In order for to properly understand the relevance of the newly published guideline on chronic pain in the right context, I need to explain the status of Complementary and Alternative Medicine (CAM) in Scotland, the role of SIGN and of guidelines in general first. The people who already know this, please bear with me.
The purpose of SIGN guidelines is to inform health professionals in Scotland of best practices and provide recommendations for effective practice in the management of clinical conditions based on the best available evidence. They are not proposals.
In the case of chronic pain, SIGN recommends (as did NICE in 2009 for non-specific low back pain) what is considered ‘Alternative and Complementary Therapies’. In this case the recommendation is for using manual therapies and manipulation (including massage and acupuncture) for low back pain, neck pain and osteoarthritis. The reason why your GP friend hasn’t heard about it yet may be because the guidelines were only launched on the 12th December. Also, the guidelines are for the whole of chronic pain management including medication dosages, Chronic Pain Service Model etc - not just regarding CAM. Your friend would benefit from visiting the new chronic pain support website on www.chronicpainscotland.org .
GPs are encouraged to be aware of and follow all guidelines. Patients are also entitled to ask for and to expect the best recommended treatments for their condition in the NHS.
In the case of the use of complementary therapies in the NHS, even though they are recommended for the conditions above, as it stands right now, GPs are unable to refer patients for those therapies as they won't know who to refer to and how to refer. According to the BMA (http://bit.ly/BMACAMGuideline ) and the Scottish Government (http://bit.ly/DeptHealthDoc2005) , GPs remain responsible for the patients they refer to CAM therapists so they are expected to assess therapists' qualifications, insurance status, etc which is absurd. I’m currently discussing this with NHS Lanarkshire.
As detailed on the links above, the Scottish Government has made quite clear that it's up to individual Health Boards to decide what treatments there are available in the NHS and this includes CAM. (you'll be able to find all my activities - and MSPs supporters) on this on www. http://bit.ly/CAMintheNHS)
In order for GPs to be able to refer chronic pain patients to the recommended therapies in the same way that they refer to physio, for instance, two things need to be put in place ASAP: CAM regulation and a referral pathway. My main focus is to argue the urgent need for those two things to happen (through Parliament questions, correspondence with NHS Lanarkshire and through the Cross-party Group on Chronic Pain of which I'm a founder member).
The Dept of Health in Whitehall have already helped create and funded an organisation to regulate CAM (the CNHC) THROUGHOUT THE UK but the Scottish Government has refused to acknowledge them until now (when Nicola Sturgeon was the Health Secretary). Having a regulatory body means that GPs can be confident that therapists a suitably qualified and conform to standards - that's how it currently works in England and Wales.
I'm in direct contact with the CNHC and with Scottish therapists registers in Scotland. (I’m told that there are over 100 CNHC-registered therapists here).
So, regulation would be very simple and quickly set up in Scotland through the CNHC - it's just a matter of the Government recognising the organisation as a UK-wide regulatory body (in the same way that the BMA regulates GPs throughout the UK).
Referral pathway is straight forward enough to set up.
So, in summary, although the mechanisms to make CAM available through the NHS haven't been set up, this doesn't mean that patients shouldn't demand CAM therapies when they are clinically recommended as best interventions for their chronic pain.
Patients AND GPs should be encouraged to ask for those therapies so that Health Boards understand that they need to do something about it (or even that they risk being sued under a few ‘headings’ – including breach of human rights).
As some of you will know, I’ve been in touch with Dr Kohli – NHS Lanarkshire’s Director of Public Health, to try to find a way to progress on the issues of patients’ right to equal access to the guideline recommendations in Lanarkshire. Some local GPs have started recommending patients for CAM pain management but only those who can pay – a situation that is not acceptable.
At the launch of the SIGN guideline, I was also invited to join NHS Lanarkshire’s Service Improvement Group (SIG) which I have accepted. I’ll report on developments there as well as necessary. It’s good to bear in mind that any patients can apply to join their local SIG.
Things move faster and get done when users lead. So, the more patients declare that they want drug-free treatments and demand it from their health service, the better the chance that it will happen and quickly.
Please get in touch with me if you need to clarify anything or need any assistance on this, including access to the Parliament’s Cross-party Group on Chronic Pain (chronic pain patients are most welcome)
Your GP might be interested in learning the content of this email – he/she would be very welcome to contact me too regarding this issue.
I have added some more new people to this mailing list to make it less time consuming for me (but, of course, I’ll contact you individually when necessary). Do let me know if you would like me to remove your address from this list.