What causes concerns? Reflections on the latest NCOR concerns and complaints report

Understanding what concerns are reported by patients can help us (osteopaths and regulator too) to reflect on what we do and how we do it, to consider what we can learn and take actions to reduce the risk of complaints and concerns in the future.

Firstly, I am pleased to be able to highlight that the overall rate of concerns remains low. On average around 3% of osteopaths have concerns raised about them each year. And many of these concerns are resolved locally. However, every concern raised is an opportunity for us all to learn.

Key areas of concern

Boundary issues including sexual impropriety

The latest report, collated from 2019 data, shows a significant increase in concerns about sexual impropriety with 17 cases; this is the highest ever recorded. Examples include: conducting a personal relationship with a patient, texting crude messages and/or images to a patient, inappropriate touching of breasts, thighs or massaging of the patient’s groin or buttocks.

Since this report was collated the increase in transgression of boundaries cases is continuing. Our fitness to practise reports show continuing increases in boundaries cases during 2020 and 2021. These can relate to emotional and professional boundaries too and not just to breaches of sexual boundaries.

We have recently begun to publish a series of boundaries case scenarios and responses to support the application of the Osteopathic Practice Standards (OPS) in practice.

Listening and communication including consent

Communication concerns and complaints were slightly higher this time than the previous 6-year average, although still significantly lower than 2013 when data first started to be collected. This seems to demonstrate that the profession’s increased focus on consent and communication, as part of the CPD scheme and from CPD providers in this area, has had a positive impact. But it continues to remain a key area of focus because communication and consent goes to the heart of patient care.

Examples include disregarding or not acknowledging information from patients, absent or incorrect communication to patients, failure to obtain valid consent or no shared decision making with the patient, and failure to communicate effectively.

Clinical environment

Concerns and complaints about the clinical environment were above average in 2019 this was due, in particular, to concerns and complaints about value for money. It could be argued that issues around value for money are also tied up in effective communication with patients.

Trust in the profession and regulation specific complaints

A critical hallmark of any regulated profession is public trust. The public’s trust and confidence in the profession as a whole (and the reputation of the profession generally) can be seriously undermined by an individual osteopath’s professional or personal conduct.

So, it is significant that there was an almost threefold increase in complaints in this area in 2019 compared to the average over the previous six years. This increase relates primarily to conduct bringing the profession into disrepute but also to failing to respond to patient complaints or engaging in complaints processes.

Standard D7 of the OPS is helpful here:

‘You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace.’
Examples of conduct that could bring the profession into disrepute include:

• not acting within the law
• not showing compassion to patients
• not showing professional courtesy
• not behaving honestly in personal and professional dealings
• not maintaining the same standard of professional conduct in an online environment as would be expected elsewhere
• abusing alcohol or drugs
• behaving in an aggressive or violent way in your personal or professional life
• allowing professional disputes to cause behaviour below the standards expected
• falsifying records, data or other documents

Effective complaints management

It is worth reflecting on the fact that many of the concerns and complaints in this report were in fact managed at the local level and did not require escalation to the regulator. Concerns and complaints provide a good opportunity to hear and learn from patients, with a well-handled concern or complaint potentially resulting in a stronger bond of trust between the osteopath and their patient, leading to improved patient care. Well managed patient complaints can be an excellent learning experience and can lead to greater patient advocacy about practice.

Standard D4 of the OPS states: ‘You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise.’

Other concerns

Other persistent concerns, although much reduced from their peak during the reporting period, included concerns about inappropriate advertising and failure to maintain professional indemnity insurance.

Key points in practice

Here I set out some practical activities which you might want to undertake to help put the key learnings from the report into practice:

Boundary issues: Think about Standard D2 of the OPS, which states: ‘You must establish and maintain clear professional boundaries with patients, and must not abuse your professional standing and the position of trust which you have as an osteopath’. Reading the associated guidance will provide support in terms of navigating complex emotional and professional boundary issues and personal relationships to keep patients safe.

You could discuss the series of boundaries case scenarios and responses we have recently begun to publish (highlighted in our latest ebulletins) and your own responses with a colleague. This can help to inform practice and can also count as an objective activity and may cover Themes A (Communication and patient partnership) and D (Professionalism) as part of the CPD scheme.

Listening and communication including consent: Have a look at OPS Theme A: Communication and patient partnership, recognising that communication is effective only when the intended message is actually received by the patient, not just when something is said or published. There are also a wealth of resources on the this topic on the CPD website including case studies and articles to support learning in this area.

Clinical environment: It’s important to remember always to check that the patient has received your message as you intended it. This is important both inside and outside the clinical setting. Ensuring appropriate preparation in advance of the appointment and that the patient’s expectations are understood and met at the conclusion of the appointment are critical in supporting a successful therapeutic relationship. 

Trust in the profession and regulation specific complaints: You might find it a helpful exercise to reflect with a colleague on the examples given above and in OPS D7 about the types of conduct that could bring the profession into disrepute. You could consider, ‘would patients and colleagues think this was behaving professionally?’

Ensuring that professional indemnity insurance is in place and that advertising is compliant can help to avoid these types of concerns which can affect patients, the ability to practise and the reputation of the profession. You might find it helpful to check this joint message from the GOsC, the Advertising Standards Authority and the Committee of Advertising Practice, which was issued in April

Effective complaints management: Why not team up with another osteopath to review your own complaints processes? You can work to ensure you’re providing maximum opportunities , to hear from patients if they are dissatisfied and to help work towards resolving their concerns and improving care.

Stay connected: A key theme in these learning points is the opportunity to discuss practice and undertake CPD with others. In fact, reviewing these points and undertaking the activities suggested can help you to enhance your practice, connect with your colleagues and can also meet almost all of the requirements of the CPD scheme including getting objective feedback from an osteopath or other health professional.

Read the full NCOR report