I turned up for my second ever meeting of the GOsC, feeling a bit like the court reporter. I was at an advantage this time: I was able to find the building, I knew there would be coffee, I had managed to find the agenda and papers on the GOsC website – (Just before the meeting you can go to “About us” at the top, then “The organisation”, then “Meetings”) – and I even knew the names and faces of most of the staff. Brian was going to be late? Ahhh, I knew Brian. I met him last time! I went in a bit sheepishly though, not really sure how my previous post had gone down, but was happily reassured by Matthew (the money guy) that it had gone down well. Pleasingly, there were a couple of other osteopaths there this time, so I had some company in observers’ corner.
There is quite a lot of procedural business, and talk about things that I can’t recount because it makes my eyes glaze over and my brain go a bit foggy, and none of that will be mentionned here, although I’m sure it is quite important. But there is also some discussion and information which I find extremely interesting, and that is what you will find conveyed here, together with bucketloads of personal bias and subjectivity. The GOsC will at some point publish the official minutes of the meeting on the GOsC website. That is where to go if you want something reliable and complete.
Applications for new Council Members
Initial talk was about the applications for new Council Members. I think they need about five more osteopaths starting in April, but it’s too late to apply now, I’m afraid. Any of us osteopaths could apply for these, and they are effectively a part-time job for those who are interested in the regulation of our profession. However of 87 applicants, 65 were lay people and only 21 were osteopaths. I was quite surprised, but seeing as I hadn’t applied myself because I didn’t think I had enough skills,and I thought the competition would be too fierce, I can see why the numbers are low. There was a really useful day recently held by the GOsC, teaching us how to apply for the job. As Alison White (the chair) commented, lots of things that are obvious to the sort of people who are used to applying for those kind of posts, aren’t the slightest bit obvious to people like me, who’ve spend the last 18 years in a treatment room, and never really properly applied for a job in my life. So Alison felt that the day had underpinned the applications of some osteopaths who would not have applied without it, and they intend to repeat that exercise.
Working in Australia and New Zealand
There was some talk about working towards streamlining the process by which we could work in Australia and New Zealand, or vice versa. I didn’t catch the detail of this, and in any case it’s not at a final stage, but apparently although there are only 36 overseas-qualified osteopaths on our register, the process of getting them registered here takes up a disproportionate amount of time and money.
PSA – the regulators’ regulator
In case you hadn’t heard of the PSA, they are the regulator overseeing GOsC (plus several other healthcare regulators, including chiropractors). It seems they are struggling with new concepts about what they are trying to measure. They are not measuring GOsC on the good practice they maintain, achieve, support?, but instead on what they do with bad practice. This was a little over my head, but it doesn’t sound well aligned with the osteopathic principle of looking for the health, not the disease.
Fitness to Practice Report
This was the part of the meeting that made me sit up and take notice.
Firstly, as an aside, I had no idea so many people were passing themselves off as osteopaths when they are not registered, but there are a steady stream. These are called “section 32” cases, and there are about 34 active cases right now, so more than I’d have guessed.
Advertising complaints – yes it’s a hot topic
There have been 129 complaints made, in a time period I’m sorry I can’t specify, relating to advertising. They are not made by members of the public complaining that we claimed to treat something but in the event we couldn’t. They are made mostly, or even exclusively, by the Good Thinking Society who have a project to stop osteopaths advertising things that aren’t on an approved list. They sincerely believe they are acting for the best, and are pretty metal-plated in that sincere belief. The campaign started this Summer.
Twenty of those cases have already been closed, because they fall under the threshold criteria. I had never heard of the threshold criteria, but there is a list of reasons to dismiss complaints which aren’t bad enough to constitute professional misconduct, and they are things like parking violations, vindictive ex-spouses tryng to ruin your career (by exposing your penchant for adulterous S and M parties, for example), anonymous unverified complaints, and so on from A to O. I believe complaints about advertising are below the threshold because they fall outside the remit of the GOsC, but instead fall under the remit of the ASA (Advertising Standards Agency). It’s only if the osteopath flouts the ruling of the ASA that the GOsC is involved. Find the threshold criteria here
The list of conditions that the ASA say osteopaths can treat are those supported by robust clinical trial evidence. However many osteopaths treat people with conditions for which there is not yet such robust clincial trial evidence (note we are treating the people who have the condition, not the condition. How many times…?) The GTS have a view that we are falsely claiming to treat conditions that they think we can’t, or that don’t meet the standards of evidence they would like, and they see it as a moral, and a public protection, issue.
This is a rather tricky issue to discuss, not least because Simon Singh who is a main player in the GTS, is right about a lot of things, and because he seems like a nice guy. He might have come to an erroneous conclusion, but it is a conclusion that many a rational observer would come to from the sidelines, even many osteopaths. Regardless of the rights and wrongs (and don’t worry, this will be debated, it’s not going to go away), he has a bee in his bonnet, he is clever, highly motivated (not totally sure by what), and he has a well organized osteopathy campaign, with its own project manager. Not only that, he is match fit from a presumably expensive and unpleasant long legal process when he was sued for libel by the General Chiropractic Council (who made the ill-fated decision to sue, resulting in an eventual home goal, when he expressed the opinion in print that chiropractors gave bogus treatments). He is not going to give up, especially right now when the Good Thinking Society is on a roll, achieving victories in their fight to restrict NHS funding of homeopathy, and harnessing the power of twitternet by recruiting other science fans to their cause. I personally think the only thing to be done is for us all to abide by the ASA code and then try to convey what we do in a way they understand, and then work on the robust evidence. But first, sort out the advertising. That’s it. Do it now. Forget how much you’ve just spent on those new leaflets, just think of the poor GOsC potentially buckling under the weight of having to process 25 new complaints a month, with the threat of escalation if we don’t comply.
The ASA don’t want all those complaints any more than the GOsC, so Maurice Cheng (of iO) along with the GOsC are also talking to them about how we can describe what we do without claiming efficacy of treatment for specific conditions. Good luck with that, and hopefully soon we will have new guidelines and can debate the rights and wrongs of osteopathy at our leisure. We might even get some research going, who knows.
It seems that GOsC fall slightly between a rock and a hard place here, or rise above the fray, whichever way you look at it: the Good Thinking Society think the GOsC should be a kind of policeman of what they think is poor practice, however even if GOsC were to agree, they regulate people, not procedures. The osteopaths think GOsC should be a kind of PR agency, promoting us and defending us from the likes of Simon Singh, however neither is it the job of GOsC to protect the reputation of the profession. GOsC have their statutory duty defined in law, and they are doing it. They just don’t want to have to deal with a load more complaints than they can cope with. GOsC is not the profession, and we collectively have to protect our profession through good practice. It’s murky territory here, to try and navigate it is not simple, and I think I’ll move on swiftly as I seem to be sinking into a bit of a quagmire.
Complaints about commerical rivalry
There have also been a rise in complaints resulting from arguments between rival osteopaths. I guess these are about taking patients from practices, or setting up your clinic next door to the one in which you’ve been an associate. I’ve got a feeling these might also fall under the threshold criteria. The general advice seems to be to lay down the ground rules when you start working with someone, although in my experience if you fall out, anything you said at the start becomes irrelevant anyway.
Over half of complaints which went to the PCC were dismissed
Apparently the cases the PCC hear are taking longer than they used to, as they are more complex and serious. I’m not sure why. Apparently the quality of advocacy has improved. But over half were dismissed, leading one member to question if too many were being referred on. There is a question over whether the standard for moral opprobrium is set too high, as it is only a matter of judgement.
The Legal Nitty Gritty
There is a good summary of Shaw vs GOsC on the Blake Morgan website (the legal firm presumably employed by the GOsC), something to do with an appeal – that the judgement of GOsC had simply been too harsh in their finding of unprofessional conduct in one case. I think the GOsC won that appeal, but check for yourself. They refer quite a lot to the Spencer Judgement, which set some sort of legal precedent. One for the legal eagles here, or the people going through the FtoP process.
There aren’t that many referrals to the health committee, and many osteopaths self-refer (sometimes by filling out details of medical conditions when they renew registration). A bank of conditions is being compiled.
Interim Suspension Orders
There have been a few more of these. Again I am really surprised. I think these orders (called section 60 orders by the GOsC) stop an osteopath practising until they have been given the go ahead by the FtoP committees. They used to be given for, say 6 months, then renewed, but I think that the issue is that legally they can’t keep being renewed so unfortunately they are just in place, indefiintely, until a hearing is completed. it was acknowleged that this was not ideal and was an extremely difficult situation for the osteopath, but public protection had to be paramount.
A three-year rolling programme was mentioned. The high level of confidence in osteopthy held by both the regulator and the public was mentioned. NCOR and PROMS were mentioned, especially with regard to the proposed development of the capacity in the profession to use evidence. There was also a question about how GOsC could expand and develop its relationships with patients. A requirement has been written into a new bill requiring the GOsC to “promote wellbeing” of patients, amongst other things, but this seems a vague generic term, open to various interpretations. All regulators are having this term added, but it was not totally clear to anyone what it means in practice.
The annual income of the GOsC is about £2.8 million, mostly from our registration fees. However there has been an increase in expenditure on these more serious and complex FtoP cases, and two osteopathy schools are closing (Leeds and Oxford Brookes), so fewer osteopaths are joining. The registration fee is going to stay the same at £570. Apparently there is some investment in a fund, as well as cash reserves in the bank, and there was some talk about charitable status enabling us to move that to a better performing fund, or even the money being removed from the fund and put in the bank. (The stockmarket has not been especially kind to our investment.)
Osteopathic Practice Standards Review
The OPS came to life in 2012. There is a review of them. it seems that more guidance is needed about why we have them and how they are used. There is a question over whether there should be an overarching statement of values. The GOsC WANT critical feedback, but are aware that we might be suffering consultation overload. There was a suggestion that specific groups might be targeted. I really think they should just bump up the NCOR contribution (which stands at £12000 per annum) and plug into that already existing network. We at Haywards Heath already have a good old chinwag about what the GOsC is up to, with Carol keeping us up to date and us all chipping in with our opinions. Why not make it a formal thing and feed it back to them? It’d make us feel important, get NCOR some sorely needed funding, and it would utilize the brainpower of a load of geeky osteopaths who don’t minding wading through those kind of documents, all for the thrill of spotting an inconsistency or an unworkable principle.
New CPD – Continuing FtoP
A new scheme is going to start. Many of us who were very fearful at the start were comfortable with it by the time they’d found out more about it. Osteopaths have some serious “antibodies” to peer review, according to Tim (Walker, Chief Exec), and he again referred to the PPP of years ago, as the “elephant in the room” . He went on to mention the “poison in the well” in a positively exuberant shower of metaphor. Gosh those PPP wounds went deep, didn’t they? Oh dear, I’m doing it now. Maybe some things are just so sensitive you can only refer to them indirectly, Yes it’s a bit like treating people. Indirect techniques are sometimes the only way.
There was a whistlestop tour of the committees at the end. I clocked the fact that 62% of us renew online, which is appreciated and encouraged because it saves time and money, and that there are quite a few committees. There are seven in total: the three FtoP ones we have mentioned – the IC, PCC and HC – and four others, variously called the Audit, the Remuneration and Appointments, the Education Registration Standards Committee, the Osteopathy Practice Committee, or something like that. Then all of a sudden Tim turned to me and I realised that it was time for observers to leave. The public session is then over, and it turns private. And mysterious. It’s anyone’s guess what happens then.