Impact Integrated Medicine Partnership

Background

The Impact Integrated Medicine Partnership provides access to free acupuncture, chiropractic and homeopathy within a primary care setting to patients living in deprived inner city areas.

What is the problem you are trying to solve?

This provision aims to address inequalities. These interventions are rarely available in the NHS, despite 70% of patients wanting access to complementary medicine. Impact was set up in response to residents’ requests for access to complementary medicine made at a consultation event held by our previous funders, New Deal for Communities (NDC). NDC are a government funded regeneration programme set up to address deprivation in two inner city areas, Radford and Hyson Green. These are areas where health inequalities are high, and 28% of the population are from black and minority ethnic (BME) groups, including refugees and asylum seekers.

What local organisations are involved?

Impact is supported by Nottingham City Primary Care Trust (PCT), who we’ve worked with closely, as well as NDC and local GP practices, including St Luke’s Surgery and the Forest Practice.

How many people are running this project and who are they?

Impact is run by a four person team, and also has a steering group made up of stakeholder representatives, including Nottingham City PCT staff. The two directors are also practitioners - one is a chiropractor and the other a homeopath. We also have an acupuncturist and an administrator.

What local population are you targeting?

The target population is the residents of Radford/Hyson Green, and other similarly deprived areas in Nottingham. Since Impact opened, 48% of our patients are from BME communities, in an area where 28% of the population are from BME groups. 30% of our patients consider themselves to have a disability, and 38% are men.

How many people are you targeting?

We aim to treat between 350–700 patients a year.

Interventions

What interventions are you using to address the problem?

Acupuncture, chiropractic and homeopathy have been provided for patients with long term conditions (including mental health conditions) via GP/health professional referral or self-referral. Only patients living within defined high-deprivation postcodes have received free treatment. External evaluation of our work demonstrates that our interventions are effective in treating musculoskeletal disorders, mental health conditions, chronic pain, back pain, and gynaecological/menstrual disorders.

Is the project design based on evidence? If so, please state reference.

The project design was based partly on a similar integrated service based in Marylebone, which has been comprehensively evaluated. The project design was also influenced by Newcastle Complementary Therapies Project, where comprehensive health outcomes were also measured ¹ .

Outcome

What outcomes or planned outcomes are you measuring?

We are measuring: (a) improvements in patients’ health and wellbeing, using outcomes measures SF-36 ² and the measure yourself medical outcome profile (MYMOP) ³ , acupuncture, chiropractic and homeopathy are provided for patients with long term conditions (including mental health conditions) via GP/health professional referral or self-referral; (b) reductions in frequency of GP visits following completion of treatment at Impact; (c) reductions in prescribed medication; (d) reductions in secondary care referrals; (e) patient diversity; and (f) patient satisfaction.

Do you have any outcomes or results yet? If so, what are they?

• Health outcomes measures SF-36 and MYMOP show that patients with mental health conditions, musculoskeletal disorders, chronic pain, back pain and gynaecological/menstrual disorders reported statistically significant improvements in health.
• 76% patients go to see their GP less, including patients who were previously frequent attendees.
• 87% of patients, who were on conventional medication when they began treatment, report reducing or stopping the medication on completion of treatment at Impact.
• 85% of patients who completed satisfaction questionnaires are very satisfied with the service, and 15% are satisfied.

Our 2006 report, entitled ‘Innovation, Choice and Effectiveness – acupuncture, chiropractic and homeopathy in primary care’ which contains comprehensive evaluation results, is available in hard copy and PDF (via our website). Details of our work can also be found on the NHS Alliance website ⁴ (we are NHS Alliance Acorn Award 2006 winners), and the NHS Live website ⁵ .

We are planning to conduct an economic evaluation in 2007.

Is your project relevant to a government target or guideline?

The project is relevant to the following paragraphs in Health Reform in England: update and commissioning framework ⁶ :

• A more personalised service for patients;
• Better, more sensitive provision for vulnerable and excluded members of society;
• The development of more collaborative work, across clinical divides, to construct care pathways around the individual needs of patients;
• The provision of choices which reflect the individual’s beliefs, values and preferences as well as clinical need; and
• The availability of choices around the type of treatment as much as about the place of care
• Strong engagement with patients and the public.

Feedback

What obstacles did you have to overcome to set up this project?

We are in the process of changing the referral criteria, so that demand (which has been very high) is easier to manage.

What have you learned about the project so far?

There has been a great deal to learn about:

• Creating integrated services so that patients with long term conditions receive appropriate interventions at the right time.
• Ensuring that the service is accessible to patients from all sections of the community.
• Ensuring that we keep a range of other health professionals and organisations informed about our work.

What would you do differently?

At the start of the project, we did not put a limit on the number of consultations per patient. This made demand management more difficult, and we would do that differently now – with a limit of around 12 consultations per patient.

References:

1. Peters D, Chaitow L, Harris G, Morrison S. Integrating Complementary Therapies in Primary Care: A Practical Guide for Health Professionals. The Journal of Alternative and Complementary Medicine 2003; 9(5):801-801.
2. SF-36.org. A community for measuring health outcomes using SF tools. 2004. http://www.sf-36.org (accessed 11 April 2007).
3. and http://www.hsrc.ac.uk/myop/main.htm
4. NHS Alliance. 2007. www.nhsalliance.org (accessed 11 April 2007).
5. NHS Institute for Innovation and Improvement. NHS Live. http://www.nhslive.nhs.uk (accessed 11 April 2007).
6. Department of Health. Health Reform in England: update and commissioning framework. www.dh.gov.uk 2006 (search for 276311, accessed 11 April 2007).