Research publications

We carried out research in 2014, 2018 and 2023 to explore public and patient perceptions of osteopathy and osteopathic regulation. The most recent research in 2023 aimed to provide an understanding and track changes in public and patient perceptions of osteopathic care and regulation over time.

It found that there continues to be a fair amount of confidence in osteopathy amongst the UK public and that the work done by regulators to set educational standards and ensure that healthcare professionals keep their knowledge and skills up to date also helps to build public confidence.

• Public perceptions report 2014
• Public perceptions report 2018
• Public perceptions report 2023

In 2021 we commissioned research into patients’ expectations of osteopathic care as part of a wider programme of work to enhance knowledge of the attitudes, needs and concerns of the public and patients who seek the care of osteopaths.

The research found that when seeing an osteopath in private practice, over 96% patients were satisfied, and 69% of the most widely held expectations were being delivered well, many extremely well. However, the study also identified gaps between expectations and delivery of care, which have a negative effect on outcomes of care.

Between 2019 and 2023, the GOsC undertook a thematic review to explore the roles patients play in pre-registration osteopathic education in the UK and to what extent patients may further contribute to osteopathic education. The review presents a number of findings and recommendations.

In 2020, we developed our Patient Involvement Forum to improve the way that we engaged with patients and to make the patient voice central to our work.

In 2023, we surveyed forum members to understand their experience and the impact it has had for them and we also had internal discussions about the impact of the forum.

The evaluation found that the forum has had a significant positive impact on the work of GOsC and forum members are positive about their experience of being a member of the forum, although areas have also been identified where improvements can be made.  

To produce a snapshot of current osteopathic practice, KPMG surveyed a stratified sample of UK osteopaths in 2011 for the GOsC, achieving a 28% response rate.

A project to develop and pilot a research tool that would enable osteopaths to collect, share and compare patient data, funded by the GOsC and led by the National Council for Osteopathic Research between 2008-2010, helped to profile current osteopathic practice in the UK.

The project found that the tool developed performed extremely well, and that it was clear, easy to complete and generated useful data.

This research explores the factors among osteopaths, patients and osteopathic organisations that support, encourage or inhibit osteopaths from practising in accordance with the Osteopathic Practice Standards. It was undertaken by an independent team of academic researchers, led by Professor Gerry McGivern at Warwick Business School.

The final reports were published in 2015. The research found that compliance with the Osteopathic Practice Standards was largely fear-driven rather than values-based; that GOsC’s proactive engagement with the profession was improving perceptions of the OPS, though formal Fitness to Practise hearings risked leaving osteopaths less professionally engaged; and that professional isolation was a significant driver of poor practice, with confidential peer discussion review identified as the most effective mechanism for proactively improving standards.

Exploring and explaining the dynamics of osteopathic regulation, professionalism and compliance with standards in practice: final report

Appendix 1: Osteopathy Practice, Profession and Regulation Literature Review

Appendix 2: Regulation Literature Review

Appendix 3: Survey Questionnaire

Appendix 4: Survey Results

In 2020, Professor Gerry McGivern and colleagues undertook this research to develop understanding around compliance with regulation and the embedding and embodying of the Osteopathic Practice Standards.

The findings demonstrated the impact of our regulatory activities over the past five years and informed our communications strategy and approach for 2021 to 2024.

Since 2016, we have undertaken surveys to assess the impact of the CPD scheme, in terms of the three strategic objectives of the scheme and to see whether osteopaths are engaging with the scheme and using the Osteopathic Practice Standards (OPS), getting support from colleagues as part of the CPD scheme and creating networks of support and building a professional community. The surveys also examine the role of the peer reviewer and osteopaths’ experiences of the Peer Discussion Review (PDR) process.

This research was undertaken because there is limited information about how best to support newly qualified health professionals training and working in the independent health sector.

Through the research we identified enablers that are predictive of a positive transition into practice and barriers predictive of a less successful transition into practice. We also heard about further support needs for newly qualified osteopaths.

As part of our statutory duty to promote high standards of education, in 2011 we commissioned a research project to help us understand how prepared graduates of osteopathy training courses are for practice. Our aim was to find out whether further support is required to help osteopaths make the transition from student to practitioner in order to ensure that patients continually receive a high standard of care.

The research found that new osteopathy graduates were generally “safe, if not always effective” — with osteopathic education’s strong emphasis on patient safety coming at the expense of developing clinical effectiveness, interpersonal skills, and business acumen; that there was significant diversity and variability in graduates’ preparedness across OEIs, clinical placements, and early mentorship experiences, making it impossible to identify a typical trajectory into practice; and that the profession’s high value placed on autonomy, combined with the prevalence of self-employment and isolated practice, left many new registrants feeling unsupported and ill-equipped during their early months in practice, despite most desiring more structure and guidance during that transition period.

It is a patient’s right to be made as fully aware as possible of any known risks associated with a healthcare intervention, before consenting to treatment. To gain a better understanding of any potential risk that may be associated with osteopathic care, four interlinked research projects were funded by the GOsC.

Adverse events associated with physical interventions in osteopathy and relevant manual therapies

We commissioned research for a systematic review of published literature to investigate the risks associated with manual therapy. The searches were carried out during March 2008.

The literature review found that major adverse events and death are rare as a direct consequence of manual therapy, however, minor adverse events are common in those receiving manual therapy. However, manual therapists should proceed with caution and avoid cervical manipulation when dealing with patients presenting for treatment of neck pain and stiffness who additionally have, cardiovascular insufficiency, history of recent trauma and unusual headaches.

Communicating risks of treatment and informed consent in osteopathic practice

This project was initiated to provide guidance to osteopaths on good practice relating to communicating to patients about any risks of treatment.

The research provided some important information on effective ways of communicating risk of adverse effects to patients in the context of osteopathic practice; good practice when seeking informed consent from patients for osteopathic care; and, what osteopaths should be aware of in order to understand clinical risk effectively.

Insurance claim trends and patient complaints to the profession’s regulator

This study examined the nature and frequency of complaints made about osteopaths and insurance claims against them during the period 2004-2008.

The study provided rich data about osteopathic complaints, a baseline for future monitoring of trends, but also concludes that further testing is required of the new classification for osteopathic complaints and also, that further qualitative research is needed to test the hypothesis generated within this study about why patients complain.

Investigation of osteopaths’ attitudes to managing and assessing risk in clinical settings and patients’ experiences and responses to osteopathic treatment

In 2013 we commissioned research to document reported treatment reactions and adverse events; to provide a description of UK osteopaths’ risk assessment and risk management; and to describe and model osteopaths’ and patients’ perceptions and beliefs about adverse events and treatment reactions.

The findings of the research include extensive new data that is relevant to:

• the training of osteopaths
• the development of guidance for practitioners and strategies for minimising risk to patients, notably the assessment of the frequency and character of minor and major adverse events
• the analysis of the patient experience.

The GOsC, the Institute of Osteopathy and the providers of osteopathic indemnity insurance have been undertaking a collaborative data collection initiative since 2013, with the aim of better understanding the nature and frequency of concerns raised about osteopaths and osteopathic services.

The participating organisations have developed a common system for classifying concerns, and apply this classification routinely in their case management. The organisations’ aggregate figures are pooled annually and independently analysed by the National Council for Osteopathic Research.

Further information on the findings of these annual reports can be found on the NCOR concerns and complaints report webpage.

Osteopaths are required to be open and honest if things go wrong. This is known as the duty of candour and is set out in Standard D3 of the Osteopathic Practice Standards. GOsC aims to support osteopaths to carry out this duty. To help us do this, we commissioned research with the General Chiropractic Council (GCC) to better understand public perceptions of the duty and how it should be implemented in osteopathy.

The research provided important information about patient views on the duty of candour, expectations on how it should be applied in practice and patient and public views on what they need to hear from practitioners when things go wrong.

We worked alongside the General Chiropractic Council (GCC) to commission a literature review that looked at how touch is communicated in the context of manual therapy.

The literature review found that touch is multi-faceted making it a complex phenomenon to investigate. It also found that despite the importance of effective patient-centred communication in healthcare practice, there is limited published research that enhances the understanding of communication in relation to touch and professional boundaries specifically within osteopathy and chiropractic therapies for professionals and patients.

In 2016, all osteopathic educational providers agreed to participate in a thematic review of boundaries to support teaching and learning in this area and Julie Stone, an independent consultant, was commissioned to write the report.

Some of the findings from the research were that boundaries are recognised as being an important part of osteopathic training and that good boundaries are seen as a key element of professionalism and are widely taught as an integral part of training on professionalism. The research also found that for some education providers, training on managing boundaries is implicit rather than explicit.

In 2021, we commissioned an update to the thematic review to take into account the changing social, political and cultural climate and context within which osteopathic education sits. 

The research found that whilst education providers are the primary source of professionalism and boundaries training for osteopathic students the Osteopathic Practice Standards and formal education only partially influence professional behaviour and do not deter serious boundary violations, with students also identifying inter-generational and cultural gaps between themselves and staff.

In 2023 we commissioned researchers at Middlesex University to take an independent look at our key registration trends to enrich our understanding of the current patterns within the osteopathic sector in terms of student numbers entering on to osteopathy courses and the numbers of osteopaths joining and leaving the GOsC Register. Understanding these areas helps us, the profession, and our key stakeholders to consider what this might mean in terms of planning for the future for the delivery of undergraduate osteopathic education, workforce planning and for patients.

In spring 2012 we carried out a survey of osteopaths’ views. Our aim was to get feedback from osteopaths about how we communicate with them, how they communicate with us and what we can do to improve the services we provide. Responses were received from 1,342 osteopaths, equivalent to 30% of the profession.

Whilst the survey found that osteopaths had confidence in many areas of our work, there were also areas where we needed to do further work, such as a lack of understanding of our role and duties as a healthcare regulator.

Following the 2012 survey, in 2024 we undertook further research to explore how osteopaths, students, educators and partner organisations perceive GOsC, including how we perform our role as regulator. We wanted to know the extent to which the profession understands our role, and how they think we are performing as the regulator, to identify where we need to focus our resources, and where we need to make changes.

Overall the findings showed:

• Individuals with a clearer understanding of our role and remit tend to be more positive than those who have a lower level of understanding.
• The majority of respondents to the survey had negative perceptions of the GOsC (64%), around a quarter (24%) were neutral, and 11% were positive.
• ‘Fear’ and ‘necessary’ were the two most common words associated with GOsC.
• A third of those that responded to the survey (33%) said they have some trust in the GOsC or trust the GOsC completely; a fifth (19%) neither trust nor distrust the GOsC and almost half (46%) don’t trust the GOsC at all or have little trust in the GOsC.
• There were common misconceptions among osteopaths, students and educators about our role. The most common belief was that GOsC lobbies the government on behalf of osteopaths (59%), followed by advocating or educating the public on the benefits of osteopathy (50%).
• Those with positive views of GOsC tended to have more direct experiences with the organisation, whereas those with negative views tended to be influenced more by the experiences of others in the profession.
• There is a general lack of awareness of some of the work GOsC is doing to support and engage with the profession, for example attending regional group events and visiting students during their education.

The research also provided a number of recommendations which are informing the work we are doing in response to the findings, including short and longer term plans to help us build trust, reduce fear and tackle the misconceptions held about our role.