Thoracic acupuncture

What is changing with thoracic acupuncture?

From 1 July 2024, the CSP is excluding cover for acupuncture/needling used around the thoracic region and/or the thoracic organs. Cover will remain for claims arising from its use before this date.

The thorax is the part of the human body from the below the neck (below C7 cervical vertebra) and above the abdomen. The thorax includes the anatomical areas bounded by the ribs, the sternum, the spinal vertebra, and the diaphragm. The thoracic area contains the internal thoracic organs including the heart and the lungs.

We are not providing a list of excluded points. This is because:

• Nomenclature of points is not consistent across all modalities that use needling techniques – for example, acupuncture, dry-needling and injection-therapy all have different point location naming systems.
• We expect all registered physiotherapists, by virtue of their training in anatomy, to be able to confidently identify where the thorax is and clinically reason whether a needling location lies over, or near to, underlying lung tissue such that pneumothorax is a foreseeable risk to treatment.

Please refer to our Learning from litigation: pneumothorax document for more detailed information.

Have you removed thoracic acupuncture from the scope of physiotherapy practice?

No. Thoracic acupuncture has only been removed from the scope of indemnity cover provided by the CSP PLI scheme. Thoracic acupuncture, like all acupuncture (except for in/fertility), remains within the scope of physiotherapy practice.

Members may continue to use it provided they are educated, trained and competent in the modality and have appropriate indemnity in place from an employer or other indemnity provider.

Which CSP members are affected?

These changes only affect members providing thoracic acupuncture/needling. All other acupuncture/needling remains covered by the PLI scheme, (except acupuncture for in/fertility, which is already excluded), subject to policy terms and conditions. If you work in the NHS or are employed by an independent hospital provider, you may not need to do anything as your indemnity for all the work carried out as part of your employment is provided by your employer. You can continue to provide acupuncture services in line with your service specification.

If you work in independent practice as a private practitioner, either as a sole trader, practice principal or contractor; run your independent practice through a limited company or partnership; or undertake any of your own work outside the scope or your employment, you must take action now to either stop providing thoracic acupuncture/needling services from 1 July 2024 or seek additional insurance cover for these services.

Why is the CSP making this change with thoracic acupuncture?

Regrettably, the CSP PLI scheme has continued to receive a regular and frequent number of claims relating to pneumothorax from the negligent use of acupuncture/needling over the thoracic region. There is no defence to such claims and the CSP PLI scheme pays out a significant sum of money to people harmed by negligent use of acupuncture/needling in the thoracic region.

The CSP needs to take pragmatic risk-management decisions based on balancing the need to provide a viable and sustainable PLI scheme for the majority of members, with the need to contain the costs of the PLI scheme to the CSP as a whole.

What happens after 1 July 2024 for thoracic acupuncture?

No cover will be provided for claims relating to the use of thoracic acupuncture/needling. The CSP PLI scheme will continue to provide cover for claims arising from thoracic acupuncture/needling that was undertaken prior to 1 July 2024, subject to the policy terms and conditions.

What about patients with muscle hypertrophy or structural abnormalities of skeletal anatomy around the neck and shoulders?

As with all your patients, you must have an appropriate knowledge of both surface and underlying structural anatomy when you use acupuncture/needling and be able to apply this theoretical knowledge to the specific context, circumstances and presentation of your specific patient.

Where any structural abnormality or physical presentation is actually or potentially present that means you cannot be clear on the location of the underlying thoracic structures, you may wish to consider an alternative intervention to avoid the risk of negligent pneumothorax to your patients.

What if patients demand thoracic acupuncture from me, or say they undertake it at their own risk?

Your duty of care to your patient remains at all times and it cannot be waived or delegated. Patients do not have the right to demand any specific intervention where a healthcare professional does not believe it is clinically appropriate.

Where members believe they are justified in providing thoracic acupuncture services, from 1 July 2024 they must seek alternative insurance for this activity.

Where can I find further information about insurance for thoracic acupuncture?

Neither the CSP nor Acupuncture Association of Chartered Physiotherapists (AACP) are regulated by the Financial Conduct Authority (FCA) to give insurance advice to individual members.

For specific insurance-related enquiries, please contact the CSP insurance brokers James Hallam on 01245 321185.