We all know the fees are going up, but the whys and wherefores might not be so obvious.

Everything seems to be going up, except, strangely, my income. But why is the GOSC fee going up in particular? Is it just general inflation? Or is there more to it? I tuned in to the recent GOSC webinar to have all my questions answered. And just in case you weren’t able to be there yourself, here’s a brief rundown of what I picked up.

It’s definitely happening

This isn’t a case of consulting about whether to put the fees up. It’s about how much to put them up by. The options are £50, £75 or £100 per annum. Or, 96p, £1.44, or £1.92 a week. If this makes you feel gloomy, bear in mind, that if it had tracked inflation since that figure was set in 2014, (something GOSC legally can’t do for some reason), it would now be about £920.

And don’t forget, it’s tax deductible!

The fees used to be much higher

Yes back when I became registered the fee was £750. We were all delighted to hear about the reduction, especially in those days when £750 could probably buy you an annual gym membership, a football season ticket, and a few nice dinners out.

Maybe there was an unfortunate typo in the first press release which reversed the first two digits and the regulator had to brave it and go with it so as not to look foolish. Who cares? We were happy, and I have noted, with annual delight, that it has stayed at this level for a long time now – over 10 years, according to Matthew. And he should know. Matthew has been Chief Exec since 2019 but has been a steadfast fixture in osteopathy’s corridors of power for 26 years, and knows the history.

GOSC is spending more than its income

Yes, outgoings more than incomings. I guess most of us have been there! However hopefully not to this extent. Between 2023-2026 GOSC spent £540,000 more than it earnt. Yes that’s more than half a million pounds. Why? It’s not just the rising cost of living that we are all too well aware of. Although the rise in operating costs is a significant factor.

There are more complaints than ever

Yes this is a biggie. Complaints are up by 74% on the 2018 figure. I think Matthew said it’s running at 80 a year, and these are expensive to deal with. The resident staff must be run off their feet. And investigations and hearings involve many other people, some of them lawyers, who all have to be paid for their attendance.

NB Your perennial advice – ***PLEASE CHECK YOUR INSURANCE RENEWAL DATE NOW AND SET A REMINDER***

AND ANOTHER WARNING – TO ANY OSTEOPATHS USING PLATELET RICH PLASMA INJECTIONS – you need to check you are legally allowed to be doing this, because it has become very tightly regulated.

Why are there more complaints?

Your guess is as good as anyone’s but it is not specific to osteopathy. The entire healthcare system is experiencing an increase.

Maybe the general public now has more access to make a complaint and more confidence to challenge professionals. We are also post-MeToo – women no longer have to put up with things they used to, and what might have been seen as an unnerving encounter with a dodgy-individual-best-avoided is now more likely to be reported and taken seriously. These boundary transgression cases (osteopaths accused of crossing lines which shouldn’t be crossed) make up over 40% of the caseload, can be very complex and time-consuming. In addition, maybe expectations of health care professionals in general are higher.

I am even guessing that this might be part of the AI transformation of society. Think about it. Until recently, you might have an appointment with a healthcare professional, and go home wondering if there was something not quite right, or satisfactory. You might even talk to a couple of people, google a bit, you’re still not sure, and you might just leave it. Now, you can type your experience straight into your AI of choice, always listening, always sympathetic and understanding. You write your experience, as subjectively as you like, and it comes back with a link directly to the complaints hotline of your chosen regulator, complete with a nicely detailed summary of the possible standards which have been breached.

A little experiment

I just typed this into Chat GPT

I just visited a chiropractor, and he stayed in the room while I undressed, but he did give me a gown and was looking away, but then he asked me to stand still and then bend over and while I did he had his hands on the top of my bottom. Should I complain?

This is what it came up with

“I would consider it reasonable to raise a concern, although I wouldn’t automatically conclude that the chiropractor behaved improperly or had a sexual motive.

There are two distinct issues:

1. He stayed in the room while you undressed.
   The GCC’s current consent guidance says that when clothing needs to be removed, the chiropractor should explain why, obtain consent, and give the patient privacy to undress and dress. Offering you a gown was appropriate, but it doesn’t replace the privacy requirement.
2. He put his hands on the top of your bottom while you bent forward.
   That could quite plausibly have been a clinical examination — for example, assessing pelvic position, lumbar/pelvic movement, muscle tone or landmarks. The fact that he asked you to bend over and touched the upper buttock/sacral area doesn’t, by itself, make the contact inappropriate. But the important question is whether you knew what he was going to do and consented to it. The GCC says consent needs to be informed and that patients should understand what an examination involves.

So, if what happened was essentially:

“Take your clothes off; I’ll look away”
you undress
“Stand there and bend forward”
you bend forward and he puts his hands on the top of your buttocks without explaining that he was going to palpate there

…I can understand why you’d be thinking “Was that actually okay?”

And you don’t have to decide that it was sexual or that he intended anything improper before raising it.”

This is entirely reasonable and good advice, and it does go on to sensibly suggest contacting the practice first, but it also includes the link to the GCC site, making it very easy to submit a concern. And yes, if this happened as written, the practitioner might need to work on his communication and consent skills, but you can see how AI might enable and encourage more complaints.

I’m not saying it’s necessarily a bad thing, I’m all for public protection and maintenance of standards, but it might be part of the reason for the increase.

(Ok, I have just got slightly carried away having some afternoon AI fun and typed in a genuine past disappointing encounter I had years ago with a maternity nurse. I typed it as if it had just happened, and asked its advice. The AI has advised me to complain and, without my bidding, written the complaint email and supplied the appropriate email address. Try it yourself! )

It’s not just about the complaints though

Even if the number of cases settles down, this isn’t a problem that is going to disappear overnight. GOSC says that even if the caseload plateaus or reduces, the underlying deficit will continue because expenditure is still greater than income.

Is the shortfall because fewer osteopaths are joining the register?

In a word, no. The register is staying the same size, despite reported trouble getting new students to sign up for courses. Although there is some new life shooting in Liverpool (Liverpool John Moore University possibly coming into play), and there is even talk about a potential apprenticeship standard, the osteopath population is an ageing population. Maybe because in the current economic climate none of us can afford to actually retire.

Can’t the GOSC just make some savings?

Yes, they already have. I’m not quite sure what “including patient voice work in existing roles” actually means, but it’s saved us £18 000. It seems that bringing things in house – things like education quality assurance, research and data analysis – has made huge cost reductions, along with leaving staff vacancies unfilled, but it’s still not enough.

Is some of this because the rules are ancient?

Apparently, yes. GOSC thinks some of the cost of Fitness to Practise is baked into the legislation itself. The legislation is described as outdated, prescriptive and inefficient, and there are circumstances where one case can require several separate meetings or hearings in a very short period.

So there are savings GOSC can make — and has made — but there are also things it can’t simply change itself. Currently the lawmakers are busy with modernising the GMC, NMC and HCPC legislation so it might take a while before they get round to us – we’re talking a few years.

What about part-timers?

There is no option to charge part-time osteopaths different amounts. The question of whether one could charge based on turnover gets brought up from time to time, but due to the legal “strait-jacket” this simply cannot change for the foreseeable future.

But didn’t they sell the building?

Yes, the building has been sold for £3.3million and they have already downsized. It was a lovely big building, a stone’s throw from Tower Bridge, but it was costing £150 000 a year to run. Is that right? Surely energy bills haven’t gone up that much? It has helped GOSC replenish the coffers, and they are going to have 8-9 months’ worth of operating costs in reserve. In this era of depreciating currencies it will be interesting to see how they manage this. I’m guessing Bitcoin is out of the question?

Can’t we just amalgamate with the HCPC?

Yes, some other regulators are cheaper, and have considerably more people paying in their subscriptions, but this is not something that is even on the table in any way, shape or form right now.

Do I have a say?

Yes! You have until 29th October 2026. You can find the consultation document here.

To go straight to the financial annex (lots of graphs) go here

If you have more questions, or want to hear from the horse’s mouth, sign up for the next webinar, to be held on Tuesday 13th October here.

Or even log on online to the next Council Meeting in November. I’m not sure what day it is yet but keep an eye on the GOSC emails and it should be in there. You don’t have to commit to the entire day – just log on and off as you fancy, but I think you do have to let them know that you wish to attend or log on beforehand.

In the meantime, enjoy these last embers of Summer, and see you soon

Thanks for reading