The Code Conversation - food for thought?

Last year I blogged about the conflict inherent in the relationship between the chiropractor and patient, and I think the time is right to revisit this discussion in light of the review of the Code. 

Progress in developing the new Code

First, I want to update you on progress in the development of the new Code. 

Later this month, Council meet to discuss first principles – in fact which principles underpin the new Code.  

We think the current principles hold good. But we are proposing two new principles 

1. Workplace behaviours around others 

2. Clinical safety (safeguarding and incident prevention in the clinic, rather than safety of treatment which is covered elsewhere).  

These are based on the feedback we received during the Code scoping review and to keep the GCC code in step with the other healthcare regulators.

Developing Standards

Once the principles are in place, the hard work to work up the standards - the fundamental expectations of the Code - starts. 

Each standard sets out the behaviour you agree to honour as a condition of registration. They set the expectations that the public, your patients and your colleagues can have of you as a registered healthcare professional.

Our duties

This brings me back to my point around the behaviours demonstrated by chiropractors and how the Code might tackle them. 

The GCC has a duty to: 

• Protect, promote and maintain the health, safety and well-being of the public

• Promote and maintain public confidence in the profession of chiropractic 

• Promote and maintain proper professional standards and conduct for members of the chiropractic profession. 

Arguably protecting the public from harm is wider than preventing injury and some activities damage public confidence in the profession.

Some food for thought: 

• Are open plan treatment rooms with several patients being treated at once, compatible with modern expectations of consent and privacy with care centred around the patient?  

• Are financial inducements offered to patients, such as online discount vouchers and free initial consultations that lead to lengthy packages of care. a conflict of interest too far? 

• Is there a place for lengthy packages of care at all? Where treatments extend for a long time should there be more prescriptive requirements for the review, with the patient being an equal partner in that review? 

• We know that patients expect the practitioner to be connected with the wider health and care system so they are signposted to the most appropriate professional: should there be a presumption that chiropractors will write to GPs following each contact with a patient, with a copy sent to the patient? 

• Should there be unequivocal rules around the use of chaperones covering a wider cohort of patients?  

• Are patients clear about the competence of their chiropractor to carry out activities that are not universally used by all chiropractors – techniques such as dry needling, cupping, therapeutic ultrasound and laser treatments? 

Conclusion

As I said last May, 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. 

As we develop the Code we are considering whether there is a need to incentivise and disincentivise some practices. Equally, at this early stage it is a conversation with the profession, and I welcome your reflections in response. 

We will be holding a series of online events in April (once the outline principles are agreed) to discuss the new Code further – but we welcome any thoughts you have in advance of those events to help us shape our discussions.

Nick Jones. 
CEO and Registrar