Exploring Healthcare Integration: The role of chiropractic care within the NHS

BCA Communication Committee Member, Marc Sanders, who practices in Nottingham, talks about his journey so far as a Chiropractic Research Council-funded PhD student at the University of Southampton; his chosen research topic is on integration of chiropractic care in healthcare systems with a particular focus on UK integration.

I think my decision to research integration of chiropractic care started with the complaints my late father, Bryon Sanders, who practiced in his own chiropractic clinic in Nottingham for nearly 20 years, had about how chiropractors collaborated with the NHS. It still surprises me how little other healthcare professionals know about the extensive training chiropractors have and how we can help patients who are suffering from musculoskeletal (MSK) conditions. It is also a surprise that a significant number of GPs/healthcare professions don’t know that we are regulated. It’s a duty for BCA members and chiropractic professionals to push forwards what we know and find ways to improve what we do as chiropractors. Research shouldn’t be seen as a limit on what we do, it should create opportunities for what we can do so our profession can continue to grow and thrive.

I think, and due to what I have discovered through researching in this area so far, that direct exposure and experience with chiropractors can positively influence the relationships we have with other healthcare professionals. These ‘boots on the ground’ experiences can really have an impact in changing negative perceptions about the chiropractic profession in the UK, and informing other healthcare professionals about the high level of competency we have regarding the diagnosis and management of MSK disorders for patients.

Integration in practice

Integration can be seen as a spectrum; from working better with the NHS at the ‘private practice – NHS’ interface to the opportunities for employed roles in the NHS for chiropractors. There are, therefore, many opportunities along this spectrum for our profession to engage with other healthcare professionals, to create a shift in perspectives for the long-term.

Through my work in private practice and knowledge of chiropractors currently working in the NHS, I have already seen a positive change. This is not only in GP’s knowledge base about our profession but in GPs who include chiropractors as another healthcare professional to signpost their patients to in private practice, alongside physiotherapists and osteopaths. One example includes the high satisfaction of a group of GPs in Dorset with the MSK services provided by chiropractors and the high level of confidence they have in these chiropractors seeing their patients instead of them. We are looking to publish these results, which include patient outcomes and satisfaction, as soon as possible. There are of course still healthcare professionals that are ill-informed or under-informed so there is more work to be done, but maybe this is because they lack direct experience with chiropractors, given that the vast majority of care that is delivered by chiropractors is within private practice in the UK.

Research of healthcare integration

Through my research as part of my PhD of three research studies, I have been mapping out international models of chiropractors working with other healthcare professionals and healthcare systems; this will help us to have an overview of what might work best for the UK (through a type of systematic review that looks at the causes of the success and failure of different models). For the second study, which is now well underway with 18 chiropractors who have already been interviewed, I aim to help us to understand the problems, solutions, and aspirations of the UK profession towards working with the NHS. Or in other words, what do we want, what don’t we want, how do we want it to look like over the next 5-20 years and beyond, and how can we create something that is sustainable. It’s not a simple question of whether we want to be involved with the NHS or not, as we are already involved when we hear the experiences of our patients, whether that is past experiences or experiences when we refer patients into the NHS for care that they require. I see it more as a question of ‘how can we improve this relationship with the NHS for the benefit of our patients so that they receive the care they deserve?’.

Enhancing integration through structural reform

It is clear that we need a strategy. or set of strategies, to improve this relationship with the NHS, but it is not for me to decide these strategies and ways of working. These strategies should be created based on the aspirations and needs of individual groups of chiropractors in the UK. Again, this isn’t a black and white problem, different groups and demographics of chiropractors will have different needs; some will prefer to stay 100% in private practice whilst others may want to work in the NHS on a part-time basis due to commitments at home, to see a different variety of patients compared to clinic practice and develop their competencies and skills further in areas that they are clinically interested in, or to work in larger team-based environments. Some chiropractors have said that whilst they are happy working in private practice alone, they would like there to be a choice for other chiropractors in the UK profession to work in the NHS.

So, if this isn’t a question of ‘are we in or out?’ with respect to the NHS, what would you like it to look like in your area of the UK for your needs and those of other chiropractors?