1. INTRODUCTION

1.1  The Glastonbury Complementary Health Service

The Glastonbury Complementary Health Service provides the opportunity for general practice patients to be referred, free of charge, to one of five non-conventional therapies.  Established in 1992 in a three-partner practice in a small rural town, the main aim of the service is to provide a safe and professional complementary health care fully integrated into primary health care.  The establishment of the service was, in part, a response to the demand from patients, a high proportion of whom are regular users of complementary therapies, and in part arose from the concern on the part of GPs that patients were sometimes putting their health at risk through use of complementary therapies in a way that was not integrated with the conventional treatments being received.  It also arose out of the experience of the GPs themselves that complementary medicine had a part to play in the treatment of many common conditions, yet access to such therapies was limited by the income of the patients.

Five complementary therapies were made available within the practice: osteopathy, acupuncture, herbalism, massage and homeopathy.  These were provided by six qualified practitioners who worked on a basis of one half day each per week.  There were two osteopaths, allowing for one full day of osteopathic treatment a week.  Two of the GPs provided some homeopathic treatment for patients on a symptomatic basis, but the addition of the homeopath (medically qualified) to the service enabled full-length homeopathic consultations to take place.

All referrals to the service were made via the GPs, and patients could receive up to three hours of treatment on each referral.  The number of sessions this provided varied from practitioner to practitioner: for osteopathy, for example, patients received an initial one hour appointment followed by four half-hour appointments, for massage they received four three-quarter hour appointments, and for acupuncture, herbalism and homeopathy, six half-hour appointments. Initially, at least, all sessions were pre-booked at weekly intervals (apart from appointments with the herbalist).  Later, the appointment system became more flexible, with practitioners arranging their own appointments from week to week, apart from the initial appointment.

1.2  The research

The scheme was funded by a research grant from Somerset Health Authority, as part of a research project on the contribution and cost-effectiveness of different therapies attached to primary health care.

However, because complementary therapies are not normally provided as part of NHS services, the Glastonbury project had a somewhat broader set of questions than the other two studies.  Initial discussions with the practice, practitioners and Health Authority elicited the following set of research questions:

1.  What contribution can complementary medicine make to primary health care?
2.  Which patients can benefit from complementary medicine?
3.  What are the advantages and disadvantages for the practice of having a complementary health service?
4.  Can such a service be cost-effective?

The research methodology included a number of different sources of data. These included:
- Referral forms on all referrals to the service filled in by GPs and complementary practitioners,
- Questionnaires filled in by patients on referral to the service, on completion of treatment and six months after referral, and
- Interviews with a sample of patients, and with practitioners and other health service staff.

Response rates on the questionnaires were reasonable initially, but deteriorated over time:  82% returned their questionnaires following referral, 76% returned questionnaires on completion of treatment, and 55.6% returned their questionnaires at six months after referral.  Only a small proportion of patients completed all three questionnaires.

It is relevant to note, at this point, that the research did not aim to establish the effectiveness of complementary therapies per se, but aimed to examine the potential role for such therapies within general practice.

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