1. Regulation as a learning community
Tim Walker
Chief Executive, GOsC
19 September 2016

2. What is regulation?
‘The control, governance or management of a larger system by a smaller system’
‘A rule or directive made and maintained by an authority’
‘A framework which allows professionalism to flourish’

3. The traditional approach
Regulatory systems for healthcare professionals tend to have a core set of activities:
Approval and quality assurance of educational courses/ programmes
Holding a register of current practitioners
Setting standards of competency, conduct and ethics
Assuring continuing competence of practitioners
Managing complaints and disciplinary proceedings

4. Avoiding harms
Discipline
Point of Harm
‘Upstream activity’
Time

5. Challenges in avoiding harms
Disciplinary processes – tail that wags the dog
Little systemic analysis of harms:
Why these occur
Who is involved
Lack of coherence in ‘upstream’ interventions that can reduce harm (or evidence that supports them)
How to measure events that don’t happen

6. What do we know about ‘harms’?
Analysis of 660 GOsC complaints, indemnity insurance claims and concerns raised with professional association (NCOR 2016):
311 conduct
333 clinical care
10 convictions
6 adjunctive therapy

7. Significant concerns Conduct Clinical care
Failure to communicate effectively (44)
Failure to obtain valid consent (42)
Sexual impropriety (39)
Communicating inappropriately (32)
Failure to protect patient modesty/dignity (27)
Clinical care
Treatment causes new of increased pain/injury (118)
Inappropriate treatment/treatment not justified (60)
Treatment administered incompetently (34)

8. What do we know about people?
Analysis (unpublished) of 131 individuals investigated by the GOsC (n.b. not all resulted in an adverse finding)
Headline findings:
71% male, 29% female
Median age 46
Peak between 6-15 years after graduation
Age at graduation appears to be a factor (>30s more likely to be investigated)

9. What do we worry about as a regulator?
Engagement with standards (McGivern et al 2015):
76% ‘familiar with current standards’
44% ‘standards reflect what it means to be a good osteopath’
49% ‘I have a clear sense of whether I am complying’
Communication and consent – see complaints/ concerns data above
Practitioner isolation – 56% practise on their own more than 90% of the time (KPMG 2011)

10. A new approach to CPD
Requirement that CPD covers the breadth of an individual’s practice and the GOsC’s standards:
Communication and patient partnership
Knowledge, skills and performance
Safety and quality in practice
Professionalism
Compulsory elements on communication/consent
Requirement for objective feedback, e.g. patients, colleagues, audit
Peer discussion at end of three-year cycle
Key words are: engagement, community and support

11. New tools to support practice
Developing practice-focused guidance underpinning standards, explaining the ‘why’ not just the ‘what’
Exploring patients’ and osteopaths’ values and what interventions can be used to reduce risk of misunderstandings
Working with the profession to support the development of local learning communities

12. Why learning communities?
‘Communities of practice are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly’ (Wenger and Trayner 2015)
Continued development of professionalism in practice requires more regular interventions than can possibly be provided by a regulator
Space is needed for professionals to have supportive, reflective conversations

13. Implications for regulation
The disciplinary element of regulation is unavoidable, but…
A model based on deference and fear is demonstrably ineffective
Shifting the focus ‘upstream’ will require new thinking and regulators carrying out new roles
An ideal profession needs to be a participative learning community that supports both autonomy and responsibility
Regulators can play a facilitative role to both support and be part of that learning community

14. References
KPMG (2011) How do osteopaths practise? McGivern et al (2015) Dynamics of effective regulation NCOR (2016) Types of concerns raised about osteopaths and osteopathic services in 2013 to Sparrow (2008) The Character of Harms: Operational Challenges in Control, Cambridge University Press: Cambridge, UK Wenger and Trayner (2015) Introduction to communities of practice