By: Charlotte Stone

Abstract
Multi‑bed acupuncture clinics ‑ a recent and successful phenomenon in the UK ‑ utilise a new business model
for the provision of more affordable acupuncture treatments. Patients benefit from reduced cost of treatment
in exchange for some loss of privacy, and they overwhelmingly report being treated in a communal setting as
a positive experience. Practitioners benefit from a highly stimulating and supportive working environment, a
significantly increased potential client base and the satisfaction of providing more accessible treatment.

Acupuncture treatment in the UK has
predominantly been provided by a single
practitioner treating one patient at a time in
a private room, and usually staying with the patient
throughout the whole treatment, which might be
expected to last 45‑60 minutes in total. This is in
contrast to China, where cost‑ and patient‑ effective
treatment models have evolved over the centuries to
the current practice whereby patients usually receive
acupuncture treatment in large rooms containing
several beds. These effectively resemble the wards
found in conventional hospitals, although in this
case they are used for out‑patients. Thus one or more
doctors may treat several patients simultaneously.
Of all Complementary and Alternative Medicines
(CAM), acupuncture uniquely lends itself to this
style of practice, as needles usually have to be left
in the body for 10‑30 minutes. During this time, as
the patient rests, the doctor is free to treat another
patient.
The first well‑established clinic following a multi‑bed
model in the UK was the Gateway Clinic, London.
Founded by John Tindall in 1990, the clinic is funded
by the National Health Service’s (NHS) Lambeth,
Southwark and Lewisham Primary Care Trust (PCT),
and lies in the grounds of Lambeth Hospital. In 2004‑5
the clinic received £94,000 of funding and treated over
400 patients per week (Thomson, 2005), working out
at a fee of £4.52 per patient per treatment. All patients
must be referred by a general practitioner within the
local catchment area and can receive a maximum of
12 free treatments per referral. Patients with HIV and
Hepatitis C are given priority, can jump the waiting
list which is often several months, and can receive
unlimited treatments. Recently, due to constant
high demand and an ever‑expanding waiting
list, the clinic has had to restrict referrals to those
conditions clearly demonstrated by quality scientific
trials to be successfully treated by acupuncture,
i.e. musculo‑skeletal conditions, headache, cancer
treatment support, etc. In spite of this clinic’s perennial
cost‑effectiveness and popularity, its model has not
been replicated elsewhere in the NHS.
One of the first multi‑bed acupuncture clinics
independent of the NHS was the Dragon Acupuncture
Project in Brighton. It was founded in 2003 by Nik
Tilling and Calum Thomson out of a pragmatic need
to make a living in a town with a high number of
established practitioners, many new acupuncture
graduates, and a supportive but impecunious
population. It was inspired by the Gateway model, and
quickly became popular with the local community.
Other practitioners heard of the Dragon’s success,
or were themselves inspired by the Gateway, or
by clinics in the United States such as ‘Working
Class Acupuncture’ in Portland, Oregon, founded
by Lisa Rohleder, an eloquent and passionate
advocate for the integration of multi‑bed
acupuncture practice into American healthcare
(see www.workingclassacupuncture.org and www.
communityacupuncturenetwork.org). Since 2004,
13 new independent multi‑bed clinics have been
established in the UK, with more expected this year.

What is a multi‑bed acupuncture clinic?
I would like to propose a definition of multi‑bed
practice as one where a practitioner treats more than
one patient per hour in the same room, with the aim
of making acupuncture treatment more affordable.
Beyond that, it is clear that multi‑bed practice differs
widely from country to country and clinic to clinic:
“In the USA, an acupuncture treatment was more
commonly offered using recliner seats and point
prescriptions involving ’distal’ acupuncture points.
Charges were also often made on a sliding scale basis,
averaging $15‑35 per individual treatment. In the UK
a more traditional approach was taken to providing
low‑cost, multi‑bed treatments, where full‑body
acupuncture is more commonly used but on multiple
beds. Reduced rates are offered by treating more
than one person at a time, but usually on a fixed rate
averaging £15.” (Potter, 2008).

It is not exactly clear why the difference exists between
the two countries. I suggest that a ‘tradition’ has
rapidly emerged in each country, whereby the model
of practice in the first successful clinic has largely
been followed by subsequent clinics.
In the UK, multi‑bed clinic models vary widely.
The Gateway consists of a large room with nine beds,
some separated by screens. Another large room serves
as a waiting room, and a ‘drop‑in’ ear‑acupuncture
clinic. There is a small room where patients can talk
to their practitioner in private if necessary, although
this is rarely used. The clinic employs several salaried
practitioners and is popular for newly‑qualified
practitioners to intern. Each practitioner treats up to
three patients per hour.
Some independent clinics follow this model quite
closely, for example the Dragon Acupuncture Project
in Brighton, which also has up to nine beds, some
screened off. At the Dragon, as at many of the other
independent clinics, an additional private room is seen
as essential. It is always used to take the initial case
history, and is also available for any patient to discuss
issues that feel too personal to talk about within
earshot of other patients. The Dragon treats around
130 patients each week, employing three or four
practitioners, who treat up to three patients per hour.
Other clinics are run by just one or two practitioners,
who may treat between two and four patients each
hour. Practitioners may choose to split their practice
between multi‑bed and one‑to‑one practice; others
prefer just multi‑bed practice. Most clinics use an
appointment system, fewer operate a drop‑in system.
Some clinics have their own receptionist although this
is expensive; others may make use of the receptionist
provided by the clinic where they rent space, or use
an ‘invisible receptionist’ system1.
Some clinics have found success by working
alongside, and using rooms provided by, other
organisations, such as Age Concern (Four Gates,
Ealing, London). It would appear, in fact, that due
to financial realities, no independent clinic at the
time of writing enjoys full‑time use of its own space,
but instead rents spaces in other CAM clinics, yoga
studios, etc. This is not the case in the USA, where
rents are more reasonable.
Clinics may or may not provide auricular
acupuncture, facial acupuncture, Chinese herbs
or Chinese patent herbal remedies, tui na and
moxibustion, alongside traditional full‑body
acupuncture.
What are the advantages of multi‑bed practice
from the point of view of patients?
Obviously one of the main advantages for patients
is increased affordability of treatments: “With the
national minimum hourly wage currently at £5.52
(HMRC, 2008) and the national average hourly wage
equating to approximately £9.50 (Office for National
Statistics, 2007), a single acupuncture treatment
[in one‑to‑one practice] can represent more than a
day’s pay for many people. These figures suggest
that acupuncture is likely to be inaccessible to large
sections of the population.” (Potter, 2008).
Research at the Dragon showed that 90% of patients
were attracted to the clinic because of the cost of the
treatments, with 90% also reporting that the main
benefit of this was that they could afford to come as
regularly as they needed and perhaps afford to utilise
two therapies at the same time. In order to be effective
for certain complaints, acupuncture is best performed
intensively. However, in one‑to‑one practice in
the UK, a tradition (following the homeopathy/
psychotherapy treatment model and financial
constraints) has emerged of weekly treatment being
the norm. This is unrelated to practice in China and
may damage the prognosis for some conditions.
As Giovanni Maciocia points out, “You call weekly
treatment proper treatment for here, but that’s created
by social circumstances. We’re in private practice and
people can’t afford to come more often. If they could
they would come every other day” (Kaptchuk, 1985).
73% of patients at the Dragon Project reported that
they were either receiving social security payments,
or had chronic illness, and 59.6% of patients earned
less than £1500 per month, meaning they would not be
able to pay, or only pay infrequently, for the treatment
they needed at full (one‑to‑one) cost (Stone, 2006).
Another significant advantage for patients at the
Dragon was that the clinic filled their need for a sense
of community. The research showed that initially
patients were drawn because of the low cost, with
only 7.6% either aware of or actively supporting the
ethos of the clinic. However, after experiencing the
feel of the clinic for at least two treatments, 9.6% of
questionnaire respondents specifically mentioned
that they like the sense of community, 5.7% said
it reminded them they weren’t alone in having
problems, and 44.2% said they enjoyed the atmosphere
created when many patients were treated together.
11 out of 14 respondents who made extra comments concerning “unexpected positive aspects of being
treated at the Dragon” mentioned ‘community’. One
patient (male, aged 33) noted, “I think it is positive
to be seen in our conditions by others. It humanises
illness and distress and unifies us.” Another found
that, “It makes treatment less isolating, puts my
own treatment into perspective. Makes me feel less
precious and self‑involved” (male, 47). Some patients,
particularly those with long‑term illness, simply
appreciated the social aspect of the project and enjoy
the “friendliness of the clinic with people chatting
and enjoying each others’ company” (female, 70). We
notice, at the Dragon Project, that patients are now
as likely to recommend the clinic for its atmosphere
as for its low cost. This is borne out by the fact that
17.5% of patients are on salaries of £24,000 ‑ 36,000 per
annum, with 5.2% on more than £36,000, and could
therefore arguably afford more expensive treatments
(Stone, 2006).
Practitioners in several clinics have noticed that
patients seem to respond unusually well to treatment
in multi‑bed clinics. Tom Kennedy, of Four Gates,
Ealing, says, “I feel as though the dynamic created
by a shared healing environment definitely adds
something to the process. It doesn’t suit everyone, but
most people seem quite happy in this setting. There
is a ‘buzz’ at busy times which just isn’t present in
a private setting, and quite the opposite from being
distracting, I believe this invigorates most patients.”
There is also political/ideological appreciation
amongst patients of treatment being made available
to a wider section of the community. One patient
noted, “I like the idea of a cooperative venture that
aims to make acupuncture affordable to all – not
just middle class people with plenty of disposable
income” (female, 50). Another said, “There’s a kind of
collective feel about getting treatment in a room with
other people. And it is that sense of … that it’s a clinic
that’s dedicated to the welfare of a wider community,
in the same way that a doctor’s surgery is, you kind of
feel a part of something bigger.” (female, 39) (Stone,
2006).
40.3% of patients in the Dragon Project research
reported that they liked to be left alone during
treatment, rather than feeling obliged to chat with
their practitioner. They appreciated that in a multi‑bed
clinic, they were able to relax in peace, but of course
were not actually alone in the room and therefore felt
safe. One patient had experienced an abuse of dignity
when she was being treated in one‑to‑one practice in
the past; she felt safer and more comfortable being
treated in a room with several other people at all
times, “because the chances of these kinds of abuses
happening is so much reduced” (Stone, 2006).

Disadvantages from the point of view of patients
One of the most significant concerns for NHS patients
has been shown to be maintaining a reasonable level
of privacy/confidentiality during treatment (Douglas
and Douglas, 2003). Patients were shown to be more
likely to withhold information when talking to clinical
staff in curtained‑off areas in hospital than in areas
separated with solid walls (Barlas et al, 2001). This is
obviously relevant to multi‑bed acupuncture clinics;
the research from the Dragon Project clearly shows
that confidentiality is the single most common concern
that caused patients to report a ‘negative experience’,
with a smaller number of patients concerned about
removing their clothes or seeing others’ unclothed
bodies. Patients being treated for straightforward
physical complaints reported no problems with
confidentiality. As patients required more emotional
support or had to reveal very personal information,
the implications of being treated in close proximity
to other patients became more evident (Stone, 2006).
This shows that both patients and practitioners need
to be realistic about the limitations of confidentiality
in this type of clinic. How to deal with this –
provision of private spaces and screens and gowns, for
example – is up to each clinic. Anecdotally, patients at
the Dragon report that they feel able to comfortably
receive treatment for complex and emotional issues
because they know they can talk in private whenever
they feel the need. Patients should be made well
aware of the set‑up of the multi‑bed clinic before
they commence treatment, as this will constitute an
aspect of informed consent. It must also be noted that
staff sensitivity powerfully affects patients’ feelings
around privacy, both in the NHS (Bailey, 2005) and
in multi‑bed clinics. And, as mentioned above, once
comfortable in the multi‑bed setting, the pay‑off for
less privacy seems to be a sense of communion with
one’s fellow patients.
It is inevitable that there will be more noise in a
multi‑bed clinic than in a one‑to‑one clinic, and this
can disturb patients. Patients are less tolerant of
chatter that is not related to treatment, either from
staff or other patients, for example when friends
bump into each other or practitioners “talk shop”
(Stone, 2006). Patients tend to learn to modify their
behaviour, and again good boundaries and sensitivity
on the part of practitioners are required to make the
space effective.

Different clinics choose which treatment styles they will
utilise within the tighter time constraints of multi‑bed
practice. This may result in patients missing out on very
fine or time‑consuming treatment styles such as tui na,
moxa cones, etc. For example clinics in the USA generally
prefer to use distal rather than full body points, while
clinics in the UK are more likely to try to provide a very
similar treatment to one that a patient might expect from
a one‑to‑one treatment (Potter, 2008), but this may not
always be possible.
While most patients appear to enjoy the atmosphere
created in multi‑bed clinics, there will be some vulnerable
patients who are unable to feel safe or relaxed surrounded
by other people. Acupuncture can bring up intense
feeling states and practitioners need to be extra sensitive
to the needs of vulnerable patients. Patients in the Dragon
research reported feeling vulnerable when, for example,
they unexpectedly bumped into a work colleague they may
have struggled with or feared repercussions from; or when
another patient might inappropriately have commented on
personal issues they had overheard (Stone, 2006).
What are the advantages of multi‑bed clinics from
the point of view of practitioners?
The Dragon Project was set up to enable its practitioners to
earn a living where they were struggling to do so before,
and it has been successful in this by massively expanding
its potential client base. Patients with less disposable
income are now more able to access treatment. Also,
patients are able to afford treatment frequently enough
and for long enough to get better and stay better, and to
use acupuncture for ‘maintenance medicine’ once they
are better, meaning there is a high retention of long‑term
patients. It is also easier to publicise a clinic in the local
press that is offering something new or unique, rather
than being just another one‑to‑one practitioner in a busy
marketplace.
Multi‑bed practitioners will treat between two and
four patients each hour in the UK, and up to six in the
USA. High patient numbers allow for faster practitioner
development, as it may take many years to build up to such
numbers in a one‑to‑one practice. When one’s patients are
more relaxed about the financial demands on them, a more
satisfying and clinically successful treatment experience
may emerge for all. Nik Tilling, of the Dragon Project,
explains, “It’s important to recognise that acupuncture is
not just an intellectual process, which is one of the pitfalls
of the acupuncture courses currently available. In fact, the
actual act of acupuncture (needle insertion and engaging
with qi) isn’t intellectual at all; it’s all about developing
sensitivity to what is occurring in the present moment.
Speaking for myself, I wasn’t improving in that aspect of
my practice whilst I was struggling with limited numbers
of patients working one‑on‑one. Multi‑bed practice allows
you to relax into the clinical experience. The pressure to
give unrealistic prognoses due to the high cost of treatment
is eliminated.”
Practitioners in multi‑bed clinics enjoy the ethical
and ideological aspect of offering acupuncture to a
wider section of public. Stephen Potter, recent graduate
from Westminster University, says he chose to research
multi‑bed clinics, “because I am committed to social and
health provision for all, and could not work in a situation
that perpetuated the myth that acupuncture is only wanted
or needed by the upper middle classes. It is definitely an
ideological standpoint for me rather than an economically
convenient one; I am just so happy to feel part of a growing
movement.” Multi‑bed practice enables the provision of
cheaper treatment for those practitioners who do not wish
to work within the bureaucracy of the NHS.
There are constant opportunities for learning when
working in a team of practitioners. Every practitioner has
their own specialities and one may notice at any moment
a colleague using an unfamiliar point combination or
technique. It is straightforward to ask for a second opinion,
and one’s patient will know the other practitioner by sight.
This also eradicates the need to entrust one’s patients to an
unfamiliar locum, and we find at the Dragon for example,
that we have a high retention of patients when one of our
practitioners is away, whilst many of our ‘one‑to‑one’
colleagues complain of struggling with locum care.
Finally, just as patients are protected from abuses of
dignity because of the constant presence of witnesses,
so practitioners are protected from wild accusations of
malpractice for the same reason.

Disadvantages from the point of view of practitioners.
The only real disadvantage of multi‑bed practice is being
on one’s feet more than in private practice and having
to maintain the threads of several treatments at once. I
imagine this sort of practice will suit some people more
than others – it is more physically demanding, and I am
uncertain a practitioner could sustain this five days a week.
Practitioners at the Dragon work up to three days each
week, seeing between 50 and 60 patients (which is enough to
earn a living), and appreciate their rest days. However, the
physical demands are offset by working in an emotionally
supportive environment. Many practitioners complain of
isolation and loneliness in one‑to‑one practice, with only
their patients, who may be unwell, needy and draining,
for company. In multi‑bed clinics a practitioner talks less
and needles more, and it is becoming an unofficial talk
therapist that often seems to drain practitioners the most,
whereas needling is generally considered energising. It is
not only patients who feel the sense of ‘community’ that a
multi‑bed clinic provides, but the practitioners also form
a close team bond. Even those practitioners who run their

clinics alone report that treating several patients in the
room together generally prevents any individual patient
from draining their energy. To avoid burn‑out on a
daily basis, practitioners at the Dragon recommend
a long midday break with a satisfying lunch and a
siesta as essential.

Conclusion
There is and will remain a place, and a market, for
one‑to‑one acupuncture practice in the UK. However,
the various advantages of multi‑bed clinics mean
that patients are ever more likely to be treated in a
community setting. The largest drawback for patients
– lack of privacy – is countered by the destigmatising
effect of receiving treatment in a community
space. The largest drawback for practitioners – the
demanding pace – is countered by the support of a
team and the ability to earn a living by working three
days a week in a busy clinic. The multi‑bed business
model has shown itself to be successful, and I believe
that multi‑bed practice will form a significant part of
the future of acupuncture practice in the UK.
Charlotte Stone has been involved with the Dragon
Acupuncture Project in Brighton, UK since 2004, initially
as administrator, then as practitioner when she qualified
in 2006. She has practiced NADA auricular acupuncture
in a group setting since 2004 and is a certified instructor of
qigong. She coordinates Affordable Acupuncture UK, an
organisation which aims to promote and support multi‑bed
clinics in the UK.

Affordable Acupuncture
Affordable Acupuncture UK was founded in 2007 to
inform the public and practitioners about multi‑bed
practice and to support and encourage the emergence
of new multi‑bed clinics. The Affordable Acupuncture
UK website (www.affordableacupunctureuk.co.uk)
listed three new clinics just in the month of July,
2008. If you would like further information on
multi‑bed practice in the UK, or are interested in
setting up a clinic, please contact Charlotte on info@
affordableacupunctureuk.co.uk.

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at http://www.affordableacupunctureuk.co.uk/links.html
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Endnotes
The “invisible receptionist” system may vary in details from clinic
to clinic, but essentially frees up practitioner time by allowing
patients to book appointments themselves. A clinic will provide
a diary, with instructions, a pencil and appointment cards for
patients to fill in after each treatment. Patients may be coded
by numbers or initials to protect confidentiality. Inside the
treatment room, patients will be handed an envelope into which
they place their payment, posting it in to a payment box.