In pursuit of trying to understand “Osteopathy: the Profession” in 2015, I have been reading my osteopathy magazines more closely than usual. In the Osteopath Magazine, I saw a tantalizing invitation to the next General Osteopathic Council Meeting (Thursday 16 July). “Meetings take place at 10am at Osteopathy House. Osteopaths are welcome to attend. For more information call Marcia Scott.” The day before the meeting I phoned Marcia and was told yes, that would be fine. I duly turned up at Osteopathy House (between Tanner and Druid St on Tower Bridge Rd, South of the Thames) just as the Council members were also arriving. I was met by Marcia, introduced to Tim Walker the Chief Executive and Registrar, and shown to a comfortable seat at the edge of the meeting room. I became aware that I was attracting curious looks from council members. I looked around for the other observers. “Am I the first one?” “You’re the only osteopath observing”, said Marcia. A council member kindly made me coffee, inquiring if I was part of a special interest group -(I was not) – “You’re probably the first registrant in eight years to attend”, he told me. I was surprised. Considering this is the seat of power, and these decisions affect all of our lives, I had assumed there would be observers from the institutions, or different osteopathic groups, or even just curious registrant members like myself. (Registrant is GOsC-speak for us osteopaths, and the osteopaths that sit on the council are registrant members.) Apparently the chief exec from iO is nearly always there on our behalf, but rarely nobody could attend this particular meeting.
So seeing as none of you have ever been, I will set the scene for you. The council meet on the ground floor of Osteopathy House. They sit in a large room with a typically office-y artificial ceiling and windows onto the street (they are tastefully stencilled with the GOsC symbol). It is where they hold committee meetings. They sit at desks which fit together to form a large circle. There are about 20 people present. I did try to do a headcount but it’s a bit like Oxfordshire’s Rollright Stones – each time you count them you get a different figure. There are some osteopaths there. (Of the seven osteopath members of the Council, all seven are male. Not sure what this says, but come on, girls!) There are a few GOsC staff, including the accountant and Brigid the head of Policy and Communications. And some other people. Who they were I have no idea. I guess they are the Lay members. (The official council is made up of 7 osteopaths and 7 lay members.) Tim Walker is obviously there, and to his left the meeting was chaired by an extremely admirable and able lady called Alison White. She is not an osteopath. She told me she was very experienced at knowing how businesses and organisations work. She even called it “corporate governance”. I was impressed just by that, to tell you the truth. As she gave me a brief sketch of her career she mentioned shipping regulation and the Houses of Parliament, so evidently she is not just friendly and approachable, but a high-powered mover and shaker.
Once I realised they were unused to spectators, I felt awkwardly as if I might be cramping their style and inhibiting their discussion. However Tim and Alison made me feel right at home, formally introducing me with big smiles at the start of the meeting. In fact, by the coffee break I realised that I was not so much a suspicious intruder, more an object of curiosity and delight. They were positively honoured to have a real live registrant member there, and wish more would come. I told Alison I’d expected 10 or 15 other osteopaths. “We’ll know we’ve arrived then”, she said. “Why don’t you write about it? Put it on Facebook, or Twitter”, she urged me. Brigid gave me a guided tour of the building, introduced me to all the GOsC staff, and impressed upon me that they would love osteopaths to come to visit them more, so that we’d realise they don’t have horns, or a big stick.
Listening to the meeting was a bit like tuning into a long-running drama that you’ve never seen before, with references you don’t know and interpersonal dynamics you don’t understand because you don’t know the history nor the characters. The members all have a pile of papers in front of them that they refer to but obviously you are not privy to those. Despite all this, it is still quite enlightening. So I am going to whizz through the things I understood, some of the things I didn’t, and try to pass them on to you, with the proviso that you please understand that I might have got things wrong and this is no substitute for the official minutes. Risks and benefits fully explained, here we go….
What is the ODG (osteopathic development group)?
Apparently the chairs of the Educational Institutions met some people from GOsC and it became clear that they didn’t know much about the Osteopathic Development Group (ODG). They are not alone. I’ve been hearing about this Group for a little while now, and am aware that it is associated with some kind of forward movement in osteopathy, but don’t really have a clue what involves. The GOsC resolved to beef up communications somewhat. (NB The Chairs are not the Principals, who I am sure are totally up to speed with the ODG.)
Duty of Candour
There is a new “Duty of Candour” requirement which is going to be communicated to registrants. There was some question that it might conflict with the requirements of Professional Indemnity Insurance, but that has been found not to be a problem. To understand what and why this has arisen, does the phrase Mid-Staffs Hospital Scandal ring any bells with you? After between 400 and 1200 patients were believed to have died due to poor care at Stafford Hospital over a four(ish) year period, the phrase ‘mid-Staffs’ has become a byword for NHS negligence. This spawned a series of inquiries, one of which was the Francis Inquiry. His report (2013) included a recommendation for a duty of candour with patients and their families when harm has been caused. He realised that the general covering-up and failing to admit mistakes when something has gone wrong only makes things much worse. The GOsC with other regulators agreed something that worked in an osteopathic setting in 2014. On their website they specify that we must
- tell the patient (or, where appropriate, the patient’s advocate, carer or family) when something has gone wrong;
- apologise to the patient (or, where appropriate, the patient’s advocate, carer or family);
- offer an appropriate remedy or support to put matters right (if possible); and
- explain fully to the patient (or, where appropriate, the patient’s advocate, carer or family) the short and long term effects of what has happened.
This sounds eminently sensible and I am almost relieved to have a formal obligation to be honest, rather than be in a situation where I wonder whether I should admit failings or not. Along the same lines, there was also mention that iO are putting together a Patient’s charter.
Complaints – Papers to be sent electronically
There has been a pilot in which case papers were sent electronically to a committee. Pleasingly this went smoothly with no security breach. Apparently the PCC (Professional Conduct Committee) and Health Committee don’t get papers in advance and the first day of a case is given over to reading the papers. It seems quite inefficient to me, as it did to many members of GOsC. They are considering sending them electronically in advance. The security implications were discussed (ie laptop could be left on a train) but the risk was deemed acceptable.
There were 16 cases this year and 16 last year of individuals who possibly don’t have the right to call themselves osteopaths, calling themselves osteopaths (i.e. a breach of the Osteopaths Act). There are 51 complaints overall on the books. i.e. a staggering minimum of 19 cases still being dealt with even though they must be at least 2 years old. I’m not sure who these people are? Honest but financially strapped osteopaths who are struggling to pay their fees, or ex-osteopaths using the word in their marketing, or massage therapists or outright fraudsters? While I was struck with horror at the thought of enduring the stress of the sword of Damocles hanging over my career for that long while I tried to live and work and look after my children, Alison had the regulator’s hat on and was more concerned that 1% of the Profession might be practising when they might have no business to be calling themselves osteopaths at all. Whatever hat you’re wearing, it still seems a long time.
There was a statutory appeal scheduled at the High Court on 28th July.
London Property Prices
No you haven’t strayed onto the Daily Mail website in error. Due to the exciting but slightly unsettling rocketing London property market, the property owned by GOsC is to be revalued, but the value of the building and the value of the land (which is the thing really going up in value) were to be valued separately . I’ve no idea why; some esoteric dark art of accountancy, I imagine. There was a decision to adopt something called the FRS102. Any accountants out there will know what this is. I don’t think it needs to concern us unduly. And the reappointment of external auditors. I didn’t really understand this bit. The head of the Audit Committee made a brief guest appearance here.
Interim Suspension Guidelines
Guidance talks about imposing a limit on interim suspensions. I think this is where someone has been suspended for, say, 6 months. At the end the suspension has been renewed and another period of suspension has been imposed. The Council believed that this might be acting beyond their powers, and might be challenged. Apparently someone has had their suspension extended three times (the mind boggles), but I think there is a resolve to clarify what Council can actually do or not.
The GOsC publishes more details of complaints/Fitness to Practice rulings than the GMC. It was felt by at least one member that this increased detail results in less speculation, and less speculation is a good thing.
Council Member Allowances
In May 2016 the rate of reimbursement for Councillors will rise by 13%. They have a high workload, they are merely making the rate competitive, and besides the number of councillors might be going down to ten in any case. (5 osteos plus 5 lay members) This is the first increase in five years.
New Corporate Plan
There is a new plan, currently they are doing initial scoping.
CPD Courses and Quality Assurance
The Osteopathic Educational Institutions (ie colleges) are all now mapping their courses to the Osteopathic Practice Standards. There was a question over whether CPD should also give that quality assurance. However Tim (who seems remarkably good at seeing things from the point of view of other people) thought that that would be driven by the registrants seeking courses which fulfil those things they need for their CPD. He said the CPD Consultation showed that people were against that quality assurance approach.
PSA Performance Review
Now one thing I hadn’t realised is that there is an upward chain of regulation. We live under the umbrella, or in the shadow, of GOsC to whom we pay fees, while they impose CPD and standards and generally police us, but they have something called the PSA, which they have to pay and provide lots and lots of evidence to in order to show that they are doing an OK job as a regulator. PSA stands for Professional Standards Authority and oversees nine health care regulators, including ours. But ours, and we can be proud here, are the only regulator to have achieved good standards of regulation for the past 5 years. It sounds a daunting workload and it sounds a bit like Ofsted, in that you need to do more and more and provide more and more detail in order to get the same rating, so they have done really well.
There are various things that they might also like GOsC to do, which GOsC are resisting. One is to have an online complaints system. The Council’s view, however, is that it might attract frivolous complainers (such as the one who objected to towels not being warmed) and create a pointless load of work and stress for everyone, for a trivial complaint which should have been nipped in the bud. (At the same time, nobody wants delays to serious complaints. There was a case which ended in a removal from the register where the complainer took months to pluck up the courage to complain.) There was a little discussion at this point over complaints initially being called “informal”, while waiting to become formalized. It didn’t seem quite the right word, and implied something that could be dealt with outside a formal process. In reality I think it is a complaint waiting to be screened to see how serious it is.
The PSA also felt that admonishment should have a time period. Tim again sensibly said that he viewed admonishment as an event, rather than a kind of box of shame you have to sit in for a specified time (my words not his – if it’s not in quotes, it’s not a quote).
I’m not sure how closely the GOsC has to adhere to the wishes and opinions of the PSA, but it sounded like Tim is treading on the common sense side of the line, however fine. I think there is a bit of an issue with the fact that the PSA oversees nine different health regulators, and it is important that they can accommodate the differences and allow a correct level of autonomy for different regulators. Tim made a point of emphasizing the difference between uniformity and consistency, and does not want everyone to have to do everything the same way, as everyone gets locked in, and innovation is stifled. “Uniformity is the enemy of innovation” were his exact words. There is a debate regarding active or passive regulation i.e. looking at results versus looking at process. And the audit model looks at process (ie how long does it take for complaints to be processed) rather than outcome (ie how effective is the regulation). It’s obviously interesting to we osteopaths, who practise in very individual ways and who like to be autonomous in our treatments, to hear that GOsC have similar issues.
Our fees have gone down, but the levy (what they call the fee) to the PSA is going up by 25%.
Next special guest was Dawn Carnes who made a brief appearance to inform GOsC about the work of NCOR (National Council for Osteopathic Research). Now, cards on the table, NCOR is close to my heart. I have years of fond memories of discussing papers in a cosy cerebral fug, sustained by instant coffee and chocolate biscuits, while Carol Fawkes transmitted herself live via a phone (on speaker) perched in the middle of the room; a calm and authoritative, albeit disembodied, presence. It was here that I learnt that I could whittle down a list of about 100 orthopaedic shoulder examinations to 3 (Neer’s, Hawkin’s and Speed’s); that there was no standard exercise advice for post-op hip replacement patients; that if you have a knee cartilage op when you’re young, you’ll probably end up with a knee replacement when you’re older. And so on, and so on. Somehow, in this cosy crucible, the dry practice of combing through confusing and dense research yielded reams of clinically useful information, and helped us to become confident to think critically and feel like we were at least a bit up-to-date with research, and in touch with each other. So NCOR has been a tremendous force for the profession, implementing a research infrastructure at grassroots level. They also have more centralized projects which Dawn reported on.
- PILARS . (Patient Incident Learning and Reporting System) This is for us all to use. We post a narrative of something that went wrong or could have gone wrong in practice, anonymously, and other osteopaths can comment on it. I have honestly not gone to look at this yet but I think it’s only a matter of time before we are all using it as a forum for support and information, and I hope that we learn more about the safety of all of our techniques and treatments through it, and feel a bit less isolated.
- PROMs (Patient reported outcome measures). I might have got this slightly wrong. There is an effort to compile a national dataset of outcomes. This whole idea is going down well with the wider healthcare community. There is one system whereby osteopaths report, which went OK, and one which patients report, which was not as well used. Patients can do this using a special phone app. The main way to let patients know about it is via their osteopaths, so it needs motivated osteopaths and they need motivated patients. The osteopaths get fed back lots of useful data about their patients from NCOR, which might help audit and market their practice. CPD ALERT: with the new CPD scheme with its self-audit requirements, you could earn points for yourself here, get some free marketing information for your practice, and help get some solid research for the profession i.e. kill several birds with one stone. I think it’s had a pilot so far. More info from NCOR website here
NCOR have relaunched their website and made it smart phone friendly.
There is a research priorities study underway. I think research is essential and wrote an article on the very subject recently.
Regarding finances: NCOR is now a charity, making financial management more flexible, but fundraising is their main issue. With 2 schools closing there will be less finance from the Colleges, and it seems to be quite hard to get British osteopaths to click that Paypal button. Of £9,300 that NCOR has raised through crowdfunding for a systematic review into the effects of manual therapy treatment for children, 70% came from abroad. Research is increasingly important, and we collectively are the only people who are realistically going to pay for it, as we are the people who are going to benefit from it. Tim and Alison sounded hugely keen and supportive of NCOR, and while NCOR is brimming with brainpower and enthusiasm, you can’t do much without the funds.
Development of CPD
GOsC is going to publish the feedback from the CPD consultation. An external consultant will analyse the feedback. The report is due late August. Nearly 500 people attended meetings, about 200 people responded to the online consultation, and there was written feedback from over 170 osteopaths who attended the consultation meetings. And there were probably plenty of people like me who had a good look at the proposals just after the closing date for feedback. Here is my brief overview of the new CPD requirements: NB not the official version and not checked by GOsC for accuracy.
The meeting went private
At this point, the public part of the meeting was over. I was warmly thanked for my attendance and at about 3pm, after 5 hours of meeting (including one coffee break and a welcome interlude at the “Cat and Cucumber” for bacon and eggs), I headed back for the train. I’d learnt more about GOsC and what they do that day than I had previously learnt in my whole career.
Verdict: Highly recommended for purposes of demystification and information, and in the spirit of that oft-quoted experiment that the act of observing changes the nature of the thing being observed, the more osteopaths attending the better, I would say. Don’t be shy.