Trying to put a square peg into a round hole? a qualitative study of healthcare professionals' views of integrating complementary medicine into primary care in the UK for musculoskeletal and mental health comorbidity

Problem

Complementary and alternative medicine (CAM) is used annually by around 25% of patients in the UK. Although most commonly accessed privately, CAM can be integrated with conventional care. GPs tend to be more positive about CAM for chronic conditions or those with limited treatment options. There is little research on their views regarding musculoskeletal (MSK) mental health (MH) comorbidity, which is common but challenging to treat. This study explored professionals’ experiences and views of CAM for these patients and the potential for its integration into UK NHS primary care.

Approach

We ran focus groups with GPs and CAM practitioners at three sites across England, and focus groups and interviews with healthcare commissioners. Sampling was purposive, based on professional criteria and experience with CAM. Framework analysis used frequency, specificity, intensity of data, and disconfirming evidence.

Findings

We recruited 36 CAM practitioners, 20 GPs and 8 commissioners.GPs described challenges treating MSK-MH comorbidity and agreed CAM might have a role. CAM practitioners were generally pro-integration into NHS primary care. Exercise- or self-care-based CAMs, such as yoga or tai chi, were most acceptable to GPs. A prominent theme was the different understanding of health between CAM and conventional practitioners, which was likely to impede integration. Many CAM practitioners regarded CAM as holistic, promoting self-care and behavioural change, describing conventional care as reductionist, paternalistic and passive. Many GPs felt they could not understand the philosophy of CAM, and some saw CAM as beyond their capabilities and scope. They felt that CAM was similar to social support and exercise thus addressing broader life problems than those which primary care should be treating. For GPs, their lack of knowledge about CAM and the current pressures in general practice were barriers to integration.Another concern was that integration might fundamentally change the care provided by both professional groups. Facilitators of integration were evidence of effectiveness and cost effectiveness (particularly for CAM practitioners). Governance was the least important barrier for all groups.There was little consensus as to the ideal integration model. Co-payment by patients/NHS was mentioned. Commissioners thought that CAM could be a part of social prescribing.

Consequences

CAM has the potential to help the NHS in treating the burden of MSK-MH comorbidity. The integration of CAM into UK primary care raises questions around the scope and capability of general practice and whether GPs should be involved in helping patients access CAM. Referral from NHS primary care to CAM, may be the most feasible model. However, cost implications would need to be addressed, possibly through models such as social prescribing, integrated personal commissioning, or co-payment.