This site is intended for health professionals only


GPs barred from applying NICE back pain guidance



By Lilian Anekwe

Exclusive: GPs are being prevented from putting controversial NICE guidance on low back pain into action because primary care organisations are refusing to fund its recommendations of acupuncture and spinal manipulation.

Of 127 PCOs responding to requests under the Freedom of Information Act, half said they were currently providing no funding for spinal manipulation (view our interactive map of the responses here).

And funding for acupuncture fared even worse, with only 15% of PCOs having any record of funding the procedure for low back pain in the last three years.

Even among the minority of trusts that did provide the service, six had cut the number of procedures they funded, even though NICE guidance published in May last year said it should routinely be offered.

The most dramatic cut was in NHS Central Lancashire, which reduced the number of procedures it funded for all acupuncture services from 46 two years ago to none last year – but the trust claimed funding had been transferred to a physiotherapy service.

The institute’s guidance on low back pain advises that patients should be offered exercise, a course of manual therapy or acupuncture as first-line treatments.

The recommendation was fiercely attacked by musculoskeletal specialists, who questioned whether there was evidence the treatments were effective on top of standard care.

Pulse’s investigation suggests PCOs have felt able to ignore NICE’s recommendation because of the controversy surrounding it.

NHS Newham said funding for acupuncture was limited ‘due to the limited evidence of clinical effectiveness’.

NHS Bassetlaw said it would only consider funding ‘as an individual funding request and clinical exceptionality would need to be demonstrated’.

NHS Hastings and Rother and NHS East Sussex Downs and Weald both said: ‘This service constitutes a low priority and is not funded except in exceptional circumstances.’

NHS Salford said it usually limited the number of spinal manipulation sessions patients were allowed to six, despite NICE guidance recommending nine.

Dr Chris Monella, a GPSI in back pain in Dorking, Surrey, said his local acupuncture service had been withdrawn by managers, even though he had presented a dossier of evidence, including the NICE guidance, in favour.

‘Our practice-based commissioning funding was withdrawn at the end of last year. Now access is proving very difficult.’

Acupuncture is recommended by NICE for back pain What’s happening in your area

For full details of the responses received under the Freedom of Information Act as part of Pulse’s investigation, view our map showing which PCOs are funding acupuncture for low back pain.