Osteopathic Practice Framework consultation results

The consultation on the Osteopathic Practice Framework was held between March and July last year. The consultation comprised:

• a consultation pack mailed to all osteopaths, which was also distributed to a wide range of stakeholders including patient groups;
• six regional events at which there was an opportunity for osteopaths to discuss the practice framework;
• and a questionnaire.

The questionnaires and notes and recordings from the consultation meetings were analysed by an external consultant and a report on the feedback received has now been published.

Key findings

The main findings of the consultation indicated that:

• 62% of respondents agreed that there is a need to define the scope of practice
• 65% agreed that the overall approach proposed in setting out a scope of practice seemed to be sensible 
• 48% agreed with the categorisation suggested 
• 49% agreed that the types of practice included in each category accurately reflected current practice.

However, the percentages cited above should be treated with great caution as some respondents indicated a supportive and/or positive response by ticking the „yes? box(es) but then gave a very critical or negative response in their free text. Others indicated in their free text response that they had ticked yes or no to the question they thought they should have been asked rather than the one actually asked.

A summary of the further feedback received can be found at the end of this item.

Themes and conclusions

The general consensus is that defining a scope of practice may highlight what is special and unique about osteopathy. It could also have the potential to increase understanding amongst public, patients, and other healthcare professionals of what osteopathy and osteopathic practices have to offer.

However, defining a scope of practice might not be feasible and could have negative consequences. We have also noted the antipathy to the three categories proposed and the request for a further consultation.

Other work on scope of practice

The GOsC is not the only stakeholder with an interest in defining a scope of practice. The British Osteopathic Association (BOA), in conjunction with a range of specialist osteopathic training bodies, is developing an alternative scope of practice. 

A working group has been established by the Forum for Osteopathic Regulation in Europe and the European Federation of Osteopaths to develop a European scope of practice.

The World Health Organization (WHO) will also soon be publishing the WHO Guidelines on basic training and safety in osteopathy, which includes descriptions of the different types of osteopathic practice around the world, including definitions of "Osteopathy and osteopathic medicine", "Osteopath", "Osteopathic physician" and "Osteopathic manipulative treatment".

The GOsC will continue to monitor this work and participate where necessary.

Next steps include:

• Undertaking research into patterns of osteopathic practice; 
• Researching the undergraduate curriculum, with consideration given to whether a core curriculum should be developed.  his will feed into work on the scope of practice; 
• Monitoring work undertaken by other regulators, UK osteopathic organisations and osteopathic organisations in Europe and the rest of the world. This work may inform and direct the work of the GOsC in this area; 
• Engaging with patients and the public to inform work on the scope of practice; 
• Agreeing the purpose and effect of any GOsC work on the scope of practice in light of the steps above.

Further feedback

General feedback provided by osteopaths? responses highlighted some important issues, which are likely to have an impact on the implementation of revalidation. These included:

Advantages to defining a scope of practice:

“It would bring clarity to patients about how and what conditions we treat and what type of person or condition would respond to our treatment; many people are still confused as to the difference between physiotherapy, osteopathy and chiropractic, and can't decide who treats what better.”

“If we are to be seen as professional then we cannot exist without a clear statement of who we are or what we do. Not just for marketing but for public confidence and safety.”

Disadvantages to defining a scope of practice:

“A 'scope of practice' limits the possibilities of what osteopathy can offer. This reductionist approach can not represent a holistic medicine. Osteopathy is a philosophy, not a list of techniques.”

“Possible pressure on persons who don't meet with the norm - perhaps with legal ramifications which limit the scope of osteopathy.”

Approach:

“Not using treatment approaches as a way of defining osteopathy. It is the principles behind the treatment that define osteopathy.”

“Remember - osteopathy is a broad church!”

“If you asked 100 representative osteopaths for a narrative version of their view you would get a far better take on the subject.”

Categorisation:

“Why is there a need to categorise practice? Is there a typically/less typically/least typically encountered patient? Treatment is patient not practice orientated. I have no idea - what is this based on? What is the rationale for linking the groups in each section? E.g. osteopaths working in a „least typically encountered practice? working with babies would use the cranial techniques which are listed under „less typically encountered?. To me, adjunct treatments are not osteopathic treatments and should not be included as such. And why are elite athletes a separate category from any competitive sportsman or woman?”

“I haven't seen anywhere what osteopathy doesn't include. Is this to keep the scope wide?”

Current practice:

“Cranial osteopathic work is being used by a high proportion of the profession. Post-graduate courses in cranial osteopathy have been the most attended (by days per size, per year) than any other post-graduate course in the profession. They should be in the 'core' group.”

“How do you or I know? I am not aware of any survey having been done.”