Skip to main content
    • Aa
    • Aa

Health-care sector and complementary medicine: practitioners’ experiences of delivering acupuncture in the public and private sectors

  • Felicity L. Bishop (a1), Nicola Amos (a2) (a3), He Yu (a4) and George T. Lewith (a5)

The aim was to identify similarities and differences between private practice and the National Health Service (NHS) in practitioners’ experiences of delivering acupuncture to treat pain. We wished to identify differences that could affect patients’ experiences and inform our understanding of how trials conducted in private clinics relate to NHS clinical practice.


Acupuncture is commonly used in primary care for lower back pain and is recommended in the National Institute for Health and Clinical Excellence's guidelines. Previous studies have identified differences in patients’ accounts of receiving acupuncture in the NHS and in the private sector. The major recent UK trial of acupuncture for back pain was conducted in the private sector.


Semi-structured qualitative interviews were conducted with 16 acupuncturists who had experience of working in the private sector (n = 7), in the NHS (n =3), and in both the sectors (n = 6). The interviews lasted between 24 and 77 min (median=49 min) and explored acupuncturists’ experiences of treating patients in pain. Inductive thematic analysis was used to identify similarities and differences across private practice and the NHS.


The perceived effectiveness of acupuncture was described consistently and participants felt they did (or would) deliver acupuncture similarly in NHS and in private practice. In both the sectors, patients sought acupuncture as a last resort and acupuncturist–patient relationships were deemed important. Acupuncture availability differed across sectors: in the NHS it was constrained by Trust policies and in the private sector by patients’ financial resources. There were greater opportunities for autonomous practice in the private sector and regulation was important for different reasons in each sector. In general, NHS practitioners had Western-focussed training and also used conventional medical techniques, whereas private practitioners were more likely to have Traditional Chinese training and to practise other complementary therapies in addition to acupuncture. Future studies should examine the impact of these differences on patients' clinical outcomes.

Corresponding author
Correspondence to: Dr Felicity L. Bishop, Primary Medical Care, Aldermoor Health Centre, Aldermoor Close, Southampton, Hampshire SO16 5ST. UK. Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

V. Braun V. Clarke 2006: Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77101.

H. Breivik , B. Collett , V. Ventafridda , R. Cohen D. Gallacher 2006: Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. European Journal of Pain 10, 287333.

J. Dale 1997: Acupuncture practice in the UK. Part 1: report of a survey. Complementary Therapies in Medicine 5, 215220.

K. Dew 2000: Deviant insiders: medical acupuncturists in New Zealand. Social Science & Medicine 50, 17851795.

Z. Di Blasi , E. Harkness , E. Ernst , A. Georgiou J. Kleijnen 2001: Influence of context effects on health outcomes: a systematic review. The Lancet 357, 757762.

E. Ernst 2010: Assessments of complementary and alternative medicine: the clinical guidelines from NICE. International Journal of Clinical Practice 64, 13501358.

M.A. Evans , A.R.G. Shaw , D.J. Sharp , E.A. Thompson , S. Falk , P. Turton T. Thompson 2007: Men with cancer: is their use of complementary and alternative medicine a response to needs unmet by conventional care? European Journal of Cancer Care 16, 517525.

J. Ezzo , B. Berman , V.A. Hadhazy , A.R. Jadad , L. Lao B.B. Singh 2000: Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain 86, 217225.

L. Franck , C. Chantler M. Dixon 2007: Should NICE evaluate complementary and alternative medicine? British Medical Journal 334, 506.

A.D. Furlan , M. van Tulder , D. Cherkin , H. Tsukayama , L. Lao , B. Koes B. Berman 2005: Acupuncture and dry-needling for low back pain: an updated systematic review within the framework of the Cochrane Collaboration. Spine 30, 944963.

J.G. Hughes , J. Goldbart , E. Fairhurst K. Knowles 2007: Exploring acupuncturists’ perceptions of treating patients with rheumatoid arthritis. Complementary Therapies in Medicine 15, 101108.

K. Linde , G. Allais , B. Brinkhaus , E. Manheimer , A. Vickers A.R. White 2009a: Acupuncture for migraine prophylaxis. Cochrane Database of Systematic Reviews, 2009, Issue 1. Art. No.: CD001218. DOI: 10.1002/14651858.CD001218.pub2.

K. Linde , G. Allais , B. Brinkhaus , E. Manheimer , A. Vickers A.R. White 2009b: Acupuncture for tension-type headache. Cochrane Database of Systematic Reviews, 2009, Issue 1. Art. No.: CD007587. DOI: 10.1002/14651858.CD007587.

H. MacPherson , L. Thorpe K. Thomas 2006a: Beyond needling – therapeutic processes in acupuncture care: a qualitative study nested within a low-back pain trial. The Journal of Alternative & Complementary Medicine 12, 873880.

H. MacPherson , N. Sinclair-Lian K. Thomas 2006b: Patients seeking care from acupuncture practitioners in the UK: a national survey. Complementary Therapies in Medicine 14, 2030.

H. MacPherson K. Thomas 2008: Self-help advice as a process integral to traditional acupuncture care: implications for trial design. Complementary Therapies in Medicine 16, 101106.

E. Manheimer , A. White , B. Berman , K. Forys E. Ernst 2005: Meta-analysis: acupuncture for low back pain. Annals of Internal Medicine 142, 651663.

C. Paterson N. Britten 2008: The patient's experience of holistic care: insights from acupuncture research. Chronic Illness 4, 264277.

S. Price , S.W. Mercer H. MacPherson 2006: Practitioner empathy, patient enablement and health outcomes: a prospective study of acupuncture patients. Patient Education and Counseling 63, 239245.

J. Ratcliffe , K.J. Thomas , H. MacPherson J. Brazier 2006: A randomised controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis. British Medical Journal 323, 626. Doi:10.1136/bmj.38932.806134.7C, bmj.

A. Shaw , E.A. Thompson D. Sharp 2006: Expectations of patients and parents of children with asthma regarding access to complementary therapy information and services via the NHS: a qualitative study. Health Expectations 9, 343358.

K.J. Thomas , P. Coleman J. Nicholl 2003: Trends in access to complementary or alternative medicines via primary care in England: 1995–2001 results from a follow up national survey. Family Practice 20, 575577.

K.J. Thomas , H. MacPherson , L. Thorpe , J. Brazier , M. Fitter , M.J. Campbell , M. Roman , S.J. Walters J. Nicholl 2006: Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. British Medical Journal 333, 623.

K. Trinh , N. Graham , A. Gross , C.H. Goldsmith , E. Wang , I.D. Cameron T.M. Kay 2006: Acupuncture for neck disorders. Cochrane Database of Systematic Reviews, 2006, Issue 3. Art. No.: CD004870. DOI: 10.1002/14651858.CD004870.pub3.

A. White , S. Hayhoe , A. Hart E. Ernst 2001: Adverse events following acupuncture: prospective survey of 32,000 consultations with doctors and physiotherapists. British Medical Journal 323, 485486.

S.N. Willich , T. Reinhold , D. Selim , S. Jena , B. Brinkhaus C.M. Witt 2006: Cost-effectiveness of acupuncture treatment in patients with chronic neck pain. Pain 125, 107113.

C.M. Witt , R. Lndtke , K. Wegscheider S.N. Willich 2010: Physician characteristics and variation in treatment outcomes: are better qualified and experienced physicians more successful in treating patients with chronic pain with acupuncture? The Journal of Pain 11, 431435.

D. Wonderling , A.J. Vickers , R. Grieve R. McCarney 2004: Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care. British Medical Journal 328, 747.

J. Yuan , N. Purepong , R.F. Hunter , D.P. Kerr , J. Park , I. Bradbury S. McDonough 2009: Different frequencies of acupuncture treatment for chronic low back pain: an assessor-blinded pilot randomised controlled trial. Complementary Therapies in Medicine 17, 131140.

F.L. Bishop , S. Zaman G.T. Lewith 2011: Acupuncture for low back pain: a survey of clinical practice in the UK. Complementary Therapies in Medicine 19, 144148.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
  • URL: /core/journals/primary-health-care-research-and-development
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 3
Total number of PDF views: 24 *
Loading metrics...

Abstract views

Total abstract views: 127 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 25th September 2017. This data will be updated every 24 hours.