In Conversation

This article appeared in the Summer 2016 edition of the BMAS newsletter The Point.

Thinking about setting up a private acupuncture service? Two BMAS members discuss the practicalities. Max Forrester (MF) has retired from NHS practice and Deniah Pachai (DP) is a medic working in a walk-in health/urgent care centre. And Allyson Brown (AB), Support Manager to Mike Cummings at the BMAS London Office, couldn’t help chipping in!

MF: I started my acupuncture in 1993, and used it first as a GP locum, mainly acute conditions. In 1996 I was asked to see some problem back pain patients when I was working in district general hospital as a Clinical Assistant. This turned into a twice weekly clinic seeing patients with back, neck, and knee pain and various non-pain conditions. I have always seen private patients, from the start! Firstly in my home, then at a local GP practice and finally in a room at a private physiotherapist’s practice. I don’t have a “licence to practice” now as I have retired from the NHS but I still am registered with GMC and insured with Balens. BMAS members get a special rate with Balens if they choose to insure themselves with that company.

 

In the old days I went to all the BMAS meetings as I was hungry for knowledge and wanted to hear the latest acupuncture research. I got the CoBC (I think they gave them out in the old days!), then Diploma then MSc! I try to do a minimum of 6 hours CPD per year. I personally think I have a duty to my patients to keep up to date and safe to treat them...CPD/CME, peer review/feedback. Most patients come by word of mouth, l don’t advertise, but always think I should. I am seeing conditions I would not “advertise” acupuncture helpful for. Even infertility work...with a 100% success rate (only one patient so far). Word of mouth is probably the best advertiser for me. I have a small area on the physio’s website, and I have set up Facebook and Twitter accounts ‘Dr Max Forrester Acupuncture’ and ‘Dr Max Acupuncture’ respectively.

 

AB: If you’re going to advertise online or have leaflets printed I advise checking the Advertising Standards Authority website first. If you go to www.cap.org.uk and search 'acupuncture advice' you’ll find specific advice as to what the ASA consider acceptable when advertising acupuncture services. And if you have completed six hours of CPD with BMAS in the last year you’re entitled to use the Society’s logo on your website too. Max, what about the cost of admin - do you employ a secretary or receptionist? It must eat into your earnings.

 

MF: Rent costs vary. At one place you might pay £15/hour for room with receptionist, in another place you might pay £10/hour and not have a receptionist. When working out your fee you need to take into consideration what other people are charging. And think about why you are practicing “privately”, to gain experience or to primarily make money or to cover costs?

 

AB: How do you deal with patients who have unrealistically high expectations of acupuncture?

 

MF: Never had any! I always have a long chat at the first appointment (60 mins) and talk about response rate to treatment. Private practice is very different to NHS...patients may have other expectations, not treatment related! Some don’t like being kept waiting, for example, some may expect to be seen at a time/place of their choosing… Where do you work, Deniah? What sort of patients do you see and what are your plans for your practice and/or your service development?

 

DP: Your journey through acupuncture is interesting, Max, and quite different to my current experience. After my foundation course in 2014 I did acupuncture for a handful of patients at home - they were mainly colleagues or friends. I have access to private rooms on Harley Street and have seen a few patients there but I have held back from seeing patients here as understand I have to register with the Care Quality Commission [CQC]. I attempted treating patients with acute conditions at the urgent care centre and walk-in centre where I work but have been advised by management that this will no longer be allowed. The BMAS clinic at the Royal London Hospital for Integrated Medicine is the only place I’m currently treating patients with acupuncture. As soon as I get my CoBC, I will explore the option of renting a private room at a GP surgery. I have already spoken to a colleague who owns an NHS practice who is keen on me doing this.

 

MF: I am not sure the COBC should hold you back, it is only the first step to your Diploma.

 

DP: With regards to CoBC, I suppose I feel that I need to have some form of recognised qualification before charging people for treatment. Recently I’ve come to appreciate that the challenge lies more in reaching an appropriate diagnosis following a good history and examination. As I already have a more than suitable medical qualification, the CoBC should not be a hindrance! It’s like attending a joint injection course and then practicing the technique. You just need to get on and do it! So going back to CQC, do you have to register with the CQC as a doctor if you are without a licence to practice?

 

MF: CQC! No! Acupuncture is NOT a “regulated activity” so if you are only practising acupuncture you do not need to register with the CQC. With no licence to practice you shouldn’t be carrying out any activity that’s regulated such as prescribing or providing ‘fit notes’. But you can still practice acupuncture as that’s not restricted. What you will need to do is to apply for a licence from your local authority. They are interested in safe, hygienic practice, so make sure you have arrangements in place for disposing of sharps, and that you have a handwash basin available, and appropriate flooring, that sort of thing. I believe that quite a few local authorities exempt BMAS members, and often doctors, from licensing, but you need to find out from your own local authority what their exact rules are. It’s called a ‘Special Treatments Licence’ and also covers other skin piercing treatments such as tattooing and electrolysis.

 

DP: Hmmm.... even though I am a medical doctor with a licence to practice, I don’t have to register with the CQC as acupuncture as a treatment is not regulated?

 

MF: I expect the CQC think you are going to be giving an opinion/treatment that is regulated...all I do is treat symptoms with an unregulated needle! My Balens insurance only allows me to treat “symptoms”; I am not allowed to make a medical diagnosis...so maybe it is different NOT having a licence to practice.

 

DP: CQC guidelines say ‘any treatment that is for the treatment of a disease, disorder or injury’ is included in regulated activity. So do you just record symptoms in your notes and not make a diagnosis?

 

AB: That’s certainly the definition that the CQC give, but they also say that ‘most alternative and complementary therapy’ is exempt. As acupuncture is not regulated, nor recognised by the GMC, I’d interpret this as not requiring registration with the CQC, provided that it’s only acupuncture being practised. Deniah, if you are planning to provide a diagnosis and/or other treatments for your patients, over and above acupuncture, then you do need to look at registering with the CQC.

 

MF: I record symptoms: anything dodgy I send them to see their GP! A lot of my patients come from specialists so all the tests/MRI etc have been done and the diagnosis made.

 

DP: What about health insurance companies – do I need to register with them, or is just being a BMAS member enough?

 

MF: That’s a tricky one. Different health insurance companies have different requirements and even different polices with the same insurer can have different requirements. The best advice I can offer is to check with the individual insurers and apply for provider status with them, maybe start with the bigger companies such as BUPA and AXA PPP. Patients may sometimes be expected to pay for their treatment then claim it back themselves from their insurance company, so make sure you can provide a formal receipt for them if that’s what they need.

 

DP: Do you use paper or electronic records for your patients?

 

MF: Paper - paper records or you need to register with the data protection people! Remember that paper records need to be kept securely. Paper notes need to be kept for seven years. Solicitors sometimes want a copy or opinion - with patients’ written permission of course.

 

AB: Did you know that there are lots of documents on the BMAS website you can use in your clinic? There’s an information/consent form, patient history and pain history forms, and documents you can use for recording the treatment you’ve given. You can adapt them to fit your own practice or use them just as they are.

 

Would you like to join the conversation?

 

If you have questions, answers or comments on setting up a private acupuncture practice just get in touch.

 

You can also visit the Member Forum on the BMAS website for advice on how to needle, and any other aspect of medical acupuncture.