There’s nothing to be afraid of.  That seems to be the general feeling from everyone I’ve spoken to.  I missed our local regional meeting and missed the deadline for feedback, but having spent a while this morning trawling through the CPD proposals, I feel  reassured and even somewhat inspired to start planning my future CPD.  I’m a tad disappointed that it doesn’t begin to kick in till 2016.  I am particularly relishing the opportunity to purchase brand new stationery, thus satisfying Standard 4 (maintain a CPD folder) and indulging in one of life’s more innocent pleasures at one stroke.

The new guidelines don’t seem that far from the current CPD guidelines, but are more structured and have some specific requirements.

Varied but Relevant Activities

No longer will we be able to spend 30 hours trailing around starry-eyed after our favourite course leader like a groupie.  (Standard 1 – CPD is relevant to the full range of osteopathic practice).  We will have to do a broader range of activities tailored to our specific practice (i.e. if you do research you need to improve your research skills, if you manage a big practice you need to improve your managerial skills, if you only treat marathon runners over 50 you can’t confine yourself to paediatric cranial courses, you get the idea…)  We also have to make sure that all four areas of the Osteopathic Practice Standards (OPSs) are represented.  In case they’re not on the tip of your tongue they are A – Communication and Patient Partnership, B – Knowledge, Skills and Performance, C – Safety and Quality, and D – Professionalism.  It’s worth looking them up on the GOsC website because though the titles might sound a bit vague, they are fleshed out quite specifically under the main headings and it might give you ideas for cpd activities.  There is actually a new box on the cpd summary form which requires you to state which OPS is covered by each activity.

An objective activity involving patients or colleagues

We will need one activity including input from peers or patients.  (Standard 2 –  Objective activities have contributed to practice)  How you do this is up to you, but suggestions range from the fun and sociable (role playing a consultation with colleagues and getting their feedback), to the nerdy (clinical audit) to one for the more conversationally-minded  (talking through case histories with colleagues).   I personally like the idea of anonymized patient questionnaires,  although this does open me up to the disconcerting possibility that I will spend months trying to figure out which patient thinks I talk too much, or that my footwear is not smart enough.   A theme running through the CPD guidelines is also very explicitly stated here – feedback and learning must lead to demonstrable change in your practice.  I.e. it is no good getting incredible insights into the strengths and weakness of your commnication style, or learning dozens of fantastic new visceral techniques,  without them being integrated into what you do and how you do it in your day to day work, AND being able to show this.

Three hours on communication and consent

We also have to do a recommended three hours (over three years) on communication and consent.  (Standard 3) Helpfully the GOsC have included directions to a number of approved resources which I sincerely welcome.   There is an e-learning module, YouTube conference videos presented by Steve Vogel and Pippa Bark, and links to relevant research as well.  They’re on the dedicated cpd website cpd.osteopathy.org/uk.  Click on 8 and scroll down a few pages to a page titled References.  I have spent many years aware that consent has become increasingly important, and I’ve been keen to get it right, but not quite sure exactly what I’m meant to be doing.  I’ve stopped thinking getting someone to tick a box at the first consultation is enough, but I really do need to know what the current thinking is, not least because I don’t want to be referred to the Professional Conduct Committee on grounds of failure to get consent in the worst case scenario.

Peer Discussion Review

Finally we have to have a ‘Peer Discussion Review’ (PDR) every three years to check that we’ve done enough CPD, and it’s been of the right sort, and we are better at what we do because of it.  And then plan our next 3 years.  The GOsC have helpfully provided a template to ‘walk us through’ this meeting, which should last a maximum of about 90 minutes, complete with advice on what to do if you realise you need to whistleblow a colleague half way through, or if you have a number of abortive attempts at a PDR without being able to get anyone to approve it.  That sounds mighty formal and serious, particularly as there is the option of it being conducted by institutions (who might just charge us a fee for the privilege), but I feel that we are being eased gently into this by being allowed to swap PDRs with a trusted colleague (and to sweeten that even further we get CPD hours whether we are the reviewer or the reviewee). It seems that while the general public understandably and rightly want more independent PDRs, (presumably to guard against a couple of incompetent and cackhanded chums ganging up together over a beer to fabricate a plausible PDR,) we osteopaths are an insecure lot; terrified of being criticized, judged, found wanting and maybe ultimately suspended, admonished or even struck off.  In fact the language of the proposals is unrelentingly reassuring, positive and encouraging.  The culture GOsC want to foster is described variously as “respectful”, “safe”, and “supportive”.  We are encouraged to “help colleagues feel valued”, have an “attitude of curiosity and ability to learn”, to create a “safe space”, and “promote discussion”.   The language is of giving and receiving, embracing, valuing, participating. Genuinely.  I think they are saying:  We’re not the big bad wolf!  And lay those undergraduate demons to rest!  You’re safe now. No power tripping tutor is going to publicly humiliate you.  We’re here for you, to help you. Support you.  Be the best that you can be.  Feel the love in the room!

As an aside, a couple of interesting nuggets of information are contained within the proposals: supposedly 96% of patients are satisfied (or very satisfied) with their osteopathic treatment (a figure I find wonderfully high, and I think I might be bringing the average down) and the number of fitness to practice cases is proportionately lower than that for doctors or chiropractors.  This level of patient satisfaction gives us a great bedrock to work on.  However the isolation of osteopaths is also highlighted.  Over half of osteopaths work alone, and a fifth of all osteopaths spend over half their time working from their own home.   This does raise the possibility of individuals going off at strange tangents (treating a tennis elbow by chanting their guru’s favourite mantra and advising a beetroot and jaffa cake diet), or feeling lonely and helpless with difficult work situations.

I am as wary of Big Brother as anyone, but I do think that as a small profession with a dare-I-say nebulous and shifting identity,  small evidence base and  unclear future direction, raising skill levels might be crucial to our survival.  I am skeptical about homeopathy, but I want to be able to see a homeopath if I want, and buy homeopathic medicines.  At the moment homeopathy is coming under a sustained and concerted attack due to its lack of scientific evidence.  By ensuring that osteopathy has a high standard of teaching and hands on skill, and shows a commitment to self-scrutiny and research we will help to protect the right for people to choose osteopathic treatment.  Rather than being Big Brother, The GOsC might actually be our protection from a bigger Big Brother.