Standard of Proficiency and Code of Practice Draft Document

This proposal is clearly untenable, as no document in itself can achieve such an outcome. At best the documents’ intention remains aspirational-rather than a realistic goal. If the basis of such a document is flawed in its intention, then it must fail in its outcome. Badly constructed proposals act to merely continue the endless paper trail that healthcare and other professions are asked to accede to, under the pretext of patient safety.

If regulatory processes actually worked as proposed, then we would not have  the headlines this week concerning the circumstances leading to the deaths of hundreds of patients in Stafford Hospital (Mid-Staffordshire Health Trust). Nor would we have an extesive history of the many patient deaths (Shipman, Alder Hey Hospital etc.) recorded due to professional neglect or misconduct over recent years. Regulatory mechanisms cannot justify the suggestion that they play all but a very minor rôle in patient safety, as the facts do not substantiate this. Neither does the cost to the taxpayer of funding their existence.

The requirement by The Government to ask all healthcare organisations to make patient safety their primary concern, does not oblige the osteopaths’ regulator to produce a legal document to define the profession. An opportunity now exists for our profession to define its profile and its obligations to our patients in exactly the manner requested by the Prime Minister earlier this week.

“We need to change the system to make government more transparent and accountable. The last government tried to make things happen through bureaucratic accountability, through public service agreements, targets, the whole of the public sector answering to Whitehall. Now, there were obvious problems to that system. It bred bureaucracy, it created inefficiency, and it also created a lot of unintended consequences. It also encouraged a lot of short term thinking…”

The finished document, if one must be produced, should avoid itemising each and every attribute that an osteopath may require to be effective primary care practitioner. That would be an unrealistic and futile attempt to legislate for all possible situations, and is intrinsically flawed. The current draft is possibly  reflective of the litigious individual, not the usual patient seen in practice. The final draft should aspire to defining the optimum service we can offer our patients, not the most catious and artificially constrained version. It should provide a comprehensive description of all the skills that are developed by osteopaths during their initial training, and subsequently refined and continually reflected upon during their practice. It should be sufficiently succinct and informed to be read and understood by our patients as well as those who are required to review an osteopath whose practice may lead to a patient complaint and subsequent investigation.

Attempting to measure individual aspects of the consultation and treatment process against a theoretical benchmark, provided by administrative or legal authorities is a standard norm in most professional practices. Its failure to achieve its stated objective of patient safety is patently obvious.

If In was to use the draft to measure my own practice performance with the patients I treated in this mornings surgery, I regret that I would probably fail to succeed in treating them adaquately, based on the draft basemark. Why so?

Because by omitting to demonstrably show I had ‘ticked all the boxes’ within each heading, I would undoubtably be held culpable by the legal expert who will use our finished document to illustrate my inadequacy.

Regrettably, that is how the legal system works in professional negligence cases, and leading to our current over-protectionist culture. Doubtless osteopaths will be held liable to deficiencies, negligence and impropriety on occassion-but we are not obliged to create a tool to restict our ability to deliver our skills.

We perhaps should consider a narrative based description of what osteopathic practice envelopes, in all its complexity and breadth. We need to encompass the cranial based practice together with the structuralist approach. The full spectrum of our specialism from A-Z to acknowledge the extraordiary heritage our profession has to celebrate.

It is inappropriate to rewrite the entire paper to illustrate this proposal, but if we use the initial Section A: Communication and patient partnership, to provide an alternative format to the draft, perhaps this can assist.

‘Osteopaths recognise the essential nature of trust, respect and integrity, which lies central to the relationship between their patients and themselves. Every effort is made to remember this ethos during the consultation and treatment process. Irrespective of whatever part of the patient requires treatment, an appreciation of the patients’ needs and considerations is always important.  Good communication between both patient and practitioner creates the optimum environment for the benefits of osteopathy to develop.

Every patient is essentially different, each with different needs, expectations and a unique medical history. A patient may present on one occasion with a particular understanding of their illness or complaint, yet on another they will have changed in their attitude and their needs, sometimes without cogniscance. At all times the challenge of providing a holistic approach-a workable framework to effect change-remains a constant.

On the matter of ‘Consent’, osteopaths are required to describe what form of osteopathic treatment they propose to provide their patient with, to assist in their treatment. They should also provide a guide to what side-effects from treatment their patient should expect. At all times osteopaths seek to improve the health, mobility and vitality of their patient with the minimum of side-effects’.

By providing a narrative precis of the osteopathic Standard of Proficiency and Code of Practice document, the intention is to reflect in a more realistic way, what actually occurs during the osteopathic practice. This to replace the orthodox description of medical care with its emphasis on the general to the specific methodology, and emphasis on symptomatic reduction. The alternative osteopathic model requests recognition of the natural innate vitality of the patient, and their ability to catalyse transformation without essentially relying on the biomedical pharmacopeia nor surgery, unless specifically indicated.

The current draft document represents a bankcrupt mediocrity which our profession should choose to discard. We have with this revision and reflection, an opportunity to define ourselves with a genuine authenticity.