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PCTs struggling to finance NICE back pain guidance

By Nigel Praities

PCTs are struggling to keep pace with a sudden rise in back pain referrals from GPs triggered by controversial NICE guidelines on back pain, Pulse can reveal.

A Pulse survey of 200 GPs reveals PCTs have been slow to react to the guidelines and have yet to commission sufficient provision of acupuncture and osteopath services - both recommended by NICE.

Two-thirds of GPs say acupuncture is difficult to access or is completely unavailable in their area, and 73% say the same for osteopathic treatments.

The NICE guidance – released in May – recommends complementary therapies such as acupuncture and manual therapy as additional options alongside analgesic treatment for patients with low back pain.

The recommendations were met with hostility on their release, culminating in an extraordinary move by members of the British Pain Society to oust their president, Professor Paul Watson, a member of the guideline development group.

PCTs in some areas have seen a rapid rise in GP referrals to existing back pain services this year.

NHS City and Hackney report an huge 172% increase in GP referrals to back pain services.

Other areas have had more modest rises, with NHS Nottingham City seeing a 20% increase in demand for spinal manipulation therapy and NHS Stockport reporting a 12% increase in back pain this year, compared with the previous year.

NICE has predicted a 30% increase in uptake for acupuncture and manual therapies, costing an extra £24 million for acupuncture and £16m for manual therapies, but says the savings on other procedures will outweigh any costs.

But Dr Graham Archard, RCGP advisor on complementary medicines and a member of the guideline review panel for the NICE guideline, said PCTs are unconvinced by this argument, as setting up a new service would be expensive.

‘There is good evidence that chiropractic therapy in particular does help back pain quite dramatically, but I do have some sympathy with PCTs because we only have a certain amount of money and it may be better to invest in other procedures.'

Dr Tim Barling, a musculoskeletal GPSI in Hereford who provides acupuncture and manual therapy in his practice, said little resources had been put in place to implement the guidelines.

‘We provide a service for the whole of Herefordshire – which is 160,000 people – with one person working one day a week. That doesn't really touch the surface does it?'

NICE guidance recommends acupunture for back pain Back pain, in numbers

73% - proportion of GPs in areas where acupuncture is currently not available, or difficult to access

61% - proportion of GPs in areas where osteopathy is currently not available, or difficult to access

£51.6m – estimated total cost of NICE back pain guideline

£24.4m – cost of additional acupuncture provision

£15.9m – cost of additional manual therapy provision

£51.5m – estimated savings to the NHS due to NICE back pain guideline

Source: Pulse survey of 200 GPs, NICE costing report for back pain guideline

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