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Case/Article Review 7


​You have two minutes to read the enclosed article, and you will subsequently be asked a range of questions by the interviewer. You may wish to make notes, however please note you will not be allowed to refer to your notes or the article during the discussion.

​​
A 2010 House of Commons report found homeopathic remedies performed no better than placebos - dummy treatments. In 2017, NHS England recommended that GPs and other prescribers should stop providing it. It said: "There is no good-quality evidence that homeopathy is effective as a treatment for any health condition" while the National Institute for Health and Care Excellence (NICE) does not recommend using homeopathy for any clinical condition. But the practice remains popular with some patients seeking alternative or complementary treatments.

The governing body of Bristol, North Somerset and South Gloucestershire (BNSSG) CCG, which oversees NHS services in the area, said about 40 new patients per year received NHS-funded homeopathic consultations and the overall cost in 2017-18 was £109,476. It needs to make savings of £37m in the coming financial year. "This equates to around a further 22 hip replacements or 170 cataract operations," it said.

The CCG decided to restrict referrals, at its public meeting on Tuesday. Clinicians will now need to set out why their patient is "clinically exceptional" and require the treatments. Dr Jonathan Hayes of the BNSSG CCG said: "We've looked at the balance of evidence... and collectively, taking all that into consideration, we've come to the conclusion we shouldn't continue to fund this service in our area."

"Staff and clinicians from across the CCG have closely examined the full range of clinical evidence available from both sides of the debate, consulted with local people, clinicians, patient groups and providers of homeopathic treatments," said Dr Peter Brindle, BNSSG medical director for clinical effectiveness.

But Margaret Wyllie, Chair of the British Homeopathic Association, said: "This demonstrates a lack of long-term decision-making by NHS bosses and helps to explain the ongoing NHS crisis. "The amount of money spent on homeopathy by Bristol CCG is a tiny fraction of the local NHS budget but is of enormous value to the patients who benefit from the treatment, many of whom are elderly, and have chronic health conditions.

"The CCG should evaluate the impact on the future health, and costs to the NHS, for the homeopathy patients once the service is removed."
 
(Adapted from: https://www.bbc.co.uk/news/uk-england-bristol-45028622)
​

 Outline the main issues raised.
​


Average Candidate Response
This article explores whether homeopathic medicine should be available on the NHS and raises a number of ethical considerations, such as whether it is financially justifiable or if the same money would be better spent on other areas of the NHS.
​
Excellent Candidate Response
The main issue described in this article is the potential disbandment of homeopathic treatment, and the consequences this could have on patients suffering from chronic health conditions.

The article states that providing homeopathic remedies to patients can have significant economic costs; with the NHS already under financial pressure, it is suggested that the money spent on homeopathy could be used for more pressing or consequential cases that have clear success rates, such as hip replacements or cataract operations. Ultimately, one cannot be certain that homeopathic remedies have as great a benefit on patients’ health as standard medical practices.
​
On the other hand, one potential flaw of this plan is its application. It is said that clinicians would only prescribe homeopathy to patients if their cases were ‘clinically exceptional’ – this could create a challenge of identifying ‘where to draw the line’ as clinicians are likely to disagree which individuals should qualify for such treatment, and which do not. By withholding such therapy, it could also be argued that patients would no longer have the choice of what treatment they wish to receive, a fact that could compromise their autonomy. 

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