Ministry of Health Seeks Public Feedback on Proposed Changes to Policy on Acupuncture

12 Jul 2005

The Ministry of Health (MOH) plans to revise its current policy on acupuncture and would like to invite the views and feedback of the public, the medical community and the traditional Chinese medicine (TCM) community on this proposal. There have been suggestions for TCM services to be available at healthcare establishments for patients' convenience, without compromising safety. MOH has drawn up a set of guidelines to facilitate this and is seeking public views and feedback.

All feedback should be submitted online via the MOH website at www.moh.gov.sg by 15 Aug 2005.

CURRENT SITUATION

Currently, MOH allows hospitals and nursing homes licensed under the Private Hospitals and Medical Clinics (PHMC) Act to have full service TCM clinics (including acupuncture, tuina and herbal medicine services) to be co-located within their premises. The TCM clinic must however be clearly projected as a distinct entity (e.g. different name) and clearly demarcated from the conventional medical services and is not projected as part of the conventional medical services provided by the hospital.

In addition, acupuncture services can currently only be provided at clearly distinct and separate outpatient areas in the healthcare institution and not in the inpatient wards or specialist outpatient clinics.

PROPOSED CHANGE

MOH has reviewed its current policy on acupuncture in hospitals and nursing homes and proposes a set of revised guidelines on the "Provision of TCM Services in Acute and Extended Care Hospitals and Nursing Homes" at Annex A. The key features of the guidelines are as follows:

1. Acupuncture services can now be provided in inpatient wards and specialist outpatient clinics.

2. Hospitals and nursing homes that wish to provide acupuncture services should review and update the list of conditions suitable for such modality of treatment based on the latest clinical evidence.

3. Hospitals and nursing homes that wish to provide acupuncture services for conditions where the evidence of efficacy is lacking will have to provide them under a clinical trial basis, subject to the standard scientific and ethical review and approval from the relevant authorities.

4. The registered medical practitioner in charge of the patient must ensure that the referral is appropriate and the reasons and consent for referral are properly documented.

5. Registered TCM practitioners providing acupuncture services need not be under the supervision of registered medical practitioners. However, they are answerable to the TCM Practitioners' Board for their actions.

6. Hospitals and nursing homes that require credentialing of practitioners should require the TCM practitioners to be credentialed to provide acupuncture services in their respective institutions.

RELATED DOCUMENTS

Proposed Guidelines on the Provision of TCM Services (see Annex A)

Annex A

(PROPOSED) GUIDELINES ON THE PROVISION OF TCM SERVICES IN ACUTE AND EXTENDED CARE HOSPITALS AND NURSING HOMES (2005)

Co-located TCM Clinic

1. A full service TCM clinic (including acupuncture, tuina and herbal medicine services) can be co-located within the premises of acute and extended care hospitals and nursing homes licensed under the Private Hospitals and Medical Clinics (PHMC) Act.

2. The TCM clinic will be considered a separate entity and will not come under the purview of the PHMC Act. The healthcare institutions (HCI) should however keep MOH informed of the setting up of the co-located TCM clinic.

3. The HCI concerned must take steps to ensure that the TCM clinic is clearly projected as a distinct entity (eg. different name) and clearly demarcated from the conventional medical services and is not seen as part of the conventional medical services provided by the hospital.

4. As TCM is not under the purview of the PHMC Act, the co-located TCM clinic can set its own policy with regards to its referral system and TCM services to be provided. However, the TCM clinic must ensure that its TCM practitioners have the appropriate registration with the TCM Practitioners Board.

Provision of Acupuncture Services

1. Acute and extended care hospitals and nursing homes licensed under the PHMC Act that wish to provide acupuncture services as part of their package of services to their patients can proceed to do so. These services may include appropriate general TCM diagnosis and consultation as part of the acupuncture treatment, but must exclude the use of other TCM treatment modalities.

2. The acupuncture service could be provided by the HCI's own doctors (who are registered acupuncturists), TCM practitioners employed by the HCI or TCM practitioners of the co-located TCM clinic. The TCM practitioner who is engaged by the HCI to provide acupuncture services must not administer other modalities of TCM to the patient.

3. HCI that require credentialing of practitioners should require acupuncturists to be credentialed in their respective HCI.

4. The provision of acupuncture services should be in accordance with the clinical evidence. The use of acupuncture for conditions where evidence of clinical efficacy is lacking should be carried out with full disclosure and documentation, or on a clinical trial basis, subject to the standard scientific and ethical review and approval from the relevant authorities.

5. The acupuncturists/TCM practitioners would be allowed to see patients referred by the registered medical practitioner in the outpatient clinics and the wards.

6. The TCM/acupuncture practitioner is answerable to the TCM Practitioners' Board for his actions. If the acupuncturist is also a registered medical practitioner he would be answerable to the SMC too.

Referral for Acupuncture Services

1. The registered medical practitioner in charge of the patient is responsible to assess whether acupuncture is appropriate for the patient and refers the patient accordingly. The registered medical practitioner in charge must explain to the patient the reasons for recommending acupuncture and ensure proper documentation of the reasons for referral and obtain informed consent.

2. Inpatients would not be allowed to seek acupuncture treatment on their own accord. Outpatients may on their own accord (i.e without a doctor's referral) choose outpatient TCM treatments at the co-located TCM clinic, in which case they would be considered as any walk-in-patients to the TCM clinic.