According to BCA president Richard Brown the General Chiropractic Council is a “cracking success”, Zeno is still not convinced

June 9, 2010
By

At the recent European Chiropractic Union conference in London BCA president Richard Brown outlined  why the UK regulatory model is a “cracking success”, I wonder if the pun got a laugh or were there chiropractors present who knew the reality of regulation for the chiropractic profession. Many will see the medicaliseation of chiropractic as a good thing narrowing scope of practice to diagnosable conditions which respond to various treatments and NHS contracts. Forgetting the words of Ivan Illich that by “focusing on illness” we are marginalising ourselves from the majority of healthy people who chiropractors have most to offer. There is no cure for osteoarthritis by the time signs and symptoms have developed from prolonged spinal joint dysfunction / Subluxation, the degenerative process has begun. Immobilise a joint guess what happens GCC chiropractic skeptics? Keep the joints moving what happens then??

As usual BCA med heads like to complicate a very simple process. Brown told chiropractors that The emphasis placed upon patient protection was the over-riding factor that influenced the medical profession to support legislation for chiropractors and was probably the factor that ensured it was smoothly and successfully steered through Parliament. (Presumably to achieve this the BCA had to convince the medical profession that chiropractic is dangerous and the public needed protecting from dangerous unscrupulous chiropractors.) The groundwork undertaken by the BCA in establishing support consistently stressed that for the public to be adequately protected, the chiropractic profession needed to be subjected to a robust system of regulation.

Brown then goes on to explain the benefits of mandatory continuing professional development. Effective from 1 September 2004, all registered chiropractors were mandated to provide evidence of their postgraduate and learning activities by filing a return to the GCC each year. The impact of this on chiropractors was a formalised system of post-graduate learning; while many chiropractors had always engaged in a process of lifelong learning, this was not the case for all. Nevertheless, as a maturing profession, taking responsibility for continuous improvement could not fail to be in the public interest and from a safety perspective, patients stood better protected from those taking a cavalier attitude to practice. However it might be reasonable at this point to ask if the BCA were being cavalier in accepting physiotherapists and medical doctors setting these GCC “standards” of education for the chiropractic profession. Because the GCCs education committee had no answers when challenged by “Skeptic Barista” who merely questioned the fundamental principle underpinning chiropractic; that there is a relationship between the structure of the spine and the function of the nervous system and wellbeing (subluxation theory).

If this relationship does not exist as stated by the GCC, then how can the GCC claims that chiropractic is anything more than a very expensive massage. The GCC will claim the evidence states “Manipulation” is an effective treatment for back pain, but what is causing the pain- NERVES? You would struggle to get ten chiropractors to agree on a medical diagnosis of back pain because of the complexity of the structure of the spine.  However most chiropractors could agree on a “vertebral subluxation dysfunction” as a cause of pain and now the GCC is telling registered chiropractors that because they have not been able to answer the questions of a  skeptic wind up merchants chiropractic must change. I have engaged with the skeptics and never given an inch, I can agree to disagree. Skeptics are perfectly entitled to their opinions and reading their blogs they are not going to change their minds, even with the better lawyers or plethora’s of evidence.  Its difficult to understand why it is more important for the BCA/GCC alliance to win a few skeptics over and ignore the vast majority of chiropractors and their patients. What amuses me is the  sketics are still scathing of the GCC, apparently unable to appreciate the only reason anyone is paying any attention to Zeno et al is because the GCC is only regulator who would investigate these complaints. Which takes us to Browns analysis of the Fitness to Practise.

Fitness to practise

Perhaps the most significant consequence of the Chiropractors Act 1994 was the inception of fitness to practise hearings. Chiropractors whose fitness was impaired, either for health reasons or for reasons of conduct or competency, could now be subjected to investigation into their actions with the potential consequence of their having their ability to practise being suspended or withdrawn. For the first time, chiropractors were subjected to legally enforceable rules and their practice could be publicly scrutinised. This scrutiny intensified in the wake of the Bristol14 and Shipman15 inquiries and a number of recommendations were made that impacted on the accountability of health professionals. The failings highlighted in both inquiries prompted a review of standards, criteria and thresholds to guide future fitness to practise panels and to ensure that by their actions the public was protected from similar tragedies in the future.

Chiropractic regulation brought with it a heightened awareness of a profession that hitherto was little known. The publicity that accompanied the passing of the Act and a greater knowledge and utilisation of chiropractic treatment brought with it expectations in line with medical care, that of results-based intervention and high standards of conduct, practice and education. For some chiropractors this was as unexpected as it was unwelcome. The euphoria of anticipated benefits of regulation was quickly replaced with a realisation that accountability was very real and that a failure to reach expected standards may be met with patient complaints and, worse still, referral to fitness to practice tribunals.

The Chiropractors Act required that all allegations against chiropractors be formally investigated by the Investigating Committee.16 There is no room for latitude in the legislation; no matter how trivial the complaint seems, the matter has to be considered by the Investigating Committee. For the chiropractic profession this had and continues to have a number of implications.

Loss of livelihood is a major life event, rivalling divorce, bereavement and bankruptcy. Hearings of the Professional Conduct Committee (PCC) of any of the healthcare regulators strike fear into any respondent facing proceedings, not least because of the available sanction of erasure or suspension from the register. For this reason, it remains one of the most relevant consequences of regulation. For patients, chiropractors and society, the assurance that unacceptable professional conduct can be addressed is one of the strengths of regulation.

The loss of professional autonomy

There seems no doubt that, had the pan-professional Health Professions Council (HPC) been in existence prior to 1994, the chiropractic profession would have been included under the banner of its numerous professions; indeed, the Foster Review17 makes the point that no new regulatory bodies will be formed, all health professions henceforth being targeted for HPC inclusion.

There are clear risks to the profession in subsuming chiropractic into a body such as the HPC. The separate and distinct nature upon which it has prided itself would be diluted, not least in the eyes of the public who, even now, find it difficult to distinguish between chiropractors and osteopaths. Incorporation into a body in which there are in excess of 20,000 physiotherapists would also be likely to present difficulties; the ethos of a primarily NHS-driven organisation will clearly differ from chiropractic and the historical friction between the professions is likely to make chiropractors deeply suspicious of a disproportionate influence within the HPC.

It is therefore for the chiropractic profession to clearly demonstrate that it has the need to remain autonomous. It needs to do this by acting in a manner that shows its maturity as a profession and its ability to regulate itself effectively to afford maximum patient protection. Although it has been given a stay of execution as a result of the impending UK General Election in 2010; within 5 years, the eyes of the regulatory world will be on the GCC to prove itself worthy of retention as an autonomous body. Success in this area will not guarantee continued sole-profession status but, without a fight, chiropractic as part of a larger regulator seems a distinct possibility.

This ominous prediction of future professional homogenisation tends to suggest that a further programme of streamlining is inevitable. One could argue that with two professions such a chiropractic and osteopathy, governed under near-identical legislation with a similar scope of practice and patient profile, this may be a sensible move. The role of a ‘Manipulative Therapists Council’ may not present significant difficulties of transition or merger, at least as far as the individual professions are concerned. However, it seems more likely that as small regulators they will be subsumed into the much larger HPC.

Regulatory reform and revalidation

Statutory regulation of chiropractors has necessarily brought with it exposure to the full impact of regulatory reform. The shift from voluntary regulation to self regulation and the inclusion of the profession under the umbrella of the UK statutory regulated health professions has resulted in it being subjected to legislation which, despite not having arisen from the actions of chiropractors, has nevertheless had a profound effect on the regulatory framework to which they are subjected. Events have changed the way that chiropractors are regarded in law and by their patients and by other healthcare colleagues. The level of accountability for chiropractors has risen in line with the raising of the bar generally amongst healthcare professionals.

Yet, while the focus may be predominantly on conduct, regulatory reform both in the United Kingdom and Europe has impacted in other ways on the lives of chiropractors. Any study of such reform would not be complete without consideration of the Human Rights Act,18 but other legislation has also affected chiropractic practice, such as that relating to the use of ionising radiation[19] and [20] and accessing patient records.21

One of the most contentious recommendations to come out of the Shipman Inquiry was the revalidation of health professionals. This required that set standards be met for a health professional to remain on their statutory register. It was stressed that such a system of revalidation had to fulfil two criteria: it had to be formative (an aid to development) and summative (there had to be a check that the required standard had been met). For the chiropractic profession in the UK, the format is still subject to consultation, yet it seems inevitable that chiropractors will need to demonstrate core competency on an ongoing basis.

Future developments

From a relatively comfortable position of self-regulation, healthcare reform has resulted in significant changes for chiropractors and the patients whom they serve. The delivery of health care for all regulated professions has been forced to change through tragic events and the pace of reform has been swift and dramatic. While protection of patients must be the prime objective, this has arguably led to a common practice of defensive medicine, but has also led to a ‘council of perfection’ approach in which healthcare professionals are judged differently and the bar has been elevated to aspirational but unrealistic levels. An emphasis on the civil standard of proof in regulatory hearings has done little to help the fears of practitioners in practice, who perceive that the Sword of Damocles is constantly hanging over them.

For patients, this change hopefully assures them of better standards of care and protection from those who do not meet designated standards. That they can trust their health care provider to deliver safe, effective care is fundamental and regulatory reform has placed these central tenets at the top of the agenda. The process of reform will result in societal changes in attitudes to healthcare with heightened expectations that medical and non-medical professionals may find difficult to satisfy.

Whether this will result in a migration of chiropractors into allied but non-regulated professions remains to be seen. The growth in popularity of the chiropractic profession will dissuade those considering joining lesser known groups, yet a perception of ever-increasing pressures on their practice may drive them to depart. Should this occur, the very objective of regulation will fail; that patient protection is afforded by statutory regulation will have no bearing on these practitioners. However, in reality, it is unlikely that this will occur in great numbers and chiropractors will adjust to the new system of regulation despite protestations of an overbearing system that suffocates their freedom to manage patients and deliver traditional chiropractic care.

Change is inevitable. The opening of the Register back in 1999 started these changes; chiropractors instantly became more accountable for their actions and, for those who chose to register, this accountability meant being answerable to a body which had the power to divest practitioners of their livelihoods. Regulation was soon realised to be a double-edged sword. Fiercely criticised by those expecting a benevolent organisation, the GCC soon became a figure of dislike and distrust amongst those force to comply with standards at odds with their previous practice style. Reform has further fuelled these attitudes and, along with the establishment of a super-regulator, control of the profession has been diminished and a perceived authoritarianism has replaced any initial feelings that statutory regulation might be first and foremost a self-interest group.

Under the umbrella of self-regulation, chiropractors have been subjected to a tide of change that has engulfed all regulated health professionals. Patient protection has been central to this revolution; on the back of historic public inquiries, the chiropractic profession has been forced to adopt changes to its regulatory systems and constitutions that have dismantled a duty to promote the profession and have distanced chiropractors from the regulation of chiropractic.

In the United Kingdom and throughout the rest of the world, there continue to be protagonists, seeking development and furtherance of the profession, and antagonists who strive to plot its downfall. Both groups will shape the future of chiropractic, influencing public opinion, politics and professionalism. The adoption of ideas and the learning of lessons from mistakes made in health care in general and chiropractic in particular will ensure a continued focus on the profession in years to come.

The near-utopian existence that has benefited many chiropractors may be reaching a crossroads. The growth in numbers may limit career opportunities in private practice and, with lessening availability, may come a more concerted effort towards inclusion. The Musculoskeletal Services Framework (MSF)22 and the implementation of the NICE guidelines23 may bring about a change in policy from those who previously had not considered chiropractic to be a viable care option for those suffering from back pain. Future inclusion of chiropractic services in NHS care models may therefore be a realistic prediction over the next decade and several proposals for inclusion have been forwarded,24 although collaborative projects25 will rely upon clear lines of communication between professions and a willingness to embrace new approaches.

Certainly, the prospect of a harmonisation of chiropractic education and standards across Europe seems desirable, yet the regulatory status of nations is irregular and in some cases non-existent. Consequentially, such harmonisation may be some way off, yet a commitment from EU ministers gives encouragement that non-medical practitioners will be included in future health measures.

Future aims for the chiropractic profession must be to secure legal recognition in all nations; to achieve this aim, influence must be brought to bear on governments to secure the political will to drive regulation forward. The model adopted by the UK, i.e. that of focussing on the protection of the public and securing support from the medical profession, has been effective in achieving legislation and integration. Learning from the experience of other nations is vital, and it seems that future countries’ regulation will be under an umbrella act that provides similar frameworks for various professions26 and reflects WHO policy supporting full integration of traditional and complementary/alternative medicine.

The incorporation and implementation of national guidelines will change some historical perceptions of chiropractic; perceptions that, regrettably, have been perpetuated by various quarters of the profession, intent on promoting an evangelistic image of questionable ethical value, and perceptions promoted by those opposing chiropractic for no other reason than malevolence and professional jealousy. The responsibility and duties imposed on the profession by statutory regulation have meant that, over time, the status of chiropractic both in the UK and the world has evolved. That status differs from nation to nation: from South Africa, where chiropractors are regulated with allied health professionals, to Switzerland, where chiropractic education and regulation affords parity with medical doctors. The independent status of the UK, at least for now, ensures recognition as a separate and distinct profession.

Conclusion

The Chiropractors Act was welcomed by those for whom regulation of the profession represented a giant leap forward in terms of acceptance and public protection. The culmination of years of dedicated lobbying, conciliation and unification placed chiropractic on the healthcare map of the United Kingdom, a small profession gaining the recognition of Parliament and joining the elite club of health professions thought by many to be outside the regulation radar. The General Chiropractic Council was established, registration with which was thought to be the path to respectability and status. However, with rights came responsibility and with the advent of fitness to practise hearings, the profession was forced to wake up to the reality that regulation was in fact a double-edged sword.

Despite question marks over autonomy and separate regulation, the future for chiropractic is bright. Changing perceptions and a popularity that belies the diminutive size of the profession, coupled with a growing expectance from colleagues in other regulated health professions would suggest a future in which chiropractic maintains and develops its status as a safe, sound healthcare provider.

Notwithstanding threats to its independence, the status of chiropractic as a regulated healthcare profession will not be taken away and as such, the duties incumbent upon chiropractors will continue to be rigorous. Such rigour will ensure survival as the public continues to demand greater safety and performance from those professionals in whom they put their trust

Having read this, check out Zenos blog and the way his complaints are progressing and tell me Richard Brown or the BCA/GCC alliance is good for the development of the chiropractic profession in the UK.

Remember Chiropractors to not treat or cure conditions they correct subluxations and let homeostasis/ innate do its thing. The chiropractic profession should be thanking Zeno for focusing our minds on this concept. I shall continue to provide traditional chiropractic services as long as members of the public ask for it, the rest of the profession have the same choice I had. Die on your knees or champion the reforms so desperately needed in health care.

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Related posts:

  1. How are the General Chiropractic Council and the British Chiropractic Council going to deal with Zeno’s complaints
  2. Richard Brown Vice President of British Chiropractic Association argues that the criticism of his profession is wide of the mark
  3. British Chiropractic Association asks the General Chiropractic Council to seek prescribing rights for its members
  4. Zeno only doing what BCA leaders did to UCA executive
  5. The British Chiropractic Association have perfected the art of putting heads in sand.
  6. Zenos original complaint against BCA chiropractors
  7. It should be obvious to the GCC that these are vexatious cases
  8. GCC amend the Chiropractic Act to keep their coffers full.
  9. GCC chair Peter Dixon fiddles while Chiropractic burns
  10. GCC begin defining a biomedical scope of practice using the sceptic complaints as cover

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  • http://spinaljoint.com Richard Lanigan

    Hi John,
    The chiropractic profession is where it is because of the apathy which allowed people like Richard Brown, Tony Metcalfe and Peter Dixon take control of the profession. BCA member Richard Rummary resigned from the GCC in 2000 and his resignation letter made clear the problems we were facing http://www.chiropracticlive.com/?m=200007. The letter was brushed under the carpet I did not see it or know he had resigned until 2001. I had hoped by being thrown off the GCC I might have drawn a bit more attention, unfortunately not.

    Sue Wakfield asked me to write a report for BCA council after being an expert witness in the second case to come before the GCC in 2001, and recognising these problems, after reading it the council refused to comment or advise their members. So I sent this letter to BCA members in 2002 http://www.chiropracticlive.com/?p=84 and Byfield had me charged with Bringing the BCA into disrepute.

    The BCA always believed they were the top dog and the GCC was the tail unfortunately the tail has been wagging the dog for ten years. The BCA council has consistently failed to seek the opinions of their members and act in their best interests and the profession is where it is today.

    Brown is talking about revalidation, funn how the BMA told the GMC to shove their plans http://health.caledonianmercury.com/2010/05/28/bma-rejects-plans-for-doctors-mots/00692
    and the BCA sees it as necessary for the future of chiropractic? In ten years the BCA has made many howlers, never having opposed the GCC on anything being their biggest mistake.

    Hi Le Saucisson, The Government spent one billion on this shit, so called skeptics, the voice of science are banging on about chiropractors claiming to treat millions of christian babies while big pharma are cleaning up with Swine flu.

    Skeptics have a blind spot about vaccination. Their scepticism seems limited to unorthodox approaches to health care. Orthodox interventions lacking in scientific evidence are never questioned so you would have to ask are they sceptical or prejudiced. I did about 15 postings on swine flu last year, lead “skeptic” Andy Lewis called it a typical CAM tactic “whataboutery” he seemed to think chiropractors should be limited to answering question from people who are not remotely interested in the answers.

  • le saucisson chocolat

    mmm, i am sure many have seen (even sKeptic/establishmentarians) this story

    http://www.washingtonpost.com/wp-dyn/content/article/2010/06/04/AR2010060403034.html

  • John

    I re-read your post Richard (it is quite long and detailed) and think I have for myself come to realize the beginnings of the problem and the mindset of this numbskull Richard ‘Charlie’ Brown.

    From the excerpt ‘Fitness to practise’

    ‘The publicity that accompanied the passing of the Act and a greater knowledge
    and utilisation of chiropractic treatment brought with it expectations in line with
    medical care, that of results-based intervention and high standards of conduct,
    practice and education.’

    How did this perceive expectation of results-based intervention come about and why wasn’t it challenged?

    Why does Brown equate medical care with high standards of conduct, practice and education, when clearly none of these are associated with medical care?

    Brown then goes on to speak about a ‘loss of professional autonomy’ and that he believed the public ‘find it difficult to distinguish between chiropractors and osteopaths.’

    So the BCA / GCC response to the threat of loss of autonomy was to give it away to a committee of a medical practitioner, a physiotherapist and a couple of anti chiropractic medipractors. Huh? Well done assholes.

    Can Brown give us his definition as to the difference between an osteopath and a chiropractor? Presently any UK chiropractor I have generally asked replied with ‘they don’t take x-rays and aren’t as good as us.’ Funny it was the same response when I asked about McTimmoneys…

    Then the best bits (-:

    ‘within 5 years, the eyes of the regulatory world will be on the GCC to prove itself
    worthy of retention as an autonomous body. Success in this area will not guarantee
    continued sole-profession status but, without a fight, chiropractic as part of a larger
    regulator seems a distinct possibility.’

    Please God let this fail and let chiropractors take charge of regulation within the HPC.

    And now for the unveiling of the BCA vision for the future of uk chiropractic:

    ‘One could argue that with two professions such a chiropractic and osteopathy,
    governed under near-identical legislation with a similar scope of practice and
    patient profile, this may be a sensible move. The role of a ‘Manipulative
    Therapists Council’ may not present significant difficulties of transition or
    merger, at least as far as the individual professions are concerned.’

    And with the preparations beginning with the beginning of the merger of the AECC and The British College of Osteopathic Medicine, this vision is set to become reality if left unchecked.

    What do the Osteopathic profession think of being led by the BCA into a medipractic future?

    http://www.osteopathicphilosophy.com/main1.htm
    http://www.osteopathiclocum.co.uk/osteopathic_treatment/osteopathic_philosophy.html
    http://www.bakman.co.uk/page4.htm

    And this is further ed by Brown’s admission that ‘the chiropractic profession has been forced to adopt changes to its regulatory systems and constitutions that have dismantled a duty to promote the profession.’ Why promote something in opposition to the vision?

    ‘yet it seems inevitable that chiropractors will need to demonstrate core
    competency on an ongoing basis.’

    Richard do you know of other professions that must do this and what does it consist of?

    ‘For patients, this change (i.e. GGC regulation [my insertion]) hopefully assures them of better standards of care and protection from those who do not meet designated standards.’

    Can Charlie Brown substantiate this assertion?

    Then Brown goes on to spell out his vision for the BCA /GCC medipractic model of governance no doubt using the ECU as its base to push off:

    ‘Future aims for the chiropractic profession must be to secure legal recognition in
    all nations; to achieve this aim, influence must be brought to bear on governments
    to secure the political will to drive regulation forward. The model adopted by the
    UK, i.e. that of focussing on the protection of the public and securing support from
    the medical profession, has been effective in achieving legislation and integration.’

    I can only hope this would be resisted but given that no one voted against the BCA bailout its looking doubtful if not shameful that such a thing would be allowed to befall chiropractic Europe wide.

    The we hear the BCA double speak

    ‘The incorporation and implementation of national guidelines will change some historical perceptions of chiropractic; perceptions that, regrettably, have been perpetuated by various quarters of the profession, intent on promoting an evangelistic image of questionable ethical value…. The independent status of the UK, at least for now, ensures recognition as a separate and distinct profession.’

    We must become medipractors but seperate and distinct and those adhering to the chiropractic model are unethical and need to be regulated away.

    My question is what are Professor Cunliffe’s (Brown new description) thoughts on all of this?

    And then the best is saved for last…

    ‘Despite question marks over autonomy and separate regulation, the future for
    chiropractic is bright.’

    Not under your stewardship Charlie Brown.

  • Barney

    Zenos blog is worth reading by EVERY registered chiropractor to see just how the GCC is handling these complaints. You could not make this up! It would be worthy of a Monty Python skit if it were not so disastrous for the profession. It clearly demonstrates that the GCC’s handling of the skeptic’s complaints is cumbersome, unrealistic and incompetent.

  • http://spinaljoint.com Richard Lanigan

    I think you are going to be surprised. For years the chiropractic profession has taken the path of least resistance. They have accepted the medicalisation of chiropractic without considering the cost. Zeno has forced them into a reality to check and consider how they articulate what they do.

    Is chiropractic a treatment for certain conditions, or are chiropractors simply stimulating nerve receptors in spinal joints. Even you Skeptic Barista know the answer to that, all chiropractors know the answer to that question. Unfortunately the quacks in our profession, those who were not clever enough to get into med school and with time on their hands have taken control of the profession. They convinced colleagues of their need to explain what they did in medical language and the importance of “Statutory self Regulation”.

    I am not against regulation, I am against arseholes with personal agendas and private investigators regulating me. Dont you think its a bit odd that the body that regulates chiropractic profession that had an explanation of subluxation on its website did not even offer an explanation for it, when its easily explained as I did on your blog, or do you think I was trying to bullshit you.

    For ten years I have been saying the GCC is not fit for purpose, possibly 95% of the profession would agree with that assessment. Now even sceptics like Zeno and Gimpy are saying the same thing about the GCC so what is the point of the GCC? Many Chiropractors have spent their careers living in fear of the GCC Stazi police.

    The Information Commissioners Office told the GCC that they were in breach of the Data Protection and forced them to release their secret files on me, this I hope will get the Department of Health and CHRE looking closer at their performance.The most interesting part of the files is that they failed to get what they were looking for but could not bring themselves to admit that they had tried and failed to entrap me into saying I was a chiropractor.

    At the end of this the only people who will have reason to thank Zeno will be the chiropractors themselves because their future is not being regulated by Margaret Coats and Zeno and 17.5% VAT is a small price to pay for peace of mind.

  • http://skepticbarista.wordpress.com/ Skeptic Barista

    “The chiropractic profession should be thanking Zeno for focusing our minds on this concept.”

    Watching with interest to see just how many chiropractors offer their thanks to Zeno !

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