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TEN THINGS EVERY GP SHOULD KNOW ABOUT OSTEOPATHY

1 What is osteopathy?

The General Osteopathic Council defines osteopathy as: “...a primary care profession, focusing on the diagnosis, treatment, prevention and rehabilitation of musculoskeletal disorders, and the effects of these conditions on patients’ general health.
Using many of the diagnostic procedures applied in conventional medical assessment, osteopaths seek to restore the optimal functioning of the body, where possible without the use of drugs or surgery. Osteopathy is based on the principle that the body has the ability to heal, and osteopathic care focuses on strengthening the musculoskeletal systems to treat existing conditions and to prevent illness.
Osteopaths’ patient-centred approach to health and well-being means they consider symptoms in the context of the patient’s full medical history, as well as their lifestyle and personal circumstances. This holistic approach ensures that all treatment is tailored to the individual patient.”
Osteopaths are trained to examine areas of the body using a highly-developed sense of touch, known as palpation, to determine conditions and identify the body’s points of weakness or excessive strain. Osteopathy is a “package” of care that includes skilled mobilising and manipulative techniques, reinforced by guidance on diet and exercise.
The osteopath will discuss with the patient the most appropriate treatment plan, estimating the likely number of sessions needed to treat their condition effectively. If the osteopath thinks that the condition is unlikely to respond to osteopathic treatment, the patient will be advised on how to seek further care. Osteopaths are skilled in diagnostic techniques and trained to identify when a patient needs to be referred to a GP.
Increasingly osteopaths are working alongside GPs and other healthcare professionals, providing treatment both privately and through the NHS. Commonly treated conditions include back, neck and shoulder pain, headaches, sport and work-related injuries, arthritic pain, joint pain and digestive disorders.

2. Is osteopathy safe?

Osteopaths have rigorous clinical training in musculoskeletal disorders. Most courses involve four years full-time study. As part of their training, osteopaths gain primary care skills including triaging for pathology, and will refer back to GPs if further investigations are indicated. Osteopathy is a statutory registered profession, with approximately 4,600 registered osteopaths in the UK. The British Medical Association has produced guidance for GPs confirming that it is safe for GPs to refer to registered osteopaths as they are statutorily regulated and fully accountable to the patient.

All osteopaths, wherever they work in the UK, must be registered with the General Osteopathic Council (GOsC), who regulate the practice of osteopathy in the UK. It is against the law for anyone to call themselves an osteopath unless they are registered with the GOsC.

3. Is osteopathy effective?

A Medical Research Council trial in 2004 entitled UK Back Pain Exercise and Manipulation comparing treatment options for lower back pain found that spinal manipulation, added to GP care, is clinically effective and the most cost-efficient option for patients.
In 2006, the Department of Health published guidelines entitled The Musculoskeletal Services Framework. A joint responsibility: doing it differently which advocated the establishment of multidisciplinary clinical assessment services and recognised that MSDs can often be resolved quickly and effectively by treatments such as osteopathy.
When taken as a ‘package’ including osteopathic treatment, advice on posture, and exercises, osteopathic care provides a cost-effective, efficient service, with high patient satisfaction rates and referral safety.
Osteopathy should be considered by GPs as a key part of the patient pathway for musculoskeletal conditions: in the times of GP fundholding, GPs referred to osteopaths much more frequently than they do at present because they saw it improving patient outcomes.

4. Can I refer patients to an osteopath on the NHS?

Some osteopaths offer services through the NHS and in some areas doctors are able to refer patients to an osteopath for treatment funded by the NHS. In England this will depend on the policy of your new clinical commissioning group (CCG). Under the now-defunct Primary Care Trust system, a recent study by the British Osteopathic Association indicated that GPs in 18% of PCTs made referrals to osteopaths on the NHS. In Scotland and Wales, the local Health Board determines availability under the NHS. In Northern Ireland, the local Health and Social Service Board determines availability.

5 How widely available is osteopathy?

There are more than 4,600 osteopaths registered with the GOsC, which includes some who practise abroad. According to the GOsC, those practising in the UK carry out more than seven million consultations every year. Of those consultations, 54% of new patients are seen within one working day of contacting the osteopath and 95% are seen within one week.
The GOsC states: “The profession attracts almost equal numbers of male and female practitioners, and some have already qualified in another healthcare practice such as medicine, nursing or physiotherapy.
“The majority of UK osteopaths (86%) practise in England, with 3.2% in Scotland, 2.4% in Wales, 0.4% in Northern Ireland and 8.4% working overseas.
“Most osteopaths are self-employed and work in the private sector, although some are working in multi-disciplinary environments within the NHS and in occupational healthcare in public bodies and private companies.”

6 How do I identify a qualified practitioner for referral?

You can use the search facility of Commissioning.GP to find an osteopath by geographical area. Alternatively, you can use the register maintained by the GOsC at www.osteopathy.org.uk/information/finding-an-osteopath to find an osteopath by name, town, county, postcode or country. You can also search on the British Osteopathic Association register (BOA) at www.osteopathy.org/fanost using the same features. The BOA have also produced an app which can be download from itunes for iphones or the market place for android. The app provides details of BOA members, their location and how to get there.

7 Are there clinical guidelines for referring a patient to an osteopath?

Yes. Guidelines for the referral of patients to an osteopath were published by the General Medical Council in Good Medical Practice in 2006. This guidance confirms that GPs can refer patients to osteopaths as statutorily regulated health professionals.

8 How much does treatment cost?

Treatment costs vary across the UK. The GOsC currently estimates that treatment typically range from £35 to £50 for a 30-minute session. Reduced-cost treatment is available from all osteopathic training schools, who operate clinics where students train under the supervision of a qualified osteopath. Patients can access quality care here at a reduced rate. The GOsC maintains a list of training schools to find a training school clinic.

9 How can osteopathy save NHS resources?

Musculoskeletal disorders (MSDs), including lower back pain, whiplash-associated disorders, joint injuries and repetitive strain injuries, affect millions of people every year. The Department of Health estimates that up to 30% of all GP consultations are about musculoskeletal complaints. The costs associated with treating MSDs, in terms of clinical staff time, increased waiting times for investigations, screening and increasing prescription costs, are substantial. Referral to secondary care and tracking patient progress accordingly leads to further cost, bureaucracy and burden on GP time.
Osteopathy is an approach to health and wellbeing in which the role of the musculoskeletal system is emphasised. Although osteopathy can be used to treat a range of conditions, osteopaths treat many patients with musculoskeletal disorders.
The National Institute for Health and Clinical Excellence (NICE) has recognised the benefits of osteopathy in its guidance for treatment of low back pain in May 2009, which recommends that a course of manual therapies (to include osteopathy) is considered for patients with low back pain.
Building on the clinical studies quoted in the NICE guidelines, the National Council for Osteopathic Research (NCOR) and the British Osteopathic Association have conducted a standardised data collection (SDC) exercise. The report is available on the NCOR website at www.ncor.org.uk.
In the SDC study, data was collected on 1,630 new patient episodes in 2009. More than one- third (39%) of patients had a satisfactory resolution of symptoms and were discharged after their course of treatment. A further one-third (39%) of patients took the opportunity to return for “episodic care”, ie; preventive treatment at intervals, often called maintenance care. 10% were referred on for investigation or treatment. Less than 1% had not completed their course.
Simple patient-reported outcome scale was used which asked patients to tick which box best described their overall outcome at that date. The data provided useful statistics, with 74.3% of patients self-reporting as “improved”, “much improved” or “best ever” after the first treatment, rising to 80.7% after the final treatment and less than 1% in the “worse” category.
The costs associated with treating MSDs in terms of clinical staff time, increased waiting times for investigations, screening and increasing prescription costs, are substantial. Referral to secondary care and tracking patient progress leads to further cost, bureaucracy and burden on GP time.
Osteopathy can reduce the need for such interventions, providing a cost-effective alternative treatment route. The SDC exercise recorded the number of treatments until discharge or end of the initial course, as a representative measure of outcome as well as being useful for evaluating cost-benefit. The number of treatments recorded in the SCD ranged from 1 to 17 with a mean of 3.45 (SD=2.04) treatments to discharge. The mean of 3.45 treatments per course was unexpectedly low, but may be due to the follow-up period being two months (only allowing for four to five fortnightly appointments). The fact that relief of symptoms was rapid supports the validity of the data.

10. Where can I get more information about osteopathy?

The General Osteopathic Council (GOsC)
The GOsC was established by the Osteopaths Act 1993 to “provide for the regulation of the profession of osteopathy”. It sets and maintains standards of osteopathic practice and conduct; maintains a Register of qualified professionals; assures the quality of osteopathic education and training; helps patients with complaints about an osteopath; and removes anyone who is found unfit to practise from the Register. The website is an extremely useful source of information on all aspects of the profession.
Website: www.osteopathy.org.uk

The British Osteopathic Association (BOA)
The BOA is the professional body which represents osteopaths in the UK. It was formed in 1988 from the merger of three long-established professional bodies which represented osteopaths. Its website is a good source of information for patients considering treatment by an osteopath and has an extremely useful and easy to use series of videos on exercises for a healthy spine. The site also has a database of osteopaths which can be searched by name of osteopath, name of clinic, name of town or postcode.
Website: www.osteopathy.org

Source: Commissioning.GP gratefully acknowledges and thanks Kelston Chorley, Professional Development Consultant of the British Osteopathic Association, for his help in supplying the bulk of the information given here.