonomy of commissioners and providers and permits private sector involvement, although the entire system remains state-funded.

In this context the integration of CM is very controversial. There are five NHS homeopathic hospitals, integrated with their respective local NHS providers and staffed by registered health professionals trained in CM. Despite their titles they provide a wide range of CM, homeopathy now forms less than 40% of the activity of the largest NHS homeopathic hospital, the Royal London Homoeopathic Hospital.

There has been a high profile campaign to exclude the NHS homeopathic hospitals and CM from the NHS. Arguments against integration of CM include claimed lack of evidence and diversion of resources. Some commissioning bodies have restricted CM or stopped their contracts with the NHS homeopathic hospitals. This has met strong public and political opposition mostly on the grounds that it denies patients the choice which these reforms claim to increase. The private sector has shown increased interest in providing integrated services inside and outside the NHS.

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