Blog: Trying something new

We all have a responsibility to improve and develop, whether developing your own skills and practice as a chiropractor, or, for the GCC, improving our own processes and approach.

This month we are launching several changes. We’ve redeveloped how we present the register, updated how we collect declarations about health and character under section C15 of the Code of Professional Practice and, most significantly, we are trialling a new Mediation Service.

This month also marks the start of a new CPD year, making it a useful moment to think about what it means to introduce something new. For registrants, that might mean developing your skills or considering whether to introduce a new or innovative technique into your practice. For the GCC, it means being prepared to test new approaches, evaluate the evidence and change course where necessary.

That principle is particularly relevant to our Mediation Service. We believe it has real potential to support earlier and more constructive resolution in appropriate cases. But we are testing that belief rather than assuming it. Throughout the trial, we will gather evidence about how the service performs in practice, what difference it makes for the people involved and where it can be strengthened.

The same discipline matters when you consider introducing something new into your own practice.

Your responsibilities when adopting a new or novel technique

Chiropractic is a worldwide discipline, and chiropractors from Australia, America, Canada, South Africa and across the globe promote their techniques, and often their patented technology, to the UK profession.

I was recently contacted by a chiropractor who had concerns about a particular paediatric approach being taught in the UK as CPD by a chiropractor from overseas. Although the GCC sets requirements for the amount of CPD you must complete each year, we do not approve or quality assure individual CPD providers.

We take the view that it is your responsibility, as a professional, to source appropriate training and use that to develop your skills and practice. It is also up to you to decide, having completed the training, whether a technique is appropriate for you to offer to your patients. Do you have the appropriate skills, knowledge and training? Does the approach meet the standards expected of a GCC-registered chiropractor?

One of the hardest, and perhaps bravest, decisions you can make after completing an intensive two-day seminar is: “This is not for me.” I would like to remind you that this is always an option. The learning and reflection involved still form part of your professional development, even if your conclusion is that the technique should not become part of your practice.

But what if, having considered the training and available evidence, you decide there is merit in a new or innovative technique and wish to introduce it into your practice?

Introducing something new into your practice

The Code of Professional Practice (D11) expects you to use evidence-based practice to select and implement safe, appropriate care that meets the needs and preferences of the patient. This can present a particular challenge when a technique is new or there is not yet a strong body of evidence for it.

The GCC does not define a scope of practice for chiropractors, nor does it approve or prohibit particular treatment techniques. Decisions regarding the care of patients remain matters of professional judgement for individual registrants.

I also recognise that the existence of a limited evidence base does not, of itself, establish that a technique is unsafe or ineffective. Every clinical innovation will, by definition, begin from a place where the evidence is less established.

My interest, therefore, is not in determining the acceptability of a particular technique. Rather, it is in highlighting the professional responsibilities that accompany the introduction and promotion of novel techniques where the evidence base remains uncertain.

Our primary objective, and yours, must be to protect, promote and maintain the health, safety and wellbeing of the public. Where the promotion and publicity surrounding an approach has outpaced the development of a substantial body of clinical evidence and professional acceptance, it is particularly important that patients are given clear, objective and evidence-based information to support informed decision-making.

You should therefore consider:

• how you have satisfied yourself regarding the available evidence supporting the technique and any claims made in relation to it;
• how uncertainties regarding effectiveness and safety are explained to patients; and
• how alternative, evidence-based treatment options are discussed as part of the consent process.

With novel techniques, there may also be responsibilities beyond those specifically set out in the Code of Professional Practice. For example:

• If the technique involves a specialist device, does it fall within the Medical Devices Regulations 2002, and are there applicable regulatory requirements?
• How are you promoting the approach? Do claims made on your website, social media channels and other promotional materials accurately reflect the current state of the evidence?
• Have you considered your professional indemnity insurance? Are there requirements to inform your insurer that you are introducing a novel or unusual treatment approach?