The Medicines and Healthcare Products Regulatory Agency (MHRA) is responsible for regulating medicines in the UK. This includes ensuring that medicines and medical devices are safe and bringing prosecutions when medicines legislation has been broken.
On 5 January 2011, the MHRA confirmed that homeopathy and the regulation of homeopathic products are included in the EU Directive on pharmaceuticals and are a treaty obligation of the UK. Registration of homeopathic products for marketing is conditional on quality and safety criteria and evidence that the product is indeed a homeopathic product (as recognised by homeopaths). However, the powers of the MHRA (given by Parliament) allow it to regulate the marketing of products; not the activities of practitioners or the choices of patients.
Homeopathy is a form of complimentary and alternative medicine which takes a holistic approach to diagnosis and is based on the idea of treating “like with like”. It is based on a theory that substances which cause symptoms in a healthy person can, when vastly diluted, treat similar symptoms in a sick person. Homeopathic remedies are of botanical, chemical, mineral or animal origin and are prepared by a process of successive dilution..
The current regime: should we be concerned?
The governance of homeopaths appears disjointed and somewhat confusing. Whilst there are self-regulated professional associations of homeopaths (the Society of Homeopaths being the largest), there is no regulatory body overseeing the profession as a whole. This is despite previous attempts to establish an independent single registrar.
The British Homeopathic Association works closely with the Faculty of Homeopathy, based at the Royal London Hospital for Integrated Medicine, whose health profession members integrate homeopathy into their practice. Whilst it is possible to search the list of members of the Faculty, it would seem that it only covers those already qualified under another medical discipline (and who are governed by other bodies such as the General Medical Council, Royal College of Nursing and the General Dental Council amongst others).
As of 27 September 2010, the General Pharmaceutical Council (GPC) took over the regulatory functions of the Royal Pharmaceutical Society of Great Britain (RPS). The GPC has responsibilities under the National Health Service Reform and Health Care Professions Act 2002 in relation to the monitoring of health professional regulatory bodies, which includes fitness to practice. The RPS has in the past investigated homeopaths and taken remedial action. Factors considered (as with other fitness to practice assessments) included the practitioner demonstrating insight, whether a remedial action had been taken and if the individual was a current risk to patients. However, the method of reporting a concern about a homeopath seems unclear from a patient’s perspective.
There are four recognised and NHS funded homeopathic hospitals in the UK, based in London, Bristol, Glasgow and Liverpool and a third of primary care trusts in England are still funding alternative medicine (according to a recent poll by “GP” magazine (18 February)). The Government currently appears content with homeopathy continuing to be funded, with PCTs responsible for making decisions locally. This is despite calls to curb spending and/or ban homeopathic remedies (including by the British Medical Association).
As part of the Government’s plans to devolve central agencies of many healthcare decision making and funding functions, the availability of homeopathic medicine will increasingly be determined by GPs at a local level. However, it is unclear what, if any, guidance will be given as to whom referrals should be made. GPs across the country are currently able to refer to the four NHS funded hospitals irrespective of location, although it would appear that this is not common practice.
For GPs wishing to refer patients for more local homeopathic treatment, there is currently no one source of approved practitioners to ensure that patients receive treatment from an appropriately qualified and regulated practitioner.
How can GPs ensure patient safety?
We understand The Society of Homeopaths is now working towards applying to the Health Professions Council (HPC) for statutory regulation. This is a multi-professions regulator which already regulates psychologists, dieticians and art therapists (amongst others). If successful, this will be a clear progression for the profession bringing it alongside other complimentary medical practices. However, it seems unlikely that any decision will be made in the coming year.
Given the call for a strengthened system for regulating healthcare practitioners and products elsewhere, and in light of the continued debate about the beneficial effect of homeopathic medicine, we suspect that homeopathy will continue to remain under scrutiny.