Osteopathy concerns: An opportunity for learning and reflection

There was a significant increase in the number of concerns related to professional boundaries that were received by the General Osteopathic Council during 2025 and the impact of this on patients, osteopaths and the profession is severely concerning.

Patients suffer harm when they feel their boundaries have been breached, even when it’s due to a misunderstanding.

Concerns classified as boundaries cases can include behaviours such as:

• perceived sexual touching
• sexual language
• having a sexual relationship with patients
• patients feeling like they are being sexually assaulted during examination or treatment. For example, a patient may feel uncomfortable when being asked to perform a standard movement test such as stand and reach, while in their underwear, or the osteopath’s groin has been in contact with the patient briefly during a particular technique, or the osteopath has said something of a sexual nature while providing treatment.

So what do these findings mean for learning and continuing professional development?

Key takeaways: Purposeful communication

It’s all about purposeful communication – not only in the moment, but before and after a consultation.

Pre treatment

What action might you take to prevent any miscommunication occurring before treatment? Have a read of the key aspects of the OPS in Theme A – and maybe consider having a case based discussion with a colleague to reflect on if you could:

• work in partnership with patients, adapting your communication approach to consider their particular needs and supporting patients in expressing to you what is important to them?
• give patients the information they want or need to know in a way they can understand? Both for examination and treatments?
• providetreatment options including doing nothing. Clearly explained how this will work for each of the treatments for example, how you will be situated in relation to the patient? Have you got pillows to use appropriately to avoid embarrassment and discomfort?
• explain the benefits and risks of treatment including common post treatment reactions like soreness (See the NCOR website for resources on this)
  
• ensure consent by explaining your approach to examination and treatment, describing the types of treatment methods you might like to use, setting the parameters within which you will work, and explaining how the patient may indicate that they wish the treatment to stop.

During treatment

What steps can you take, to prevent any miscommunication occurring during treatment? In partnership with the patient, have you checked to ensure that your patient is comfortable and that they are not surprised by any aspect of treatment? Can you use open questions rather than closed questions to enable a patient to say ‘stop’ or ‘I’m not comfortable’? What signals might you be alert to that should suggest that you should stop even if the patient says yes it’s ok?

Post treatment

After treatment, what steps might you take to check that a patient’s response was as expected? If you are unsure about something in the consultation, how can you discuss this reflectively, anonymously and safely with a colleague to help you to take appropriate steps to keep patients safe from harm?

Finally, the osteopathic and patient relationship is always based in a therapeutic space and everything must always be for the benefit of the patient to protect confidence and trust in the osteopathic profession.

The process of raising a concern can be stressful for all even though the free and confidential Independent Support Service is there to support anyone who may be affected by a case.

If you are interested in helping us improve how NCOR reports are used to prevent concerns before they arise, please get in touch at info@osteopathy.org.uk

Read more about NCOR and the NCOR Concerns and Complaints Report

Read the latest NCOR report