Acupuncture and dry needling

Acupuncture and dry needling are two common modalities that members may wish to practise as a standalone service.


Can acupuncture and/or dry needling be part of physiotherapy practice?

Important note

Yes. Acupuncture and/or dry needling may be part of physiotherapy practice and sits within the fourth pillar of practice – kindred modalities.

The essence of physiotherapy practice is that practitioners adhere to the HCPC Standards of Proficiency for Physiotherapists which includes exercising clinical reasoning and professional judgment in their activities at all times.

You may wish to practise within just one pillar or across all four pillars. If you choose to focus on offering for example, acupuncture or dry needling services, you may do so provided that you meet HCPC practice standards and make it clear that you are working as a physiotherapist.

Frequently asked questions on the exclusion of thoracic acupuncture from the PLI scheme from 1 July 2024

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 e.g acupuncture, dry-needling, 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, under-lying lung tissue such that pneumothorax is a foreseeable risk to treatment.
  • Please refer to our Pneumothorax Learning From Litigation article 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 either an employer, or other indemnity provider.

Which CSP members are affected?

These changes only affect member providing thoracic acupuncture/needling. All other acupuncture/needling remains covered by the PLI scheme, (except acupuncture for fertility/infertility 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 to 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 need 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 health care 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 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 Tel: 01245 321185

What is the difference between acupuncture and dry needling?

Each modality has differences in its philosophy, physiology, point location and practice.

What training do I need for acupuncture/dry needling?

The only physiotherapy modality that legally requires evidence of post-registration approved training and registration is prescribing.

You must however ensure that you are educated, trained and competent in the activities you undertake as part of your practice so that you ensure you deliver a ‘reasonable standard or care’ to your patients. This means that you may choose any acupuncture and/or dry needling course that meets your requirements, and if necessary the requirements of your employer.

If you have completed an acupuncture and/or dry needling course overseas you should be sure that the learning outcomes achieved overseas enable you to practise safely in the UK, according to UK standards of acupuncture and/or dry needling physiotherapy practice.

At the current time, the CSP does not set out any specific educational expectations of acupuncture and/or dry needling educational programmes, nor does it verify that any programme is approved for UK practice. We are aware that there a range of courses available to members, which are provided by a range of educational and commercial providers. Members should make sure, before they undertake any training, that the course provides them with the knowledge and skills they need in order to establish their own competence to practise acupuncture and/or dry needling as a physiotherapist.

Some employers may require you to undertake a specific educational programme, and any course you undertake may not necessarily be transferrable to another employer. Once you have established your competence in acupuncture and dry needling you must undertake appropriate CPD activities to ensure that you maintain your ongoing competence in acupuncture and/or dry needling.

Do I have to say that I am a physiotherapist when using acupuncture and/or dry needling in my physiotherapy practice?

Yes. Many patients may be reassured to know that their acupuncture or dry needling is being delivered by a registered health professional and so you may find it useful in promoting your services. All your acupuncture and dry needling services must have an element of assessment, professional judgement and record keeping to them in order to meet the HCPC standards of practice, and therefore be considered part of physiotherapy practice.

Does the CSP PLI scheme cover acupuncture and dry needling used as part of physiotherapy practice?

The CSP PLI scheme covers all activities within the scope of physiotherapy practice, subject to the policy terms and conditions. There is an exclusion relating to the use of acupuncture to treat fertility problems. From 1 July 2024, the PLI scheme will exclude cover for thoracic acupuncture

Do I need to get any additional licenses or registration to practise acupuncture and/or dry needling?

Yes. Both are skin-piercing interventions and in the UK these are subject to additional Local Authority licensing and registration. The terms of the licensing and registration varies around the UK. You must contact your local authority and find out what the local rules are. It is likely that you will need to pay a fee to be registered to use acupuncture and/or dry needling.

Some authorities may take into consideration your requirement to be HCPC registered as a physiotherapist when deciding the licensing requirements they need. Some local authorities may allow a group practice registration as opposed to each practice physiotherapist registering individually.

Do I have to offer acupuncture and/or dry needling in a physiotherapy department?

No. You can offer your services wherever you feel your patients would best benefit. This might be in their homes, in gyms, village halls, clinic rooms or physiotherapy departments. Remember, acupuncture and dry needling are subject to Local Authority licensing, and you will need to check what additional registrations may be needed in your local area. You must also ensure the safe storage, transportation and disposal of needles, as well as hygiene and infection control issues.

Do I need to join AACP?

No. Practicing acupuncture and/or dry needling as a physiotherapist is not predicated upon belonging to a CSP professional network. Membership of a professional network such as AACP, does not provide exclusive evidence of the ability to demonstrate appropriate standards of education or fitness to practise in acupuncture and/or dry needling.

Physiotherapists who can demonstrate that they have undertaken an appropriate course in acupuncture and/or dry needling provided by a commercial, professional body or Higher Education Institution, and maintained their fitness to practise in this modality, should have no difficulty in providing a safe service to patients.

However, joining a recognised professional network may offer additional benefits such as access to CPD activities and peer support. Some employers and other organisations require their employees to belong to AACP in order to practise acupuncture and/or dry needling in their workplace. Members should be aware that this is a local requirement, and an employer is permitted to require such membership, if it is reasonable to do so, for the purposes of employment.

Can I offer cosmetic acupuncture and/or dry needling to patients as a physiotherapist?

No. This is because purely cosmetic interventions that have no physiotherapeutic purpose are outside the scope of physiotherapy practice. All physiotherapy practice has an element of therapeutic purpose and professional judgement aimed at addressing health and wellbeing needs relating to human movement, performance and function.

What kind of record keeping do I need to make when using acupuncture as part of physiotherapy practice?

You must keep some kind of record to show you meet the HCPC standards of proficiency for physiotherapists. The level and complexity of assessment and record keeping that you do will vary according to the context of your decision to provide acupuncture and/or dry needling, and the background health status of your patient.

Do I need separate insurance to offer acupuncture or dry needling?

Yes, if you are not offering these services as part of physiotherapy practice. This is because you are not working as a physiotherapist and your work is therefore not covered by the CSP PLI scheme. You should make alternative arrangements for your insurance. You will need separate insurance if you are offering acupuncture for fertility related problems as part of physiotherapy practice, or from 1 July 2024 id you wish to offer thoracic acupuncture services.

What about if I want to offer acupuncture and/or dry needling as part of my other work as, for example, an acupuncturist?

You will not be covered by the CSP PLI scheme. This is because the CSP PLI scheme only covers activities within the scope of physiotherapy practice, subject to policy terms and conditions. You should make alternative arrangements for your insurance for your non-physiotherapy work.

Further information

Acupuncture Association of Chartered Physiotherapists (AACP)

The CSP insurance brokers:
James Hallam
Saxon House
Duke Street
Essex CM1 1HT

01245 321185


James Hallam website

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