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11 October 2022

QAA at 25: Perspectives on quality in Osteopathy


Steven Bettles

Policy Manager, General Osteopathic Council

In her Defining Quality publication, QAA’s Chief Executive Vicki Stott defined quality assurance as a process that ‘acts prospectively to provide confidence that quality requirements will be fulfilled’. This provides a good starting point for explaining what quality assurance means from the perspective of the General Osteopathic Council, a statutory healthcare regulator.


As a statutory healthcare regulator, we regulate the practice of osteopathy in the UK. We set and promote standards of practice, register qualified osteopaths, investigate concerns and complaints raised about osteopaths, and assure the quality of pre-registration osteopathic education and training.


Osteopathy is a relatively small profession, with some 5,500 practitioners in the UK. There are eight providers of recognised osteopathic pre-registration programmes. These vary from universities, university colleges, single subject specialist providers and higher education provision within an FE college. Programmes also vary from full-time, usually four years, to part-time over five to six years. So the sector is small, but varied. Osteopathy is recognised by the NHS as an Allied Health Profession. Osteopathic treatment combines manual approaches (working on muscles and other tissues, mobilising joints) and advising on exercise, ergonomics, and lifestyle issues affecting health.


Our aim in quality assuring pre-registration education is to ensure that graduates are capable of practising in accordance with the Osteopathic Practice Standards (the OPS). Although the OPS are woven through osteopathic education programmes, they are primarily a set of professional standards, rather than education outcomes. We therefore also publish graduate outcomes for osteopathic education. These have recently been updated and came into effect from September this year, alongside new Standards for Education and Training.  Meeting the graduate outcomes means that we can take assurance that graduates can meet the OPS.


But how do we actually undertake quality assurance of these programmes? Again, this varies. We commission review visits - either for initial recognition or periodic review of existing programmes. We require education providers to report to us annually on a range of issues, demonstrating how they meet the standards, and reporting on student numbers, progression statistics, student feedback and educator data. We have processes for managing concerns about osteopathic education, and we further require providers to keep us informed of any changes affecting their programmes - for example, changes in recruitment, admission requirements, changes in management or governance, or in finance. Anything, in fact, which might impact of the continued delivery of standards. We also undertake or commission thematic reviews in educational matters which help to inform our and other’s understanding of the sector - for example, a current project is looking at the extent of public and patient involvement in osteopathic education.


There are defined processes and policies, therefore, as would be expected, but the ‘how’ is key. An advantage of regulating a smallish profession with relatively few providers is that we are able to develop effective working relationships with each one. We meet regularly as a group, and with individual institutions when needed to explore particular issues. Another aspect of quality assurance (QA) is the sharing of good practice, and we have recently been considering how we best achieve this. Over the next year, we are planning a series of QA based workshops for educators to explore key areas of practice - this will include such issues as professional boundaries, consent in the teaching of practical osteopathic techniques, and equality, diversity and education in education. The aim is to encourage a broader attendance than just the senior management of each institution, and get the right people in the room (or online, in fact). We’re keen not to dictate an approach, but to encourage collaboration and discussion across the sector, identifying the questions as much as providing the answers. There is a focus on continual enhancement and reflection, rather than just a meeting of minimum standards, very much in line with the definition of quality enhancement set out within the ‘Defining Quality’ publication.


Ultimately, our QA processes are aimed at providing assurance that graduates have and continue to have the necessary knowledge, skills and, importantly, attitudes to practice safely and effectively as osteopaths, upholding the reputation of the profession, and ensuring the safety and wellbeing of patients. In this vein, we are working closely with QAA and the academic and subject community to produce a revised Subject Benchmark Statement for Osteopathy, a draft of which will go out for consultation later in the academic year. Quality assurance is not just a series of compliance exercises, but an ongoing conversation and relationship that provides assurance and informs decision making and ultimately preserves the integrity of the register of osteopaths.