Over recent years regulation has become the scourge of businesses of every kind, much of it in the name of ‘Health & Safety’ or consumer protection. Remember we are healers: we already have the best interests of our patients at heart without having to produce statistics or jump through hoops as many of us did with the Personal Profile and Portfolio registration process farce. Practice audit is something that could be easily integrated into the routine of most osteopaths, but redefining osteopathy, limiting our scope of practice and having to fit into a box every few years could seriously add to the burden of making an honest living through helping people.

What many forget is that the current Government are not there forever, and with a general election looming, they may now be more open to influence or persuasion than when there was a seemingly unshakeable hold on power. As a group we would have political lobbying strength if we were united in what we want. With our patients behind us, we could achieve even more. The British Osteopathic Association are our voice to lobby for what we want as a profession, and must listen to us as individuals, groups and colleges. All we have to do is say what we really think.

GPs are constantly battling against paperwork, but they have the resources to back them up – practice managers, receptionists, and the NHS. As lone osteopaths, or as part of a small group practice, we should be very wary about accepting more paperwork just for the sake of political correctness and the trend towards acting through fear espoused by ever-increasing Orwellian regulation.

If something is inevitable – like it or not – then we need to attempt to mould the process as much as is feasible – or opt out. The question is – is the label ‘osteopath’ important to you? If so accommodation to this process is required and that should be made (by our representatives) as painless as possible. A key question is how we can best achieve that end?

The process of revalidation seems to me to have a great deal to do with organisation of information for others – how we reflect on what we do, how we keep up to date, how we do what we do, how we record what we do etc. So, as one does, I went searching in Amazon, and identified a recent book: Revalidation: Prepare Now and Get It Right by Ruth Chambers, Gill Wakeley, and Phil Bright (Radcliffe Publishing 2008) – that offers a detailed look at this process,

It contains chapter titles such as:

Collecting your evidence – including: preparing for appraisal and revalidation; identifying your professional development; what to learn etc

Demonstrating the standards of your practice – including: evidence of competence and performance; demonstrating you can provide good clinical care; good medical [osteopathic] practice; good relationships with patients; how well you work with colleagues; high standards of teaching and training; probity; high standards in research; affirming your health status; and the quality of your work in various settings (clinical, management, employer, team leader, academic post etc)_

My initial response to the prospect of having to demonstrate all this, was an ego driven sense of frustration and irritation. But are those feelings justifiable? Is it not possible, indeed likely, that I really should be able to demonstrate all (most?) of these qualities, capabilities, skills – and pretty well at that, after nearly 50 years in practice?

The time, effort, bureaucratic-irritation, are the hurdles. But the truth is that this is inevitable, so what we need to do as a profession is inform the GOC via consultation in the hope that they will pay some attention to our concerns, as to what’s important and what’s less so. And/or we should lobby our paid representatives (e.g. BOA) to do the same.

I rationalise that as I approach retirement (again), when the time comes to finally give up seeing patients (this time for good), the prospect of revalidation is less of an issue, for me personally.

In my mind osteopathy, as a philosophical model of health care, that dovetails neatly with naturopathic thinking, has little to do with what techniques are chosen to achieve therapeutic change, but has everything to do with recognition of the primary potency of self-regulation which we aim to encourage by means of our therapeutic methodology.

Observing and recording our patient management skills, technical skills and all the other revalidation requirements, including CPD requirements, may have very little to do with how well we deliver this model of healthcare – but demonstrating that we can handle all the revalidation demands may be the price we have to pay in order to continue practising.

Leon Chaitow

Corfu April 2009

Why is it happening?

Revalidation comes out of the Shipman Enquiry and the various initiatives it has spawned, including the Foster Review. The government decided it needed to be seen to be doing something to “prevent another Shipman”. In reality, there is nothing a government can do that will prevent a doctor killing patients. So instead of doing something that will be effective, it can only do something – whatever it can actually do, rather than whatever will actually work. It really doesn’t matter what, as long as it deflects political flak.

The Department of Health (DoH: what a brilliant abbreviation – straight out of The Simpsons!) has decided that it is self evident that whatever is inflicted on doctors must also be A Good Thing for every other healthcare profession. So we have to undergo a process whose ostensible purpose is to stop doctors killing patients!

It is important to realise that the purpose of this process is purely political and that it is in Alice in Wonderland territory as far as logic is concerned. It has been imposed on the GOsC and there is absolutely nothing they can do to prevent it happening.

What will it involve?

The DoH has, naturally, focussed entirely on the NHS and developed a revalidation model based on “360 degree appraisal”. As a profession mainly comprising self-employed practitioners in private practice, many of them single-handed, the DoH’s NHS model is as inappropriate to Osteopathy as it can possibly be.

So the GOsC has decided to develop a model that is appropriate to Osteopathy: one that will not place an unrealistic burden on individual osteopaths, and that will provide a positive benefit to the profession as a whole. To that end the GOsC started consulting with as wide a range of the profession as possible, through the network of GOsC regional reps, the colleges, and the BOA.

It is a principle of Revalidation that it should address risk. Where doctors are concerned the principal risks to the public are of death or serious disability due to either incompetence, neglect or malice. Osteopaths have, in comparison, a remarkably unexciting record when it comes to killing and disabling our patients!

The government’s Better Regulation Executive set out the principles of “Better Regulation”; that it should be:

• Proportionate
• Accountable
• Consistent
• Transparent
• Targeted

The GOsC is committed to ensuring that the Revalidation scheme meets these criteria in terms of the risks posed to the public by osteopaths. Any scheme that is targeted at and proportionate to the risks we, as a profession, pose cannot be too onerous. Any scheme that is consistent, accountable and transparent, is one we need not fear.

I feel the current discussion document is not sufficiently closely targeted and that it is still a bit too big. If it looks too big, people will tend to try to work out what they think the GOsC wants as an answer, rather than thinking properly about the questions in relation to their own practice. Being forced to reflect on your own practice is always a useful process, if not always a comfortable one!

The issues are about identifying the relevant risks and determining in what way the scheme should provide a benefit to the profession.

Some people are alarmed by the remediation component and see it as a sinister way for the GOsC to control the way we practice. In fact, this is a required principle outlined in the government’s Non-medical Revalidation Working Group’s report. Its purpose is to ensure that anyone “caught out” by the Revalidation process should have a chance to remedy the situation as simply and easily as possible; no-one need fear being struck off because they didn’t fill out their revalidation form properly.

What can we get out of it?

I feel that, since Revalidation is being (quite unnecessarily) foisted upon us, we should subvert the process as far as we can, to ensure that we get something out of the effort we will, inevitably, have to make.

The most useful thing the Revalidation process can do for us as a profession is to force us into doing clinical audit. If we have data from 20% of the profession every year that would provide a massive database from which real evidence about real osteopathic practice can be obtained. If we are ever to justify ourselves to the medics and the policy-makers, then that is precisely what we need. But, to be realistic, the only way we will get it is by being forced to do it. Do I perform routine clinical audit on my own practice? No. Why not? Because I am busy and there is always something else that is more urgent than setting up the system to do it. Making it part of Revalidation would certainly get it to the top of my priority list pretty quickly!

The key to audit is building in to what you do every day in practice. That way it isn’t a massive effort. I have been using the BOA’s Data Collection Tool for the past year. It collects data on new patients and I have integrated the questions it asks into my history-taking. I don’t even have to think about it, and recording the data (on the provided spreadsheet) takes less than 20 seconds. Practically effortless, and now I have data on every new patient I have seen for the past year

If a clinical audit tool were standardised in every practice in the UK, we would have a fantastic resource.