Is there a conflict inherent in the relationship between the chiropractor and patient?
Nick Jones. GCC Registrar and CEO, reflects on the risk of conflict between high quality care and running a business.
The GCC is one of 10 health and care regulators in the UK, registering health occupations that Parliament has said must be regulated. Fundamentally the GCC is responsible for protecting the health and safety of the public by ensuring high standards of practice in the chiropractic profession. Unlike many of these occupations, most chiropractic treatment is provided to a payer. Chiropractors are running a business as well as treating patients needing care.
Is there a conflict between a commercial transaction and the provision of high-quality care? My reflection is that there should not, and need not, be. Most care is good but that vigilance is also necessary. There is a risk of a conflict and an obligation on chiropractors (along with other health and care professionals) to exercise care in avoiding that risk.
We prefer to not comment on business practices, however several recent complaints have caused me to consider the relationship between the chiropractor and patient, in particular where the business practice affects the care of patients (as experienced by them) and where complaints are received.
A conclusion from our Patient Community research into consent struck me; participants having the least positive experience of a consent process had purchased an online voucher and saw that contributing to their poor experience.
Of particular concern is the inclusion of add-ons to the deal - such as an X-ray - when a chiropractor can have no idea of clinical need until an assessment of the patient has taken place. Setting out an expectation of X-ray prior to a patient being seen is in breach of GCC guidance.
Whilst we know that patients regard themselves as patients rather than consumers, we also know that the two are not mutually exclusive. The question is whether chiropractors see the person in front of them with a plan of treatment developed with the patient and with their consent; or an opportunity to sell?
Principle C of The Code describes a model of assessment, diagnosis and appropriate care based on clinical need. Standards C4 and C6 discuss revisiting the care plan and stopping or changing it based on patients wishes and needs.
Can the offer to a patient of extended prepayment plans be consistent with these requirements? Perhaps with an early review, short intervals between reviews, and a willingness to refund based on progress where treatment has been effective; a short plan may be in the patient’s interest, but is it always? Certainly excessive plans with no, or only cursory, reviews are never acceptable. We have seen objections by patients to a model with multiple appointments made after an assessment – with the chiropractor seemingly unable to convey how the patient might respond to the first treatment.
I also note plans must be worded very carefully to ensure that they meet the definition of a “fair” contract from the Competition and Market Authority. They must be clear and fair concerning issues like repayment if a patient no longer wants or needs treatment.
I recognise that chiropractors operate in a business setting. The provision of high quality, ethical and evidence-based care, in alliance with the patient, makes business sense and need not be a conflict for chiropractors. In working in such a way public confidence in the profession and its place within the wider healthcare system is enhanced.
I have offered these reflections, as we are considering whether there is a need to disincentivise the use of these (and other) practices by being more explicit as to their use or otherwise.
I welcome reflections in response.