I was taken aback a while ago when Tim Walker, chief exec of GOsC, – (I’m still not sure if “GOsC” needs the definite article, but I have finally learnt to pronounce it Jee-Osk, rather than Jee – Oh – See or Josk), talked of his bemusement at osteopaths chuckling over our affectionately held collective noun: a “disagreement of osteopaths”.  Oh yes, we love a bit of infighting in our profession, when we’re fed up with doctor bashing.  Possibly influenced by his years of involvement in politics, and observing that certain parties  prefer to bicker amongst themselves in opposition than enjoy the heady heights of power, he was surprised that we were so charmed by the fact that we are a ‘disagreeable’ bunch.

Osteapathy

Not a typo.

Anyone who ever frequented the BSO bar back in its Trafalgar Square days, will probably have had a smile at the “BRITISH SCHOOL of OSTEAPATHY” banner above it.  Being apathetic and disagreeable seemed amusing when I was a cynical 23 year old.  Yes, I liked a bit of “attitude”.  Now that I am of the advanced age where I not only purchase cracked heel cream, but seriously read the back of it to discover if there is any real reason why I can’t apply its miraculous moisturizing properties to my face, it doesn’t seem quite so cool.  And having attended iO’s “Activate your Membership” meeting at the  beautiful Royal Society of Medicine building in the heart of London, this attitude makes me more than a little concerned for our profession.  Don’t even get me started on herding cats.

iO’s Member Activation Day –  July 4, 2018

 

Maurice Cheng (full time CEO), Ben Katz (Osteopath and President), Matthew Rodgers (Osteopath and Head of Professional Development), and Georgina Leelodharry (celebrating 10 years working for iO, and Head of Operations) hosted the meeting. What they had to say was, on the one hand, a bit worrying, and on the other hand, incredibly exciting.  There could be astonishing opportunities for osteopathy in the next few years, but if we simply give in to disunity and complacency, we will certainly miss them, because the time to act is NOW.

Things to worry about

One of the chief joys of listening to Maurice speak, is, well, listening to Maurice speak.  If he’s not moonlighting as a voiceover artist for coffee commercials, or prerecording reassuring messages to be used on planes experiencing technical difficulties, he’s missing a trick.  There’s money to be made from them there smooth, rich tones.  What he had to say was important though.  There seems to be a feeling that regulation didn’t actually do what we thought it would do.  It hasn’t really increased access to osteopathy, and I don’t think osteopaths feel increased status or recognition.  There is less than one osteopath to every 10,000 people.  Less than 2% of osteopaths work in the NHS (which employs 1 million people).  We have been arbitrarily designated as  a PLCV (protocol of limited clinical value) by dozens of CCGs, (which is the NHS kiss of death, giving them a good reason not to commission osteopathy).  Student numbers are in decline, although Marjon in Plymouth is bucking the trend going from 15 to 45 students, and numbers in Swansea also on the rise.  Why? Switched-on-new-grad Aidan Twomey has a theory: he’s crunched the numbers of osteo and chiro colleges and figured out that the ones outside London are thriving, those in London struggling, suggesting that it is pricey London living putting potential students off.  The 2 big chiro colleges are outside London.  (Maurice has a theory too: people see more of a reliable career in chiro, with every chiropractor having a job within 6 months of graduating.)  But on the whole, it’s all a bit of a poor show for a profession which has been going for over 100 years.  Only 10% of the population have ever been to an osteopath. Maurice thinks part of the problem is that we need to “build an environment in which the public knows what we do”.

 

A Concordance of Osteopaths

The good news is:  osteopathy is not as divided as you’d think.  The iO crew meet a lot of osteopaths, and feel that most osteopaths are happily getting on with their own way of working and perfectly happy to live and let live.  Presumably we agree on some things – we want status, recognition, access to patients, credibility, the preservation of our profession – and the fact that we have different ideas on how to tackle a chronic tension  headache is not such a big deal.  Also the various institutions – colleges, regulator, iO, postgrad course providers, regional societies etc., are all talking more nicely to each other now, as they realise collaboration is not only more pleasant, but critical, if our profession is to take advantage of future opportunities.  When I spoke to Simon Singh, critic-in-chief, he left me in no doubt that he felt that osteopathy as a profession was doomed, and very soon to be seen off completely, as its lack of evidence base was exposed.   I’d like to see him proved wrong on that.  There is some quite robust evidence for manual therapy, (not specifically osteopathy though), and if we could just apply electric cattle prods to osteopaths to do PROMS we could have tons of data for our particular profession.

Things to be excited about

I’ve alluded to upcoming opportunities; not easy to take advantage of, maybe, but the time is ripe, and undreamt of things are just maybe surprisingly possible if we pull together and make a Herculean effort.  To paraphrase the late, great David Ben-Gurion: In osteopathy:

to be a realist, one must also believe in miracles

Ok, here are some interesting facts:

• We are now Allied Health Professionals. Yes I know.  It doesn’t sound the most immediately exciting phrase, and I have yet to understand exactly what it means, but apparently this is the biggest thing to happen to osteopathy since regulation.  It is MASSIVE, and an endorsement of our profession.  It opens lots of doors.  And those doors are opening onto a very interesting and changing landscape.  [NB thanks to Angela Cavill for pointing out this only applies in England, no other countries in the British Isles].
• We are trained in first patient contact.
• 30% of GPs caseload is musculoskeletal, but they only have 6 weeks training for this.
• There are not enough GPs now, but wait ten years and there will be even fewer – a shortage of 20-30 000.  There is an idea that other clinicians might have to take the pressure off by being first point of contact for patients.  See where this is going?  We are potentially in prime position to take advantage of this need.  Matthew is really excited about this “First Contact Practitioner Role” and once I heard about it, so was I.   Isn’t this what we’ve been wanting, for ever?  Primary, person-centred healthcare available to people who wouldn’t or couldn’t normally come to us.
• Public Health England, which we now get to talk to by virtue of being AHPs, are very interested in the way we “promote the optimum environment for health in those we care for”, rather than “treating people”.  We are used to “looking for the health”, but the zeitgeist is only just catching up.   I guess that this is an intriguing but radical paradigm shift for healthcare people, who are probably experiencing the same, stunned mindfreeze that economists went through when they first heard that the Kingdom of Bhutan had decided to measure prosperity in a Gross National Happiness Index (true fact).
• And, by the way, 12% physiotherapy roles in the NHS are unfilled.

What you can do.  Yes YOU.

1.  Stop complaining

2.  PROMS

Fingers crossed, once the new CPD scheme kicks in lots of people will start using PROMS for their objective activity.  Over 3 years PROMS has generated only 2000 patient cases.  “Pathetic”, said Maurice, not mincing his words.  Less than one subject per osteopath over three years.  Please sign up now and do it -it’s so easy – especially if you are a busy clinician who just loves treating people and doesn’t have time to contribute anything else.  Getting data, and soon, is crucial if we want to take advantage of our new AHP status.  Email Carol Fawkes  on c.fawkes@qmul.ac.uk and she’ll send you some forms to give out to new patients.  That’s pretty much all there is to it.  I think there’s a paediatric PROM on the way too.

3.  Volunteer as a media spokesperson

The iO need a stable of volunteers to respond to requests for media information.  I personally find it hard to convince even myself that I know what I’m talking about, so much as I’d like to be famous, I’m out of the picture, but if you have the self assurance and ability to think on your feet, and you know you inspire confidence, get in touch so you can be on their list of people to phone when they need someone.  Get osteopathy out there and known about!

4.  Use your specialist skills

I can write and try to inspire people and share information.  You might have some specific skill or knowledge which would help the profession as a whole.  About 3 osteopaths at the iO day had a fairly good grasp of the NHS which seemed useful.  Some of you have marketing skills.  How about research?  Ever wanted to try to write a case study?  Just have a go at something that appeals to you.  Do you think iO are missing a trick somehow?  Contact them.  If you know you’re a clinician through and through, do PROMS, and respond to research requests by students.  Don’t think “other people” are doing this stuff.  On the whole, they’re really, really not, and that’s the problem.

5.  Go to things

If you’ve been languishing in your treatment room recently, you might have missed out on the fact that osteopathy is dynamic and alive right now.  It’s packed with interesting and talented people, doing interesting and talented things.  There have been no less than 17 applications to the Osteopathic Foundation for funding for projects (the pot is £100,000).  If you’re reading this, you’re probably already on Facebook and Twitter, but if you’re not, it’s a good way to stay connected.  Do you regard the GOsC with fear and loathing?  It might seem like a bit of a financial hit, but take the day off and go to one of their council meetings.  I’ve been to quite a few and it has transformed my attitude to them.  Most of the important stuff is covered between 10 and 1pm.  If you are in London you only need to take a morning off and a tube trip.  You will get a better idea about them than any other way.

6.  Belong to iO

I left iO last year when I left frontline high street practice for the cosiness of my front room, and patients who I either knew or who were referred word of mouth.  I felt like I was fairly safe from a complaint as I use such safe techniques, have done so many courses on consent, and read about so many complaints.  I thought the main purpose of iO was to protect me from the big, bad Fitness to Practise Process.  But from going to the meeting last week I’ve realised that is only a small part of what they do, and that they can only reach for those stars with a profession united behind them.  So please support them.  We are them and they are us.

Thanks for reading , as ever, and for all the nice compliments I get about this blog!