The NHS is beginning to wake up to complementary medicine. Now there is handy guidance on how it can be integrated into conventional medicine. Claire Laurent reports

It may not be the most tactful comparison. But doubting doctors should take note: complementary medicine and primary care have a natural affinity, according to the authors of a Department of Health-sponsored guide.

Both, says Mike Dixon, a GP and a research fellow at Exeter University, 'deal with the whole person as much as the constituent parts. In both, the therapeutic encounter - the relationship between patient and therapist - is as important as the specific therapy itself '.

This natural affinity is being built on with the launch of an information pack containing guidance on complementary medicine for primary care groups and GPs. Produced jointly by the DoH, the NHS Alliance, the National Association of Primary Care and the Foundation for Integrated Medicine, the pack is intended as a basic source of information on complementary and alternative therapies.

'It's a hearts and mind thing, ' says Dr Dixon, chair of the NHS Alliance. 'It's about being open. It's permissive, saying to PCGs and PCTs that it's not beyond the bounds of reason to offer complementary alternatives.'

As a commissioning lead on MidDevon PCG, Dr Dixon says he has no wish to open 'the floodgates' to people seeking complementary medicine via NHS referral. 'One has to be very cautious: you need a good evidence base and cost argument before you can offer wholesale complementary medicine.'

The pack came about after an NHS Executive survey found that one in four adults used alternative remedies at some point in their lives. Every year, 11 per cent of us will visit a complementary therapist. The study only looked at acupuncture, osteopathy, chiropractic, herbal medicine, hypnotherapy and homeopathy. The figure rises to one in three if reflexology and aromatherapy are included.

In the days of fundholding, many practices referred patients for complementary therapies or allowed for their provision within the practice. But when PCGs were established much of this provision was removed because it was too expensive or difficult to roll out across the group, according to the National Association of Primary Care.

But a survey included in the guide showed that up to 58 per cent of PCGs still provide some access to complementary medicine.

NAPC chair Dr Peter Smith is a GP and practitioner of acupuncture and homeopathy. Any resurgence of referral to complementary therapists would be spearheaded by those enthusiasts, he says.

This may go some way to reassuring those alternative therapy practitioners concerned that GPs will use medical diagnosis to decide on the suitability of a particular alternative therapy.

Denise Tiran is a midwife and principal lecturer in complementary medicine at Greenwich University. She says: 'GPs have the ability to diagnose a gynaecological problem, for example, but what they don't have is the ability, as far as complementary medicine goes, to work out holistically what the problem is - because they're biomedically trained.'

She gives a cautious welcome to the guide, saying it is a starting point for informing GPs about complementary therapies. But she would like it to go further. The document, aimed at clinicians rather than PCGs, is 'superficial' in its account of what conditions can be treated by which therapies.

'For acupuncture, for example, they have only included chronic back pain, but it is also useful for all kinds of chronic pain.'

Dr Smith says the guide is intentionally restrictive, aiming to give GPs a flavour of which conditions could be treated with complementary therapy without making claims that might be harder to substantiate. 'If a referral doesn't work out, a GP will be less likely to refer that way again.'

And he feels that by listing those professional bodies, the guide helps draw a line between what Dr Smith calls 'weekend therapists' - those who had done just a few hours' training - and those who are qualified.

The involvement of the DoH is welcomed by the other collaborators, although a DoH spokesperson says the guide is about recognising a need for information, not an endorsement of complementary therapies.

More evidence is being collected by the House of Lords select committee on science and technology. Dr Dixon, who appeared before the committee's inquiry into complementary medicine last week, told them: 'Primary care clinicians should be open minded about the benefits of complementary medicine whether based on western scientific rationale or not.'

How effective are they?

The guide looks at the evidence for each therapy.

On acupuncture it says:

'there is reasonable evidence' supporting its use in lower back pain.

It is 'not possible to state with certainty' effectiveness in neck pain.

It is no better than a placebo in smoking cessation - but 'is associated with a sizeable placebo effect' that leads to 35 per cent of patients giving up.