Osteopathic Practice Framework

Introduction

This document relates to the GOsC draft proposal for an Osteopathic Practice Framework (OPF).  The approach taken in the draft OPF document has caused great concern to a number of osteopaths.  In its consultation, the GOsC has asked for any suggestions for alternative approaches.  This document is an attempt to sketch out such an alternative.

I have borrowed (stolen!) extensively from other people and very little of this document is original, however, the views expressed in it are also my own (and do not represent a BOA policy).

1. Purpose

1.1   The primary function of the GOsC OPF document is to provide the regulator with a reference against which to regulate osteopathic practice, but it should also provide two other benefits:

a.       to the profession: increase the transparency of regulation by informing osteopaths about the framework of regulation.

b.      to the general public: reduce anxiety and inform expectations by educating patients about the way osteopaths work, and therefore what they might expect during a consultation.

1.2   In order to produce a useful document, all three functions must be fulfilled.

2. Theoretical Basis of the document

2.1   The draft document is based on the division of osteopathic practice into “typical”, “less typical” and “least typical” areas.  These are defined according to the types of technique used, the type of presenting problem and the type of patient.

2.2   It is a basic principle of Osteopathy that our bodies have intrinsic systems of repair and maintenance and normally return to health.  Osteopaths therefore look for factors that may be preventing normal resolution and aim to address these factors to allow the body’s intrinsic mechanisms to work more effectively, rather than setting out to treat the presenting condition itself.  Treatment is therefore specific to the patient rather than the presenting condition.

2.3   Every patient is a unique individual and Osteopathy focuses on the unique individual patient: it is patient-centred.  Thus the history-taking, the examination and the treatment approach will all be unique for every patient.  In addition, every osteopath is also a unique individual with a unique combination of knowledge, experience and skills, and this adds another layer of variability to the individual patient’s experience.

2.4   As a consequence of 2.2 and 2.3 above, it is an inherent characteristic of Osteopathy that there is no “typical” experience for the patient – there cannot be, and it would be misleading to imply such a thing could exist.

2.5   It is, however, true that, even though they will be tailored to the individual patient and circumstances, there are certain features that are common to all osteopathic practice:

1. History-taking.
2. Physical examination.
3. Development of a logical, clinically reasoned working hypothesis.
4. The use of manually applied methods of both examination and treatment.

 

2.6   In order for osteopathic practice to be reflected throughout the document and for all three functions to be adequately fulfilled, the OPF should have at its heart a statement of osteopathic principles.  This does not need to be a fully elaborated theory of Osteopathy that links the various principles together, but rather just a statement of the very basic components that inform all osteopathic practice.  Despite much scepticism in the profession, the BOA’s Common Language Project (CLP) has demonstrated that there is a remarkable degree of agreement across the profession concerning its basic principles.  Such a statement of principles would demonstrate that osteopathic practice is regulated from understanding rather than the unthinking application of standardised formulations.

 

2.7   The statement of principles would ensure that the guiding principles of Osteopathy were enshrined within the regulatory framework, and this would be hugely reassuring to many osteopaths.

 

2.8   The use of manually applied methods of assessment and treatment are a characteristic of Osteopathy.  A significant part of the osteopathic training is the learning of these methods, the development of palpatory skills and the discrimination to recognise the limits of one’s abilities in using them.  The GOsC could therefore be justified in considering the further acquisition and refinement of manual skills, and recognising the limits of one’s competence in using them, to be part of the basic competence of an osteopath.

2.9   The use of adjunctive (i.e. non-manual) techniques could be considered to fall outside the scope of strictly osteopathic training and it could therefore be considered reasonable for the onus to be placed on osteopaths using such techniques to be able to provide evidence of adequate training in their use.  This would provide a practical limit to the range of techniques that the GOsC would have to regulate directly.  The GOsC would only have to consider whether the adjunctive techniques were being used in a way that is compatible with the principles stated in the OPF.

2.10 The areas of obstetric and vetinary care are covered by legislation and the OPF and other regulatory documents need only require osteopaths to practice in conformity with the applicable legislation.

2.11 The area of paediatric care is potentially contentious and practitioners prominent in that area should be consulted for advice in how the issues may best be handled.  [My personal view is that my own undergraduate training in no way equipped me with sufficient paediatric knowledge to be safe treating babies and infants and that I would need additional training to work in that field.  This is a rapidly expanding field and many osteopaths work in it entirely competently with no additional formal training (having gained the requisite expertise informally and through self-directed study), so it may be difficult to insist that evidence of such additional training should be compulsory.  However, it is a concern that inadequately knowledgeable osteopaths could start treating babies with potentially disastrous consequences.]

2.12 With the exceptions of adjunctive (non-manual) therapies, obstetric, vetinary and paediatric care, all other types of treatment/patient/presenting condition should be considered equally usual parts of Osteopathy.

3. Other content

3.1   In addition to a statement of principles, to fulfil its various functions, the document should also include:

a.       A basic description of features common to all osteopathic practice (see 2.5);

b.      Information and advice to inform the expectations of patients.

3.2   It is very important that:

a.       patients are not lead to unrealistic expectations;

b.      any advice to patients is broad enough to cover the full range of osteopathic practice;

c.       patients expect osteopathic assessment and treatment, with all that implies in respect to the need to observe and palpate structures throughout the body and not only local to the site of the presenting symptoms.

4. Integration

4.1   The integration of this document with the other key GOsC documents is highly relevant; it seems inevitable that the Code of Practice (COP) will need to refer to the Standards of Proficiency (SOP) and the OPF, and it is essential that all three be mutually compatible.

4.2   Incorporation of a statement of principles at the core of the OPF and the integrated nature of the three key documents (COP, SOP and OPF) means that these principles will be incorporated into the disciplinary framework.  This would be reassuring for many osteopaths and could increase the perception of transparency in the disciplinary process.