When Regulation Protects – and When It Starts to Exclude

Regulation matters. In a profession like acupuncture, it should. Patients should be able to trust that the person treating them is competent, that infection prevention and control is taken seriously, that sharps and clinical waste are managed properly and that treatment takes place in a safe environment.

The concern is not regulation itself, but what can happen when well-intentioned rules are interpreted in ways that create barriers which may never have been intended. That question has become particularly important in Wales following the introduction of the Special Procedures Licensing Scheme.

The scheme has brought much-needed clarity around standards, accountability and public protection. But it has also exposed some practical difficulties, especially for small independent practitioners, shared clinical spaces and low-cost community services.

Community acupuncture and access

One of the clearest examples is community acupuncture. In 2023, I started a low-cost community acupuncture clinic from a local community centre in Pembrokeshire. The aim was simple: to make acupuncture more accessible to people who may not have been able to afford regular private treatment.

For many people, acupuncture is not a one-off appointment. Treatment may continue over a number of weeks, and cost can quickly become the deciding factor. Community acupuncture offers another route into care. It does not replace private practice; it widens access.

When the new licensing requirements came in, however, the model became increasingly difficult to sustain. Under the interpretation I was given at the time, the person responsible for the community venue would also need to take on additional responsibilities, including Level 2 infection prevention and control training and the cost of a premises licence. Together, those requirements came to around £600.

For a community venue allowing an independent practitioner to use a room for only a few hours each week, that was understandably a significant commitment. The clinic closed, and the real loss was not simply a few hours of work. It was the disappearance of an affordable local service.

As far as I am aware, no equivalent service has replaced it. That raises an important wider question: if a community clinic is safe, well-managed and appropriately supervised by a licensed practitioner, should there be a more proportionate route that allows it to continue?

When shared premises become complicated

The same issue can arise in another setting: practitioners renting treatment rooms inside shared premises. This is a common model across acupuncture, complementary healthcare and other small clinical businesses.

A practitioner may rent one room within a larger building, remain entirely responsible for their own clinical work and have no involvement with the rest of the premises. Yet under some interpretations of the licensing requirements, the wider premises owner may be expected to take on additional responsibilities for a special procedure they neither perform nor supervise.

For many landlords and clinic owners, that can be enough to make them decide not to rent the room at all. What appears to be a technical licensing issue can therefore have a very real effect on public access. If suitable rooms become harder to rent, practitioners have fewer places to work. If practitioners have fewer places to work, patients have fewer places to access treatment.

That is why consistency matters.

The contradiction that deserved closer attention

One of the clearest contradictions in the current system is the relationship between clinic-based and mobile acupuncture.

A practitioner may be able to provide mobile acupuncture following an appropriate risk assessment, yet establishing access to a dedicated treatment room can sometimes prove more difficult because of premises-licensing requirements. That is difficult to reconcile.

A private home is an environment the practitioner does not fully control in advance. A dedicated clinical room can be assessed, equipped and organised specifically around infection prevention and control, with appropriate hand washing, cleanable surfaces, safe storage and a controlled treatment environment.

If the more controlled environment becomes the more difficult option to establish, it is reasonable to ask whether the regulatory balance is working as intended.

Looking across Wales

This question became more significant when I contacted six different local authorities across Wales to understand how the same regulations were being interpreted.

Several councils confirmed that it was possible, in principle, for an individual practitioner to rent a room within shared premises and take responsibility for that compliant treatment space, provided all relevant standards and licensing requirements were met.

That raised a wider issue. If practitioners are working under the same national legislation, they should not be receiving fundamentally different answers depending on the local authority area in which they happen to practise.

Licensing officers absolutely need discretion. Every building is different, every treatment room is different, and every application needs to be assessed on its own merits. But discretion should sit within clear and consistent national guidance.

Practitioners need to know what is possible, landlords need to understand what they are responsible for, and patients should be able to trust that the same national scheme is being applied fairly and consistently.

A positive clarification

I wrote directly to Welsh Government setting out these concerns. Within three days, Welsh Government had contacted Pembrokeshire County Council and raised the matter.

I later received direct correspondence confirming that the rules should be clear and consistent across Wales. I was also given confirmation that it was possible for a practitioner renting a room within shared premises to hold both their practitioner licence and the relevant premises licence, provided all required standards could be met.

That clarification was important because it did not create a route around regulation; it clarified how practitioners could comply with it.

For small independent practitioners, that distinction can make a significant difference. It means there can be a workable route for someone to take responsibility for the treatment space they actually use, without automatically requiring an unrelated landlord or business owner to accept responsibility for clinical procedures they do not carry out.

I am genuinely delighted that practitioners in Pembrokeshire now have much clearer guidance and a far more workable path for everyone operating under the Special Procedures Licensing Scheme. That is a positive outcome for practitioners, landlords and the public.

The community question remains

The clarification around shared premises is welcome, but community acupuncture remains unresolved.

I have now written back to Welsh Government specifically asking whether there could be a proportionate route for licensed practitioners to provide occasional low-cost acupuncture from suitable community venues.

This is not a request for lower safety standards, nor is it a request for exemption from infection-control requirements. It is a request for a practical pathway.

If a practitioner can demonstrate appropriate hand hygiene, cleanable surfaces, safe sharps management, clinical waste procedures, suitable equipment, proper risk assessment and full responsibility for the service being provided, then the question deserves serious consideration.

Affordable access matters. Someone living with long-term pain may not be able to pay private treatment fees every week. Someone under financial pressure may simply decide acupuncture is beyond reach. In rural areas, where choice is already limited, the loss of a low-cost service can be felt even more strongly.

Good regulation should protect the public, but protection and accessibility should not have to be competing aims.

What this says about acupuncture as a profession

The Welsh experience also highlights a wider issue within acupuncture itself. The profession is highly fragmented, with different professional associations, training routes, schools and traditions of practice.

Some practitioners belong to PSA-accredited voluntary registers, while others belong to different organisations or have followed different educational pathways. During the discussions around the Welsh regulations, arguments were made that some practitioners should be exempt from licensing because of their professional membership, training standards or voluntary registration. Welsh Government did not accept that approach.

Whatever view practitioners take on that decision, it highlights an important reality: there is no single organisation representing every acupuncturist, and there is no single route into practice. There are highly skilled and competent practitioners across different organisations, training backgrounds and traditions.

That makes collaboration more important, not less.

There will always be legitimate debate around standards, education and scope of practice, and those discussions are necessary. But there are also times when our shared interests are more important than our organisational differences.

When regulation begins to determine where practitioners can work, how they can work and whether some services remain viable at all, the profession needs to be able to speak collectively.

That does not mean every association becoming the same, and it does not mean every practitioner agreeing on every issue. It means recognising the principles we do share: patients should be protected, practitioners should be competent, regulation should be proportionate, rules should be clear, and national legislation should be applied as consistently as possible.

Greater collaboration across organisational boundaries would strengthen the profession’s ability to engage constructively with government and regulators. A profession speaking together on shared concerns is more likely to be heard than one speaking in separate and sometimes competing parts.

Wales offers an important lesson

Wales has taken a significant step in introducing mandatory licensing for these special procedures, and what happens here is worth watching.

As regulation develops elsewhere in the UK, even where the exact schemes and procedures differ, the Welsh experience offers an important lesson. Once regulation becomes statutory, practitioners need to engage with it. They need to understand it, comply with it and participate in conversations about how it operates in practice.

At the same time, when something appears unclear, inconsistent or disproportionate, practitioners should feel able to question it constructively.

Public protection requires effective regulation, but effective regulation also requires clarity, consistency and a willingness to respond when unintended consequences emerge.

Challenging regulation is not opposing it

Supporting regulation does not mean never questioning how it is implemented. Believing strongly in patient safety does not prevent practitioners from asking whether an interpretation is proportionate, and respecting the role of licensing officers does not mean avoiding difficult questions.

Sometimes constructive challenge is exactly what helps a new system become clearer and fairer. The clarification now available in Pembrokeshire is evidence of that.

But it should not be the end of the conversation.

Community acupuncture still deserves proper consideration. The profession still needs a stronger collective voice. And regulation still needs to protect the public without making safe, affordable care harder to reach.

That, ultimately, is the balance worth fighting for.

You can find my live petition on the Senedd website. Please do consider signing and sharing it to help support our industry and encourage a fair, proportionate and workable approach to regulation across Wales.

https://petitions.senedd.wales/petitions/247071

Leah Cross

Acupuncturist

Welsh Representative, Acupuncture Regulatory Authority (ARA)