Integration of chiropractic care in healthcare systems

BCA member, Marc Sanders who practices in Ealing, West London, talks about his journey so far as a CRC-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.

Even before I started studying chiropractic at the AECC University College’, I knew that I wanted to become involved in research to help promote the chiropractic profession and the great outcomes that it can achieve for our patients. I had become well immersed into the profession through the experience and stories of chiropractic through my late father, Bryon Sanders, who practiced in his own clinic in Nottingham for nearly 20 years. What surprised me the most is that the chiropractic profession, at least in the UK, is not well-recognised and we do not appear to have a high degree of professional legitimacy, despite the extent and breadth of academic learning that is required to become a chiropractor.

This realisation drove me to undertake a CRC-funded PhD at the Faculty of Medicine at University of Southampton, of which I have now completed the first year. I joined a team of MSK researchers, including my PhD supervisors; CRC funded Research Fellows, Professor Dave Newell and Dr Jonathan Field, Dr Jane Vennik – an experienced qualitative researcher in Primary Care in the School of Medicine, and chiropractor Dr Neil Osborne, who has a rich background of experience in different types of collaboration including the setup of chiropractic services within NHS GP clinics in Bournemouth. My PhD is in Primary Care and Population Sciences, and my research topic is on the integration and collaboration of chiropractors with and within healthcare systems, with a specific focus on UK chiropractors.

Integration can be defined in many ways depending on its context; therefore, it is better to see integration as a spectrum of working relationships from simple behaviours, such as referring patients via clinical letters to other healthcare professionals all the way to full immersion within a healthcare system via employment and the associated roles and scopes of practice that define those roles. Some research in this area has been published, however the reasons as to why integration is successful or not has not been clearly defined to inform how integration may occur, let alone the ways in which the UK chiropractic profession would like to integrate with the NHS.

I feel that, as a profession, whilst we would not want integration in a form of a ‘borg-like’ assimilation where we potentially lose our professional identity and skills by merging with a healthcare system, we may benefit from known and unknown opportunities by working within or align with the NHS. As well as obvious benefits to improvement of patient care through increased access to chiropractic care, there are also intraprofessional opportunities associated with integration, for example, expansion of current career pathways and roles for existing and new UK graduates. Integration can help to create new ways and structures of working, as already seen in healthcare systems in other countries, such as the well-respected employed roles in the US Veterans Health Administration, and chiropractors working in novel roles such as in radiology departments within Danish hospitals. My work will help to highlight the breadth of options of integration by giving model examples from the data I gather from different healthcare systems throughout the world.

I am currently in the process of conducting a systematic review using realist methodology to explore and describe current integrated care services that involve chiropractors in different international settings and contexts, more specifically the barriers and facilitators to integration. Realist methodology can be more useful than that adopted by a traditional systematic review which simply asks, ‘What works?’; instead, realist methods are more pragmatic as they ask, ‘What works, for whom, in what circumstances and why?’. This method will help to discover transposable lessons from similar healthcare contexts that we can use for the NHS in the future, with the aim to avoid repeating strategies that have already been shown not to work and to build upon existing strategies that sustain integration.

As part of this review, I am looking to have short informal chats with chiropractors who have previously or are currently working with or within the NHS during any time from the 1990’s onwards, to map these UK barriers and facilitators. If you are a chiropractor in the UK who has been involved in working with or within the NHS, such as obtaining an NHS contract, or working as an AQP or FCP as an example, please could you contact me by email to see if you might be able to help: The data from these informal chats will not be quoted, however they will help to verify the accuracy of potential UK chiropractic integration models to help guide types of integration that we would like to be available in the future.

In the latter parts of my PhD, I intend to conduct short interviews with UK chiropractors to find out what we think about integration and what forms of integration would be most useful to us (2022), and based on this data conduct a national survey of UK chiropractors to be inclusive of as many diverse views about UK integration as possible (2023). The results from these studies will be published to help build a foundation of data upon which we can use to inform the direction we can take next as a profession towards integration.