NHS

DoH

What are the drivers and barriers to effective integration of chiropractic into modern primary healthcare?

Group Presentation – Research Y2

What are the drivers and barriers to effective integration of chiropractic into modern primary healthcare?

NHS

DoHWhat is Primary Health Care?

Primary care is the local healthcare that we receive from GPs, NHS-walk-in centres, dentists, pharmacists and optometrists.

2011 Changes – Any Qualified Provider (AQP)

Increase patient choice Drives quality Encourages fair competition

What is Modern Primary Health Care?

Primary care is the local healthcare that we receive from GPs, NHS-walk-in centres, dentists, pharmacists and optometrists. These are the services that most often bring people into contact with the NHS

NHS

DoH

What is Primary Health Care?

Encompasses all healthcare taking place outside acute and mental health trusts.

Any Qualified Provider (AQP)

1. Increase patient choice 2. Drives quality 3. Encourages fair competition

The modern primary healthcare industry is a complex, rapidly changing competitive environment.  Healthcare revenues in the United States are approximately $1.2 trillion making it the single largest industry in the United States.  Employment projections for Chiropractors are to grow 28% between the years of 2010-2020, (a faster than average rate for healthcare professions). The increase in the public’s use of complementary and alternative medicine has grown the Chiropractic profession into the second largest primary health care profession in the United States. 

Chiropractic students face many financial barriers to establishing successful clinical practices after graduation.  New Chiropractors may be underprepared to balance the demands of being a health practitioner, busi ness owner, financial planner, and office manager simul taneously. While no reliable statistics on business failure rates exist for new Chiropractic practices, 56% of all new small businesses fail within 4 years.  Rapid changes in the health care industry have led to an increasing need for enhanced business skills and knowledge. Healthcare managers must balance issues like quality of life with bottom line profits in a way that no other managers are required to do. Consequently, gaps in any area of management can be detrimental to success in the healthcare industry. Given the growth of the profession, today’s ever-changing workplace demands, rapidly emerging technologies, the multifaceted needs of patients, and increased competition in many markets, the need for practice management skills is unmistakable. Indeed, a solid knowledge of business skills and strategy is needed by self-employed practitioners in order to prosper.

Key Findings

Chiropractic graduates have very broad and deep deficits in business knowledge. There was still a very obvious need for greater business education among the respondents and large gap between business needs and current knowledge.

Chiropractic students have unrealistic future salary expectations, high levels of actual and planned loan acquisition, an underestimation of their own risk tolerance, low levels of basic financial knowledge, and poor current money management skills. A possible mismatch between Chiropractic students’ understanding of Chiropractic practice management and the actual risks involved in running a successful Chiropractic clinic. Respondents reported good short-term personal financial behaviour, but a high percentage of respondents did not engage in mid and long range financial behaviours critical to small business success, such as using a written budget, saving money for small financial emergencies and long-term financial goals, and understanding taxes.  The most obvious implication of the study is the need for dramatically expanded business training and education for Chiropractors. Chiropractors appear to recognise very clearly that they need significant expansion of their business knowledge and skills. Significant redesign of Chiropractic programs to incorporate additional business training among Chiropractic students in College.

Conclusions

Chiropractic students did not engage in financial habits critical to the success of a small business. Chiropractic students may require a broader foundation of basic financial knowledge and the develop ment of personal financial skills to support the practice of Chiropractic as a financially viable option. Chiropractic graduates entering the profession need significantly greater business and practice management skills.  The existing gap between needed business skills and existing skills suggests that current training and education programs are not providing adequate business skills training.

NHS

Controversial History

Throughout its history chiropractic has been the subject of internal and external

controversy and criticism. Profession has battled with mainstream medicine, being

based on “antiscientific” and “pseudoscientific” ideas such as subluxation.

A 2003 profession-wide survey found "most chiropractors (whether "straights" or "mixers") still hold views of Innate and of the cause and cure of disease (not just back pain) consistent with those of the Palmers." A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today."

Dogma of subluxation

The dogma of subluxation is the biggest single barrier to professional development for chiropractors

Evidence based results

Since 1981 profession have seen a dramatic change to a situation where chiropractors are now widely accepted and have high quality scientific meetings.

In the past a focus on evidence-based spinal manipulation research has raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks (Villanueva-Russell et al 2005).

Evidence based results

2014 systematic review and update of UK evidence report showed limited number of high quality evidence for the effectiveness of manual therapy and chiropractic. Most reviewed evidence was of low to moderate quality and inconsistent due to substantial methodological and clinical diversity.

UK evidence report and current review for different musculoskeletal conditions (2014 Systematic Review)

Condition InterventionUK evidence report

Inconclusive Moderate HighNeck pain

(acute/subacute/chronic)

Cervical spinal manipulation/ mobilization alone Favourable

Mid back pain Spinal manipulations Favourable

Sciatica/radiating leg pain

Spinal manipulations/ mobilizations Favourable

Shoulder girdle pain/dysfunction

Manipulation/ mobilisation (mobilisation with

movement)Positive

Lateral epicondylitisManipulation

Mobilisation with exercise

Non-favourable

Favourable

Carpal tunnel syndrome Mobilisation Favourable

Ankle sprains Manipulation/ mobilisation Favourable

Plantar fasciitis Manipulation/ mobilization with exercise Positive

Communicationbetween professions

Drivers Barriers

Good communication Lack of good communication

Openness to discussion with the CCG’s

bias toward alternative medicine

Patient interest lack of knowledge & understandingEconomic and geographic constraints

Results & conclusions based on 9 dissertations dealing with GPs & other health care professionals attitudes towards chiropractic:

80 GP’s in Birmingham - 31% Responses 300 Anaesthetisis across UK – 24% Response

91 GP’s in Jersey- 45% Responses

Communicationbetween professions

RESULTS:> NHS GPs/HCPs ‘would’ alter their referral pattern> HCP not widely aware of the AQP scheme > Lack of knowledge regarding benefits of Chiropractic> Existing referrals on NHS for:

> Acute or chronic neck > Lower back pain > Headache

Group Conclusions

Any Qualified Provider (AQP) will be the driver for commissioning primary healthcare services here in the UK. It’s the new commissioning landscape.1. Increase patient choice 2. Drives quality 3. Encourages fair competition

No.s of Chiropractors per population are significant driver. We need to serve our communities.

Chiropractic graduates entering the profession need to reduce deep deficits in business knowledge and require significantly greater business and practice management skills. Chiropractors need to engage in financial habits critical to success in business.

We need more high quality evidence based research, that further promotes and communicates the effectiveness of Chiropractic worldwide.

To counteract the dogma of subluxation which has been the biggest single barrier to the professional development of Chiropractic.

Primary healthcare professionals recognise the validity of Chiropractic as a treatment modality. The new commissioning landscape of the AQP will open new opportunities to demonstrate wider influence in winning successful bid applications.

Any Questions?