OK I have finally got round to my second ever youtube interview, this time with Mary Monro.

Mary has written an article on issues facing the profession. It is reproduced below the video, complete with references.

The Future of Osteopathy in the UK by Mary Monro

Introduction                                                                                                

We are at a moment of seismic change in osteopathy and the wider healthcare ecosystem in the UK. Whilst change is a constant and the profession has always had to adapt, Brexit, the COVID pandemic, Social Media and the use of Artificial Intelligence (AI) are all having significant impact on both higher education and consumer health-seeking behaviour, that affect osteopathic schools and the profession. We must consider whether and how osteopathy can remain relevant to the contemporary student and client. This article discusses key issues facing the UK profession, but these changes in the health-scape have international implications for regulation, education, research and professional practice.

Currently, 5,597 UK osteopaths (General Osteopathic Council (GOsC), 2025 data) treat an average of 31 patients per week [2], equating to 9 million patient consultations per year (compared to 353 million GP consultations in the National Health Service (NHS) in England [3]). There is a growing tension between demands for tighter regulation in healthcare and an explosion of unregulated actors (including on Social Media platforms) servicing health-seeking consumers [4,5]. Does the osteopathic regulatory system adequately meet the changing needs of patients, students and practitioners?

With the entire UK university sector facing financial meltdown (an estimated 15,000 jobs were lost in 2025 [6]), how can osteopathic schools survive? Do we need a different model of osteopathic education that is attractive to students, meets the needs of the profession and is cost effective?

Within the profession, a tolerant pluralism regarding modes of treatment has shifted to an unhelpful sectarianism [7], yet our patients have a high regard for their osteopathic experience [8]. Their perspective is often backgrounded in research, with the unfortunate impacts of silencing patient views on osteopathy and losing their contribution to legitimating the profession[9]. How can we demonstrate the full value of the osteopathic therapeutic encounter in a way that meets the demand for evidence-informed care?

1.    The Changing Health-scape

1.1  Overview

The World Health Organisation (WHO) strategy for Traditional Medicine 2025-2034 “envisions universal access to safe, effective and people-centred Traditional, Complementary and Integrative Medicine (TCIM) for the health and well-being of all. It was developed based on nine guiding principles: evidence-based; holism and health; sustainability and One Health; the right to health and autonomy; Indigenous Peoples’ rights; culture and health; people-centred care and community engagement; integrated health services; and health equity”[10]. This strategy implies a closer integration between orthodox medicine and TCIM, recognises the role of political, social and environmental determinants of health and the right of every person to proper healthcare. The strategy has had a mixed response from the medical profession, with defence of the status quo, using well-rehearsed tropes about lack of evidence and risk of harm from TCIM [11], meeting robust responses about colonialism, epistemicide and reductionism in orthodox medicine. This argument indicates that a paradigm shift is occurring, driven by consumers changing attitudes and an increasing acceptance of the need for a more person-centred approach to healthcare.

The doctor is no longer at the centre – that is now occupied by the patient, who is an ‘active patient’ and healthcare consumer, as shown in Figure 1. This is a growing trend that was accelerated by the COVID pandemic, with changing attitudes in the UK about accessing healthcare and a shift towards ‘self-care’ [5]. The patient may be described as a ‘pragmatic pluralist,’ using both credentialed and experiential knowledge in their health-seeking behaviour [9], seeing ‘health’ as a spectrum from serious illness through to physical, psycho-emotional, environmental and social wellness. Figure 1 should be partially obscured to represent the lack of access to healthcare suffered by some patients due to inequalities such as poverty, pollution, poor education and discrimination.

Figure 1: The UK healthcare ecosystem, showing regulated sectors in blue and unregulated sectors in green. Some examples are given for each, but the list is not exhaustive. Unequal access to healthcare is not depicted.

Children de-centre when they begin to realise that others have different, and sometimes conflicting, perspectives and priorities [12]. The “de-centring” of the healthcare professions is both liberating for patients and a developmental shift for practitioners. If we are to be empathetic practitioners, we must de-centre and truly be therapists – the word therapy comes from Greek, meaning ‘attendance’ or ‘service.’

To understand what is happening in this ecosystem, we need to view it through political and sociological lenses. Politically, we are in late-stage capitalism, characterised by globalisation, consumerism and wealth inequality, where new markets are created by turning inward and finding endless niches to exploit [13]. Widespread adoption of wearable monitoring devices and apps is an example. Eager therapists claiming to transform your life with a gadget, exercise regime or supplement is another. But this is also a democratic shift, with consumers becoming “co-creators of health services and co-creators of value”[14]. In an unregulated marketplace, anyone can improvise as an infant sleep consultant, a fitness guru, or write a book on how to manage your menopause.

From a sociological perspective, we can see the power arc of orthodox medicine passing its peak, with implications for osteopathy and the wider healthcare ecosystem, as discussed below.

1.2 Challenges faced by orthodox medicine

Until the late 19^th century, doctors were often seen as quacks with limited efficacy. The period from 1870 to 1920 saw a flowering of alternatives to medicine in response, including osteopathy, seeking to provide better healthcare and, at the same time, saw orthodox medicine start to improve. Developments such as X-rays, ECGs, antibiotics, antiseptic surgery and the discovery of insulin began to transform medicine into an effective, technocratic force. This increased the social capital (elite status) and cultural capital (schools, institutions) of the medical profession and these were readily exchanged for economic capital [13,15]. These types of capital, and the power they confer, are not a given, however, and medicine is now under threat, for at least three reasons:

First, the biomedical model does not fit well with modern and projected health needs. The major public health concerns are obesity, diabetes, cardiovascular disease, cancers, chronic illness, substance abuse and mental health [16,17]. These, to some extent, respond to technocratic interventions when they are past the point of no return, but they arise from health inequalities, environmental and lifestyle factors and the ageing population. By 2030 one in six people on the planet will be 60 or older. By 2035 it is estimated that 36% of people over 50 will have at least one chronic condition [18]. Recent research shows a persistent rise in ‘deaths of despair’ (from suicide, and drug and alcohol abuse) [19].  Medicine is trying to shift from its biomedical model to the P4 model – Personalised, Preventive, Predictive and Participatory Medicine [18]. One initiative from NHS England is to introduce a ‘neighbourhood health service,’ a collaborative approach intended to reduce pressure on GP and hospital services [20]. P4 medicine remains within the reductive biomedical model, however [21], unable to affect the social and environmental determinants of health and with “social prescribing” presenting issues for demonstrating efficacy, as neither the problem nor the solution fit the randomised controlled trial model [22].

Secondly, medicine is eroding its own capital through a dissonance between its ideals and its practices. Modern medicine is founded on scientific, evidence-based interventions, sometimes endorsed by National Institute for Healthcare Excellence (NICE) guidelines but, in reality, patients experience poor access to care, systematic bias against minorities (race, sexual orientation, gender, disability, religion) and sometimes poor outcomes [23]. Scientific and technological excellence seems to have come at the cost of caring excellence. The medical scandals of recent years (e.g. in Bristol, Shrewsbury, North Staffs, East Kent, Nottingham, maternity and neonatal care England [24]) have revealed how a combination of top-down hierarchies with “hubristic leaders,” and a culture of coerced silence and denial have led to catastrophic consequences [25,26].

Thirdly, the NHS’s status is being undermined by long-term underinvestment in staff and infrastructure, with millions of patients now facing intolerable waiting times for elective and emergency treatment [16] and 65% of maternity units deemed unsafe [27]. This is both driving patients toward private medicine and forcing the NHS to pay for private care [28]. It’s estimated that 40% of treatments do not follow known best practice, at the best of times, let alone in an understaffed, exhausted and demoralised NHS [29,30]. According to the British Social Attitudes survey 2024, satisfaction with the NHS was down to 21%, its lowest since the survey began in 1983, from a peak of 70% in 2010 [31] and with a sharp decline from 2019. Among osteopathic patients, confidence in osteopaths exceeds confidence in GPs and physios [32].

The NHS recognises the need to change in its 10 year plan, published in a policy paper in July 2025: “the choice for the NHS is stark: reform or die” [33]. The paper proposes a shrinking role for the NHS, with greater use of technology (including AI) and a shift towards prevention, helping to reduce patient dependence on medical care. The NHS currently has little to offer people with social care needs and is overwhelmed by the prime causes of workdays lost in the UK: musculoskeletal problems (49%) and mental health (23%) [34].

1.3      Osteopathy’s position

Osteopathy sits at mid-level in the social and cultural hierarchy, with its power constrained by restrictions imposed by medicine, above it, such that osteopaths may not prescribe drugs or treat cancer, for example. Osteopathy regards itself as superior (i.e. more like medicine) to voluntarily regulated and unregulated healthcare providers, from a practitioner-centric perspective. Gaining status (in England) as Allied Health Practitioners (AHP) in 2017 has led to more osteopaths working in the NHS, currently 6% of the whole profession and this rises to 18% in the under 35 age group [2]. Medical profession acceptance of osteopathy, however, remains patchy both geographically and across NHS services. Examples include osteopathic practices that used to work with the NHS being subjected to changes in policy, such as the termination of Any Qualified Practitioner contracts; and AHP status not being extended to the rest of the UK [35].

Osteopathy shares the same biases as medicine, with practitioners and patients being overwhelmingly white, heterosexual, financially secure and non-disabled. Osteopathic principles have been criticised as ableist, as they assume that disability is a flaw to be overcome [36]. Osteopaths, like doctors, can confuse patients by using medical/scientific terminology and work with patients who may feel vulnerable, due to pain or anxiety about their health, compounding the power imbalance [15]. As largely private practitioners, the profit motive risks influencing patient management decisions. The biomedical model is used in osteopathy, but with a focus on the biophysical (mechanics, fluid and energy interactions, systems behaviour, etc.) rather than the biochemical.

However, osteopathy has always taken a hybrid and person-centred approach, using both the scientific biomedical model and other epistemologies to arrive at an holistic assessment. Results from UK osteopathic Patient Reported Outcome Measures (PROMs) show that patients give high satisfaction ratings for good communications, empathy, the opportunity to ask questions, competence and effectiveness [8]. The patient experience of osteopathy is not only about the hands-on techniques employed. Equally important is the relationship, the agency given to the patient and the sense-making involved [37,38]. The osteopathic self-management plan agreed with patients through a shared decision making process is thought to be key to the softer positive outcomes, such as social integration, reduced anxiety and better coping mechanisms [32].

1.4            Unregulated healthcare

Outside the regulated sectors of the healthcare ecosystem a ‘wild west’ is developing, fuelled by Social Media platforms. Osteopaths are sometimes tempted into this arena, adding the ‘Mummy MOT,’ Shockwave therapy [39] or other packaged protocols or technologies to their osteopathic toolkit. Some of these have evidence of efficacy, some are just well marketed and have created a demand among patients to which osteopaths respond. Osteopaths (and other professionals) may be inadvertently contributing to the spawning of unqualified practitioners by demonstrating techniques online, on YouTube or TikTok, for example. At a wedding reception in 2024, I saw a man manipulate the occipito-atlantal joints of his neighbours at the table, a skill he later told me he’d learned from a video. He is not a healthcare practitioner, has no knowledge of anatomy and did not conduct a risk assessment. There is no regulator for an untrained operator inappropriately using an osteopathic technique.

According to a UNESCO survey reported in 2026 [40], an average of 67% of the UK population (compared to 83% Norway, 61% Germany, 56% France, 74% Canada, 37% New Zealand) now seek health information online. As the report states, “People with limited health literacy, language barriers, or desperate health situations may be more susceptible to misinformation. Online health information seeking can exacerbate health inequalities if reliable information is less accessible to disadvantaged populations.” Responsible healthcare providers are contributing to democratisation and patient agency by sharing diagnostic, preventive and health promoting information, whereas others are misinforming and fleecing the health-seeking public [4,41]. Use of AI Chatbots for health information (and sometimes diagnosis and treatment) is also increasing, though trustworthiness issues are inhibiting faster growth [42].

The current administration in the USA is encouraging deregulation, delimiting AI development, leaving the WHO and cutting funding to the National Institutes of Health. This opens the door even wider for irresponsible and malign actors with global reach, as well as undermining health research and monitoring.

2.    Regulation

Healthcare regulation is a multi-layered phenomenon, that includes statutory regulation of some healthcare professions (e.g. osteopathy, medicine), some medical devices and some harmful substances (e.g. sugar, alcohol), as well as voluntary regulation (e.g. psychotherapy, acupuncture) and, at the frontline, of self-regulation by practitioners. In turn, the statutory healthcare regulators (including the GOsC) are regulated by the Professional Standards Authority (PSA), whose remit is to oversee and improve their work.

2.1      Patient Safety

Historically, the driving principle of regulation in ‘high-hazard industries’ such as healthcare has been to reduce or eliminate harm, termed Safety-I by Hollnagel [43]. However, recent thinking argues that in a system as complex as healthcare, with a great propensity for things to go wrong, this is a misguided and unachievable aim. A better regulatory approach is to focus on how things go well, termed Safety-II. Hollnagel argues that achieving resilient performance is feasible if four potentials are pursued: the potential to respond; to monitor; to learn; and to anticipate. These potentials can only be achieved with closer connection between the regulator, the profession and the public.

The data on cause for complaint against osteopaths indicate room for improvement in basic clinical skills (case history taking, examination and assessment, avoidance of forceful techniques), patient communication, and boundary awareness and management [44]. The solutions lie upstream, in the fields of undergraduate education and continuing professional development (CPD). The regulator could respond to this challenge by shaping the ‘graduate outcomes’ competencies and the requirements of the CPD scheme, to meet the first three of Hollnagel’s ‘potentials.’ Strategic assessment and inclusion of our patients’ changing needs must also feed into this, meeting the ‘potential to anticipate.’ A 2022 paper on boundary issues in osteopathy, written for the GOsC, recognises that this is a systemic problem requiring a systemic solution, rather than individual punishment [45].

In 2024 the GOsC spent just over £1million (a third of its budget) on managing a tiny number of ‘fitness to practise’ complaints. By comparison, NHS Resolution (a public body in England that handles clinical negligence claims) received 15,236 new negligence claims in 2025-26 (up from 14,428 in 2024-25), costing £3.2billion in payments to claimants and legal costs. “Much of this £3.2bn could have gone to frontline NHS care to give the service the staff and resources it needs to minimise harm” [46]. The same could be said of the GOsC’s fitness to practise spend, using it instead to invest in Hollnagel’s four potentials and adopting a ‘right touch’ approach [47]. According to the PSA, the General Optical Council (GOC) has run a mediation service since 2014 that has handled a 259% increase in the volume of complaints, while delivering a 60% reduction in unit cost per complaint [48]. There is no such option for handling osteopathic complaints.

Another emerging theme is the need for cross-profession regulation [47]. The patient journey does not occur within a single silo but often across a series of actors – perhaps seeing a GP for neck pain and being prescribed paracetamol, then attending an Accident & Emergency department when symptoms worsen, being discharged, going to see an osteopath and having a neck manipulation that results in injury. Which of the actors is responsible? Who should handle the complaint?

2.2      Standards in Osteopathic Education and Professional Development

The GOsC sets the guide to the curriculum that osteopathic schools must follow, known as the Graduate Outcomes and Standards for Education and Training (GOSET) document [49]. According to the GOSET document, this does not require the input of the profession, the employers of the graduates. How can schools adapt to the changing demands of practice without close connection between practising osteopaths and the curriculum taught to students? This is not controversial: most regulators (including for the utilities, financial industry and, in the realm of healthcare, the GOC [50]) explicitly include employers and create cross-stakeholder structures in curriculum design, school governance and performance assessment.

2.3      Other Regulatory Issues

The strategic aims of the GOsC, 2024-2030, include “championing inclusivity” in the organisation and “strengthening trust” with the profession [51]. Such aims are welcome, given that recent research showed that 46% of osteopaths have no trust in the regulator. A key priority for improvement identified by the research was “listening to the views and needs of osteopaths and students” [52]. These aims, however, are not expressed in a way that is meaningful to osteopathic schools or the profession. How well are osteopaths navigating Equity, Diversity, Inclusion and Belonging (EDIB) issues, for instance? What proportion of practices are wheelchair accessible? How can osteopathic schools support applicants who are financially or geographically disadvantaged, disabled or who fear discrimination?

Misleading claims made by osteopaths are only discovered if a complaint is made to the regulator or to the Advertising Standards Authority (ASA). This fails to adequately protect the public, a key role of the regulator. The ASA has recently introduced an Active Ad Monitoring system, using AI to monitor online advertising [53]. In 2025, the system monitored over 60 million adverts, prioritising problematic areas (such as cryptocurrency, age restricted products and healthcare) but with the potential for wider use, thereby improving intelligence, enforcement and monitoring compliance [54,55]. A recent study used AI to trawl websites of members of the Complementary and Natural Healthcare Council, searching for misleading claims [56]. They found a large number that met their criteria and, though flawed and needing careful human input, AI has the potential to provide a more efficient way for regulators and the ASA to systematically monitor registrants’ websites.

3.    Education & Research

3.1      Education Challenges

The university sector in England is struggling with cuts in government funding (the funding freeze and high inflation mean that, in 2011/12 prices (when fees were set at £9000/year), fees per student are now below £6000/year [57]), loss of fees from overseas students due to Brexit and visa issues (foreign students represented 5% of university funding in the mid-1990s rising to 23% in 2022 [58]) and lower than expected growth in British students. Overall, it is estimated that UK government policies will lead to a net reduction in university funding of £2.5bn between 2024/5 and 2026/27 compared to 2023/24 [59]. The university regulator, the Office for Students (OfS), expects 72% of universities to be in deficit by the end of 2026 [60].

Long term financial sustainability is under threat, even for the most successful universities, where high cost courses (science, engineering, medicine) and research focus (now only covering 68% of its total costs) predominate [57]. Mitigating actions may include cutting staff and courses and seeking collaboration with other providers [61]. Meanwhile there is increasing pressure to be more student-centred, offering improved access to disadvantaged groups, lifelong learning, distance learning, part-time learning, interdisciplinary experiences and connections with employers [57].

This situation affects the osteopathic schools, with responses including the recent merger of the University College of Osteopathy (UCO) with a chiropractic college, the merger of the European School of Osteopathy (ESO) and the British College of Osteopathic Medicine (BCOM), the closure of the College of Osteopaths and the closure of the ESO/BCOM undergraduate masters programme. Student applications to study osteopathy have plummeted and this is forecast to continue [62]. This is likely due to a mix of factors – student funding difficulties (43% are mature students for whom there may be little financial support [2]), the cost-of-living crisis, location of schools, lack of student accommodation, post-Brexit impacts on overseas students, single subject schools that don’t offer a broad social mix for students, accessibility issues and, perhaps, a curriculum and profession that are not sufficiently attractive and distinctive. 65% of UK osteopaths are 45 or older [2] so, unless young students are recruited, osteopathy has a limited lifetime ahead of it, regardless of its value to health.

Another perceived barrier to entry is the limited awareness of osteopathy as either a potential career or as a patient. Across Europe, only 5.2% of the population surveyed had seen an osteopath in the previous year [63], though this percentage may be higher in the UK. Even if it’s 10%, that is still a small fraction of the population who are familiar with osteopathy. The Institute of Osteopathy has run campaigns to promote osteopathy, as a career and for patients, but has a limited budget in a disseminated and intensely competitive communications landscape. Osteopaths themselves contribute to raising awareness of the profession (locally and online) but there is room for expansion.

According to the OfS, the biggest influences on a successful student experience are academic support (54%), high quality curriculum and teaching (48%) and financial support (40%). Long term student concerns revolve around career preparation and progression, developing skills for future employment, and building social networks [64]. As mentioned in the previous section, the disconnect between schools and the osteopathic profession may interfere with students’ career preparation and developing skills for employment, as noted by the Osteopathic Alliance [65].

3.2            Research Priorities

Detractors of osteopathy, from without and within, point to a weak evidence base for both osteopathic conceptual models and the efficacy of specific techniques. Should osteopathy cease to exist, then, if it doesn’t make sense or add any value? Overall, osteopathy is under-researched and most of the research that has been done adheres to the reductive biomedical model and shows modest benefits. Over 1700 osteopathic patients’ PROMs show exceptionally positive outcomes [8], however, at odds with the reductive research evidence.

Asking AI chatbot ChatGPT, “What research has been done on osteopathy?” reveals the reductive bias of research to date. Then asking, “Is osteopathy holistic?” produces a positive response that includes headings for: whole body focus, patient centred care, prevention and wellness, osteopathic manipulative treatment (“addresses not just specific symptoms but the underlying imbalances in the body’s structure and function”), mind-body connection and collaborative care.

Osteopathic principles – the body is a unit, structure and function are interrelated, the body has the capacity for self-healing [66] – are couched in biomedical terms but indicate the importance of considering the whole body. Beyond that, AT Still said that “the object of the doctor is to find health. Anyone can find disease.” He argued that “Man is triune when complete. First the material body, second the spiritual being, third a being of mind which is far superior to all vital motions and material forms, whose duty is to wisely manage this great engine of life” [67]. His archaic choice of words should not obscure his wisdom, and future research must seek to capture the entirety of these osteopathic concepts, [68].

A recent European-wide survey [69] has helped to shift the research agenda for the future, not least by including patients and practitioners, rather than only questioning the education, research and policy community. Interest in studying hands-on techniques continues to be important, but there is a gratifying recognition of broader aspects of osteopathic care, as shown in Table 1.

Table 1: Top 10 Research Priorities Identified in the PROCare Survey, 2025.

Domain	Subdomain	Topic	Score
Process of Care	Effectiveness and efficacy	Hands on techniques	54.7%
Population Health	Physical activities and mobility	Sedentary lifestyle prevention	51.0%
Basic Sciences	Osteopathic manual treatment (OMT) mechanisms	Neurophysiological effects of OMT	50.0%
Education Research	Continuing education	Quality of training and education	39.7%
Education Research	Knowledge transfer	Critical thinking	38.6%
Education Research	Knowledge transfer	Best practice integration into clinical routine	37.8%
Population Health	Public awareness and education	Health promotion	37.5%
Methodology Research	Methodology improvement	Innovative methods and research framework for Non-Pharmaceutical Interventions	37.4%
Basic Sciences	Osteopathic Manual Treatment mechanisms	Neuroendocrine and immunological responses to OMT	35.8%
Population Health	Physical activities and mobility	Behavioural change in physical activities	35.4%

Banton [70] goes further, demanding that ‘contextual factors’ in osteopathy, e.g. relationship, patient expectations, the healing environment, patients’ health beliefs, communication effectiveness etc., should be explicitly stated when planning a research study, to better understand and evaluate the mechanisms that generate osteopathic outcomes. This is most obviously important for chronic conditions (which can vary over time) and instances when ongoing stresses on a patient (e.g. caring for others, poverty, mental health issues) can affect the effectiveness of treatment.

Research needs to bring the patient experience into the foreground. Legitimating the profession is an ongoing process in a dynamic environment where the patient/consumer is increasingly important [9]. Patient-centred research is imperative to understand how we might remain relevant, to shape our education and professional development and to show our various publics and peers what the osteopathic therapeutic encounter actually delivers.

Patients have their own ways of forming opinions and making choices. Most patients don’t (or can’t – due to the specialised vocabulary used) read scientific research papers, preferring to read online customer reviews [71]. TikTok is a key source of health information for younger generations, in preference to asking healthcare professionals, despite known issues with misinformation [72]. Osteopathy needs to respond to these changes, using PROMs, Google reviews and social media, as well as research, to generate trust in the profession.

4.    The Future of Osteopathy

Are we entering a post-professional world where the healthcare professions will lose power and prestige as players in the healthcare ecosystem [13]? Will winners and losers be decided by empowered, well-informed consumers, and the term ‘evidence-informed’ broaden to mean patient preference, clinician experience and qualitative, whole person research as well as quantitative research?

Rather than centralised but fragmentary and disconnected records, will patients each have an app/chip/device that holds their entire health record, including real time monitoring of heart rate variability and hormonal shifts, alerts for regular check-ups, air pollution/pollen counts, and such like? Will patients take control of access to their data by physicians and public health agencies? Privacy, data security, ethical and technological questions must be answered, but there is already a template for this in the banking and financial system [73].

Will students choose modules from different providers and in different formats (face-to-face, online, clinical) to build a portfolio of skills and knowledge that meets their own needs as well as professional standards? This kind of  apprenticeship model is already established among other AHPs, such as physiotherapy and occupational therapy [74].

Will osteopathy better mirror local priorities, beliefs and attitudes, such that an osteopath in Scotland practises differently to an osteopath in Nova Scotia? Which aspects of the local osteopath’s role can be better done by AI, a psychotherapist, a personal trainer, a community garden project or a remotely located but specialist online osteopath? How will osteopathy overcome barriers facing disadvantaged people, enabling them to access care?

For all the changes that are swirling around us, people have forever sought therapeutic touch and someone to talk to about their troubles. Osteopaths know, from their experience in practice, the transformative potential of osteopathic care. Our embodied, enactive, relational selves must deal with dynamic and diverse situations throughout life, and osteopaths can help patients to potentise some of that complexity, possibility and ambiguity. Nicholls argues that “falling back on standardised assessments, evidence-based ‘best practice’ mandates, pre-formulated care plans, and even rules of professional conduct, can have the perverse effect of reducing the ethical conduct of practitioners. As the anxieties of undecidability are substituted with formulaic ways of thinking and acting, we increasingly ‘evacuate ethical decision making [75]’ and substitute complexity for systems and structures that are de-contextual and reductive” [13].

Osteopaths have confidence in their profession, with 69% agreeing that its strength comes from breadth and diversity of practice, 73% believing it can successfully evolve to respond to changing healthcare needs, and 77% believing that it takes a whole-person, individual approach to meeting patient needs [2]. If that’s true, osteopaths (and their institutions) should be open to change, humble and creative in their response to shifting patient priorities.

Osteopaths can revisit their roots for inspiration. As AT Still said, “to obtain good results, we must blend ourselves with, and travel in harmony with nature’s truths” [67]. A more recent expression of this concept says, “The osteopathic profession has a unique opportunity for the future, namely, promoting integrative care through its Body-Mind-Spirit tenet and incorporating manual approaches for symptom and non-symptom-based treatments” [76]. Stephen Tyreman wrote movingly, in his last editorial, about becoming a person-centred practitioner: “The practitioner’s task is not merely to explain and treat, but to provide support and insight into the meaning of illness experiences in order to enable a patient to develop a better, life-enhancing narrative and become a more whole person” [77]. The missing part, perhaps, is a sense of equality between osteopaths and patients and between osteopaths and other professionals. As Deborah Smith said, “Process-based approaches are the theme of new models alongside multi-dimensional, multi-modal, individualised treatment programmes focussed on goal-directed outcomes including the expertise of other professions” [78].

We need to embrace osteopathy in its wholeness to appreciate its value, fulfil its true potential and to clarify our professional identity [79]. Only then will we be able to communicate our profession effectively to both potential patients and potential students.

To summarise, this paper signposts potential avenues for change, including:

Navigating The Changing Healthscape

• Consider how osteopathy might remain relevant, focusing on the profession’s distinctive and popular appeal in a person-centred healthcare ecosystem, while addressing weaknesses with regard to unconscious biases and the need for more collaboration with other healthcare providers.
• Utilise PROM findings and the value of statutory regulation (trust is a key decision making factor among health consumers [5]) in promotional messages, targeting both health consumers and prospective students.
• Encourage all 5,597 osteopaths to share health and wellbeing promoting ideas with the public and encourage their patients to post reviews and talk about their osteopathic experiences on social media.

Regulation

• Consider how to bring the osteopathic profession, the schools and the regulator closer together to achieve more effective (Safety II) regulation and increase trust with the public.
• Explore a mediation-based conflict resolution model to help secure a patient-centric outcome and preserve financial resources.
• Shape the GOSET document and CPD scheme in consultation with the profession, to protect the public and to minimise complaints.
• Increase engagement between the GOsC and the profession to evaluate EDIB situations already being faced and develop a framework for handling current and anticipated issues.
• Encourage dialogue between GOsC and other healthcare regulators to consider cross-profession regulation, a need acknowledged by the Health and Care Professions Council [80].
• Explore the use of AI by the GOsC to monitor misleading advertising claims and non-osteopaths claiming to be osteopaths, or who use osteopathic techniques.
•  Consider the use of AI for cost-effectively auditing registrants’ CPD activities.
• Establish a clearer connection between the arbitrary-seeming demands of the CPD scheme and the nature of patient complaints received.

Education & Research

• Use the ‘marketing mix’ or the four Ps (Product, Price, Promotion, Place) [81], that are within our control to change, to create a more attractive educational offering in a competitive marketplace. An osteopathic school in Northern England or Scotland would overcome ‘place’ issues, for instance.
• Explore collaboration opportunities with other education providers to help students create a skills portfolio that fits the needs of the profession and meets their own interests.
• Encourage greater involvement of the profession with the OEIs to match the content of undergraduate courses (the ‘product’ offering) to the osteopathic therapeutic encounter, ensuring that graduates are fit to practise and that the course is distinctive and inspiring to prospective students.
• Explore how to reduce barriers to entry to osteopathic schools.
• Review student needs and how these could be better met, through different educational models and wider collaboration with other educational providers.
• Review research strategy to reflect the full scope of osteopathic practice and foreground the patient experience, building on the National Council for Osteopathic Research (NCOR) initiative on practice based research networks [82] and the findings of the PROCare survey [69].
• Existing osteopathic patients are willing and able to help us, if they can be given a voice in our research. As a minimum they can be invited to give reviews of their experience, talk about us on social media and add to our PROMs data.

Acknowledgements

Many thanks to Dr A Banton, Dr J Caldecott, E Lecchi and Prof DA Nicholls for invaluable education and encouragement.

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Thanks everyone for reading and for watching the video, more should be coming soonish

Penny