The McGivern Recommendations 2015

In February 2015 a team of researchers published a report into the Dynamics of Effective Regulation, which included recommendations for the GOsC.  It’s very, very interesting and shows a lot of insight into the profession, but it is quite time-consuming to read.

Click here to download the full final report

If you don’t have time for that you can also read a blog post about the report here, but if you just want to see the final recommendations that were made to help the GOsC help us comply with the OPS, I have reproduced them here:

The seven recommendations

I probably don’t need to tell you this, but read the ultra-quick version by just picking out the bold type.

1. The GOsC should encourage and support the development of more evidence relating to the benefits and risks of osteopathy, conducted in terms appropriate to osteopathic practice, to provide a firmer basis for some OPS.

2. The GOsC should provide further communication and training about the OPS, particularly the standards osteopaths complained about most, relating to:

  • Communicating risks and gaining consent from patients – clarifying how osteopaths can communicate risks of osteopathic treatments to patients in ways that do not alarm them or undermine their confidence in osteopathy. 
  • Keeping patient notes – addressing osteopaths’ concerns about what constitutes adequate note-keeping and why notes are necessary.
  • Patient dignity and modesty – Clarifying what is expected in relation to these standards to prevent some osteopaths interpreting them in ‘black and white’ terms, which do not reflect the intent of the OPS and undermine their confidence in the OPS more generally.

3. Our research supports the work the GOsC is doing in reaching out, personally engaging and improving relations with the osteopathy profession. Our research suggests this is important in terms of staying in touch with osteopathic practice and the issues osteopaths are facing, demonstrating to osteopaths that the GOsC understands what they do and the challenges they face, and legitimating the GOsC and compliance with OPS within the osteopathy profession. Professional engagement seems to be changing the stories osteopaths tell colleagues about the GOsC, which frame how they interpret and react to complying with the OPS. We recommend that the GOsC continue engaging and improving relations with the osteopathy profession in this way.

4. While the GOsC has a statutory duty to protect the public, and legislation restricts the GOsC’s discretion about whether to formally investigate complaints, the GOsC should aim to minimise the number of complaints taken to formal disciplinary investigations and FtP hearings. The two osteopaths we interviewed who had been subject to FtP hearings seemed to emerge from the process less engaged with their profession and, reflecting research on complaints about other health professionals (Papadakis et al., 2008, Bismark et al., 2013), perhaps therefore at more risk of future complaints. Alternative mechanisms may more proactively address concerns, prevent malpractice, complaints and FtP hearings. Patients might be encouraged, in the first instance, to take less serious complaints to mediation (for example, using the Institute of Osteopathy’s mediation service). Peer discussion reviews between professionals may prevent issues from developing into malpractice and complaints subject to FtP hearings.

5. The GOsC might consider introducing a risk-based ‘right touch’ approach to osteopathic regulation using the language of ‘red flags’ and ‘yellow cards’. Serious concerns about osteopaths’ practice or professionalism, which raise ‘red flags’, need to be reported to and formally investigated by the GOsC, and, if substantiated, subject to FtP hearings. Less serious concerns, which raise ‘yellow cards’, may be better addressed by professionals in ‘formative spaces’, such as the peer discussion review process, or through mediation between patients and osteopaths. To adopt this approach the GOsC needs to define ‘serious’ (red flags) and ‘less serious’ (yellow cards) issues and clearly communicate to osteopaths when they need to report concerns.

6. The GOsC must support and encourage more reflective discussions of practice, learning and sharing between osteopaths, whether between individuals or in groups. These are mechanisms osteopaths believed are effective for addressing minor malpractice, helping osteopaths generally improve the standard of their practice, and fuelling professional engagement. This is particularly important as many osteopaths practice in isolation and have few such opportunities.

7. Our research supports the GOsC proposals for a formative approach to CPD and peer discussion review demonstrating assurance of continuing FtP.

  • Our findings suggest that osteopaths must be allowed to choose their peer reviewer so that they are more be able to openly discuss their practice during peer discussion reviews.
  • Formalising the recording and reporting of peer review discussions may undermine osteopaths’ willingness to openly discuss and address problems. The detailed content of peer discussion reviews should therefore remain confidential, unless serious problems are raised. Recording and reporting might be limited to when the process took place, who was involved, confirming an appropriate structure of topics was discussed and/or providing an overview of the discussion (for the GOsC to specify after consultation with the osteopathy profession while reflecting on patient feedback and clinical audit data), developmental actions for the osteopath to take forward, and that no serious concerns (‘red flags’) were raised. The record of peer discussion reviews should be agreed between osteopaths and their peer reviewer before it is reported to the GOsC.
  • The GOsC should support training for peer discussion reviewers, particularly around challenging conversations to help osteopaths address difficult issues.
  • We recommend that peer discussion reviews take place annually, rather than every three years as the GOsC currently propose, with evidence of annual peer discussion reviews submitted every three years. This would also encourage osteopaths to think of peer discussion review as a more developmental professional process rather than associated with the submission of paperwork to renew their professional registration.
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