Continuing Professional Development (CPD)

Focused Reflection for the 2023/24 CPD year is on Equality, Diversity and Inclusion

For the 2023/24 CPD year, all registrants will be required to include a focused reflection on equality, diversity and inclusion (EDI) relating to Standard A4 in The Code which requires chiropractors to “treat patients fairly and without discrimination and recognise diversity and individual choice’ and Standard D2 in the Code, which requires chiropractors to ‘…treat all patients with equal respect and dignity’.

We have chosen this topic because of the growing body of research which indicates that patients have higher expectations from health and care professionals to promote equality and diversity, and believe it to be a requisite to safe practice[1]. Furthermore, there is a wider body of research which suggests that the health inequalities throughout the UK are widening[2] and that people who hold multiple protected characteristics are likely to see inequalities in terms of outcomes from health care[3]. We wish to ensure registrants are confident in assessing and providing care for patients who hold one or more protected characteristics that you encounter infrequently in clinical practice.

Our expectations for 2023/24

As part of your CPD return for 2023/24, the information you submit to us, by 30 August 2024, must include self-reflection on how you approach Equality, Diversity and Inclusion in your practice. We want you to tell us how well you feel you meet your professional responsibilities with regard to equality, diversity and inclusion, and how this helps you to meet the individual health needs of patients with one or more protected characteristics. We also want you to tell us how you have addressed and/or plan to address any areas you have identified for development/improvement.

We have added two questions to the online CPD portal to enable you to provide this information, as follows:

1. Thinking about your professional responsibilities with regard to equality, diversity and inclusion:
   a) How well do you feel you meet these in the assessment and care of your patients?
   b) Where do you think the gaps/areas for improvement might be in your knowledge and its application?
    
2. Thinking about areas for improvement in your ability to assess/provide care for patients with protected characteristics that are rarely encountered.
   (a) how have you or will you address this to enable you to improve your practice during this CPD year, and
   (b) how do you intend to ensure you maintain and develop your professional responsibilities in the context of equality, diversity and inclusion in future years?

To aid you in thinking about the questions above, we have produced some clinical scenarios here.

Recording your equality, diversity and inclusion CPD activities

There is no expectation for registrants to undertake a formal EDI training course for this CPD cycle unless you decide this is an area of your practice you wish to develop further. If, however, any of the CPD activities you undertake during the 2023/24 CPD year do relate to EDI, you may wish to record these in the online portal among your CPD activities in the normal way. You might also choose to reflect on this particular activity in the reflection section.

Guidance on how to complete your 2023/24 CPD return using the online portal, including your EDI reflection/development activities, is provided here.

Basic requirements

The GCC CPD programme provides a set structure for registrants to follow in order to satisfy statutory CPD rules. The basic requirements of this programme are that each year you must:

• identify your learning needs/interests and produce a personal plan of learning activities to address them
• undertake and record at least 30 hours of CPD activity in accordance with your plan, of which 15 hours or more constitutes learning with others.
• evaluate the effectiveness of the learning undertaken

In addition, the CPD activity you undertake must:

• constitute a learning experience for you. Therefore, undertaking your normal working activities does not meet the requirements of the programme
• be focused on advancing your professional development as a chiropractor ie. improving the care you provide for your patients, and/or developing the chiropractic profession.

Learning with others can include both formal learning, such as seminars and lectures, as well as informal learning, which includes clinical audit and can be conducted either in person or remotely. However, to qualify as learning with others it must incude the ability for direct and immediate interaction with either a presenter/ organiser or others present.

Examples of Learning with Others

Allowable as Learning with others

• Attending a seminar/ lecture
• Reviewing notes with a colleague
• A webinar you watch live and have the ability to ask questions and comment.

Not allowable as Learning with others

• watching a recorded webinar (this would be learning alone), unless you are watching and discussing with a colleague
• An email exchange
   

Getting your CPD summary right first time

• When thinking about what learning you wish to undertake for the year, remember CPD is about your professional learning and how it relates to your patients. It should not be about the business of the clinic, or an activity associated with your personal life.
• When completing the reflective statement for one of your learning activities, make sure it is specific to that activity and not a general comment about the learning you have done.
• The GCC undertakes random sampling of CPD reports. Therefore, if your responses do not answer the questions posed, we may require you to provide more information.
• Review the GCC CPD Guide for further advice on completing your CPD summary.

CPD for new registrants or those re-joining the register

GCC rules require you only submit 2.5 hours for each full month of the CPD year that you are registered ie. if you joined the register on 1 January, you would need to complete 8 months of CPD, which amounts to 20 hours in total.

In all cases, half of the CPD requirement must include learning with others, so for the example above, the registrant would need to complete a minimum 10 hours with others.

If you are a recent graduate and are taking part in the Royal College of Chiropractors’ Post-Registration Training Programme, you can include most of that activity as part of your CPD, the only exception being the business development training.

Reflective evaluation

A key aspect of reinforcing and deepening the learning gained from your CPD activity is reflective evaluation. Along with the other healthcare regulators, the GCC is committed to supporting reflective practice among registrants, and the CPD reporting form is designed to assist you with this.

Exploring learning and development opportunities

You may find it helpful to discuss with others (ie. colleagues, peers or those who facilitate your professional development etc) the learning and development opportunities that are likely to be most effective in meeting your learning objectives, although this would not form part of your CPD itself.

Such discussions may consider:

• the learning opportunities that you have used in the past and what you have gained from them
• your confidence in relation to learning and development generally and the different methods available
• other aspects of your life that might support or hinder your learning and development
• the learning and development opportunities that are available or that can be arranged and that will be effective in meeting your learning needs and interests ie. conferences might be useful for updating your knowledge but be less useful in terms of applying knowledge and skills in practice
• the cost (direct and indirect) of learning and development opportunities. The GCC recommends you make careful choices when investing time and money in CPD products and services
• any funding that is available for different forms of learning and development and how you can access such funding
• whether there are any restrictions on accessing different learning and development opportunities ie. whether you need to possess certain qualifications or be of a certain age
• how to manage practical issues related to learning and development such as location, timing and travel
• the benefits of you gaining formal recognition or accreditation for specific

The GCC has produced a CPD Guide to assist registrants in completing their annual online CPD summary.

Completing your CPD summary

CPD summaries must be completed online before 30 September, which is one month following the end of the CPD year.

We have produced a registrant CPD Guide to assist you in completing your online summary.

While the GCC generally audits only a small number of CPD summaries each year, we do encourage registrants to update and upload evidence of their learning throughout the year.

We appreciate that registrants will occasionally have difficulty in completing their CPD summary or learning due to unforeseen events. As such, the GCC CPD programme does allow the Registrar to waive part or all of a registrant’s learning for one year if they have experienced exceptional circumstances.

This CPD focus is for the year 1 September 2022 to 31 August 2023.

Focus on consent

For the 2022/2023 CPD year, all GCC registrants must include a particular focus on consent relating to Principle E of The Code, which requires chiropractors to obtain informed consent for all aspects of patient care.

This focus on consent follows the publication of new guidance in July 2022 that sets out the basis on which patients provide consent to treatment. It underlines the requirement that registrants must be satisfied that consent has been given before undertaking any examination, investigation or treatment. Furthermore, it sets out the principles on which good clinical decisions should be based and provides a framework for good practice that covers the various situations that chiropractors may face in their work.

GCC expectations for 2022/2023

As part of your annual CPD return for 2022/2023, the information you submit to the GCC by 30 September 2023 must include self-reflection on your knowledge and competency concerning consent.

In your CPD submission, let us know how well you feel your knowledge and its application regarding consent enables you to provide a safe and effective service for your patients. If you have identified any issues about consent, you should explain how you plan and/or plan to address any areas for development and improvement.

We have included two questions on the online CPD portal (found via your GCC Registrant Portal page) to enable you to provide this information, as follows:

1)     Thinking about consent,

(a) how well do you feel you understand and exercise your professional responsibilities with regard to obtaining valid, informed, ongoing consent for assessment and care, and

(b) where do you think the gaps/areas for improvement might be in your knowledge and its application?

2)     Thinking about areas for improvement in your knowledge and the application of your professional responsibilities about consent,

(a) how have you or will you address these factors to enable you to improve your practice during this CPD year, and

(b) how do you intend to ensure your knowledge and actions regarding consent will continue to develop in future years?

Focus on clinical governance

The GCC expects all recent graduates to commence their professional life with due regard to the essential elements of clinical governance. These include accountability for providing a safe and effective service and safeguarding high standards of care.

Therefore, in addition to the CPD requirements for all registrants, the GCC will require recent graduates to include a focus on clinical governance. The introduction of this additional CPD will help to support the GCC's aims of developing professionalism.

This additional CPD requirement is aimed at those who have registered with the GCC for the first time and have qualified within the last two years.

GCC expectations for new registrants

The GCC expects new registrants to:

• Reflect on their skills and understanding of a range of areas of clinical governance as specified by the GCC, and
• Address any aspects of clinical governance that require development.

These additional CPD activities will continue to form part of the expected 30-hour CPD requirement for the year (not in addition to). 

There are six areas of clinical governance:

1. Standards-based care
2. Using evidence to inform practice
3. Clinical audit
4. Safety incident reporting and learning
5. Patient recorded outcomes / patient satisfaction measures
6. Reflective practice

GCC requirements for each of these areas are explained within this document. Participation in the Royal College of Chiropractors' ‘PRT’ postgraduate training programme is the most straightforward way to address and meet these requirements.

Standards-based care

Understanding and applying which standards and guideline components are relevant to your chiropractic practice is a vital part of ensuring that you are working in the best interests of patients and providing the highest quality of care. For this element of clinical governance CPD, the GCC expects you to reflect on your:

• familiarity with published clinical standards that relate to chiropractic practice, such as the RCC Chiropractic Quality Standards and relevant NICE guidelines.
• understanding of how these Standards and guidelines can be applied to your practice as a key element of evidence-based practice.

You are expected to plan and undertake appropriate CPD activity that helps you identify relevant practice standards and understand how to apply them. The Standards-Based Practice module (ref ‘SBP1’) of the RCC PRT programme is designed to address this requirement.

Using evidence to inform practice

Principle C of the GCC Code requires all chiropractors to select and apply appropriate evidence-based care. This helps ensure that the most effective care available is provided to improve patient outcomes. For this element of clinical governance CPD, the GCC expects you to reflect on your:

• familiarity with the principles of evidence-based practice.
• understanding of how an evidence-based approach impacts patient care.

You are expected to plan and undertake appropriate CPD activity that develops your ability to apply an evidence-based approach in your patient care planning. The Using Evidence to Inform Practice module (ref ‘EBP1’) of the RCC PRT programme is designed to address this requirement.

Clinical audit

A clinical audit evaluates existing practices against current best practice, thereby helping you to provide the highest quality of care to your patients. Undertaking a clinical audit involves:

• Identifying a particular area of interest or concern, often based on a published standard or guideline,
• Collecting data to compare the current practice to the standard,
• Identifying shortcomings,
• Making the necessary changes, and
• Re-auditing after some time to close the loop and assess improvements.

For this element of clinical governance CPD, the GCC expects you to reflect on your:

• understanding of the process of clinical audit.
• experience in applying a clinical audit to improve your practice since you joined the chiropractic register.

You are expected to plan and undertake appropriate CPD activity that addresses or consolidates your understanding of a clinical audit and its application and/or outlines the outcomes of a clinical audit you have undertaken in your clinic. The Clinical Audit module (ref ‘CA1’) of the RCC PRT programme is designed to address this requirement.

Safety incident reporting and learning

All chiropractors are encouraged to adopt incident reporting as part of a blame-free safety culture and a routine risk management tool. Sharing incidents locally helps to ensure that the practice provided in your clinic is safe and effective. Sharing safety incidents nationally and internationally using the Royal College of Chiropractors’ CPiRLS system allows all chiropractors to learn from the collective experience, thus contributing to improvements in safety and effectiveness across the whole profession. For this element of clinical governance CPD, the GCC expects you to reflect on your:

• understanding of the process and importance of patient safety incident reporting and learning.
• awareness of local and national systems of reporting.

You are expected to plan and undertake appropriate CPD activity that furthers your understanding of, and ability to apply, patient safety incident reporting and learning in patients’ best interests. The Safety Incident Reporting and Learning module (ref ‘SIRL1’) of the RCC PRT programme is designed to address this requirement.

Patient recorded outcomes (PROMS)/patient experience measures (PREMS)

Actively collecting feedback data from patients and directly involving them in measuring clinical outcomes are important aspects of assuring the quality of the services you provide. For this element of clinical governance CPD, the GCC expects you to reflect on your:

• understanding of the importance of collecting patient-reported outcome and experience data.
• familiarity with the commonly used, validated tools and means employed to collect and evaluate them.

You are expected to plan and undertake appropriate CPD activity that helps you identify/address any gaps in your understanding of PROMS and PREMS. You may wish to consider participation in PROM and PREM data collection to help you drive improvement in your services to patients. The PROM/PREM learning module (ref ‘PRD1’) of the RCC PRT programme addresses this requirement.

Reflective practice

Reflecting on your sense and understanding of a topic or situation allows you to identify further learning and professional development areas. Reflective practice is all about active reflection on your experiences and then implementing changes or improvements in your everyday practice. For this element of clinical governance CPD, the GCC expects you to reflect on your:

• understanding of the process and value of reflective practice.
• understanding and application of the tools available to facilitate routine reflective practice.

You are expected to plan and undertake appropriate CPD activity that helps you identify/address any gaps in your understanding of reflective practice and its application. The Reflective Practice learning module (ref ‘RP1’) of the RCC PRT programme addresses this requirement.

Guidance on recording your Clinical Governance CPD activities

Guidance on how to complete the clinical governance elements of your CPD return using the online portal is provided here.

The following table outlines some of the commonly noted activities that the GCC will only accept as CPD learning activities if the learning outcomes are specified.

Each year, every registrant must complete half of their learning requirement with others. For most registrants, this means 15 hours of CPD learning with others.

While learning can take place in a formal setting, such as a lecture or seminar, it can also be informal. The GCC will accept many different types of informal learning, such as:

• case discussions
• shadowing other chiropractors or healthcare professionals
• talking to other healthcare professionals to understand their approach

It is important to remember to keep some evidence of this activity for your CPD summary and report. 

As evidence of informal learning, we recommend noting key issues and topics discussed, the date, number of hours and those who attended. Furthermore, ask all of those in attendance to sign the note and email a copy to each one. That way all in attendance can upload a copy for their own CPD summary and report.

The GCC routinely audits CPD summaries to check the quality of returns and to ensure compliance. This audit reassures the GCC, as well as the public and patients, that all registered chiropractors are keeping their skills and knowledge up to date.

The GCC has previously focused on checking evidence of attendance. However, this tells us little about how well registrants are engaging with the process. The GCC wants to ensure the CPD audit is more meaningful to you, and useful for us as the regulator, in demonstrating that you take your continued professional learning and development seriously.

Audit of CPD summaries

As part of its recent CPD audits, the GCC has focused on different aspects, such as the responses to the first aid questions posed, and first aid activities undertaken in 2019/20 and for 2020/21 the focus was on the learning activity registrants have chosen to reflect on. This is listed in their CPD summary as the learning activity which they felt was of most significance to them.

Audit of 2020/ 21 CPD summaries

For our annual random audit of CPD summaries we focussed on the learning activity registrants had reflected on, that is the learning they felt was most significant to them, together with qualitative analysis of the responses to the following four reflective questions:

• What knowledge and/ or skills did you gain from this activity?
• To what extent did the learning activity affirm or challenge your previous understanding of this topic?
• How will you implement lessons drawn from this learning activity into your professional practice?
• How has the learning undertaken guided your future learning on this and/ or other topics?
• The purpose of this was to determine how registrants were engaging with the process, for example giving sufficiently detailed answers, and the extent to which the questions were addressed.

We found that 87% of registrants engaged sufficiently and demonstrated good reflective learning, which was encouraging. Those that hadn't were asked to submit a further reflective statement, after which all were acceptable.

It is our intention to progress towards encouraging and supporting reflective practice among chiropractors.

What is the GCC hoping to achieve?

The GCC will use the findings from the audits to inform our future guidance as well as help improve compliance and to provide more support, with a particular focus on reflective practice.

What will I need to do?

You should complete the CPD summary as normal and upload evidence you have for your learning with others. Take care when completing the summary and consider your responses to ensure they fully address the questions being asked.

How do I send evidence?

You can upload evidence of your learning via the GCC Registrant portal in the same place that you complete your CPD record summary. Do not post any documents to the GCC as they will not be accepted.

What happens if my CPD summary is not acceptable?

If there is a question on how your CPD summary meets the requirements we will contact you for further information, which you will need to submit within a set timeframe.

What happens if my response is not acceptable, or I do not respond?

If you provide a response that is unclear or does not show reflection, the GCC will work with you to understand why. If you wilfully do not comply, the GCC may take steps to remove you from the Register. The GCC takes continued learning and development seriously. We expect all registrants to do so too.

Each year there will be a small number of cases where registrants have not met the requirements of the GCC CPD programme, or they have not submitted a CPD record summary at all.

In these cases, the GCC will attempt to open a dialogue with the chiropractor to resolve any issues. However, in instances where registrants do not engage with the process, or their CPD does not meet the expected standard, the Registrar will have little option but to remove them from the register.

In these cases, the registrant will always be given the opportunity to engage with the process so that the Registrar may take as much information into account as possible on which to base their decision.

In the unlikely event that a registrant’s name is removed from the register for failing to comply with the CPD requirements, an option will be open to them to appeal the Registrar’s decision. An appeal must be lodged within 28 days from the date of the removal notice.

Further information on the appeals process can be found here.

For registrants experiencing difficult times, which prevent them from undertaking learning and development activities, GCC rules allow us the waive all or part of the CPD learning requirement. 

What can I do if I haven’t completed all or part of the CPD requirement by the end of the CPD year?

In certain circumstances the Registrar may exercise a discretion to waive all or part of a registrant’s CPD requirement or allow longer for CPD to be completed if exceptional circumstances have prevented you from completing your CPD by the end of the CPD year.

When might the Registrar use their power of waiver?

Ill health and bereavement are both generally acceptable. However, all applications are considered on a case-by-case basis.

What is not considered as an exceptional circumstance?

The following generally not considered to be exceptional and for which CPD is unlikely to be waived:

• Work pressure
• Short-term problems or illness
• Personal disruptions that are not serious, which includes travel, holidays etc.
• Financial problems
• Retirement
• Disciplinary matters
• Cancellation of a CPD event.

How do I apply for waiver of my CPD?

If you have not been able to do some or all of your CPD due to exceptional circumstances, you may apply for a waiver via the Registrant portal. Once signed in, go to My CPD Summary, click the waiver link and complete the details, including providing evidence. You will be asked to confirm the number of hours you have not been able to complete as the Registrar will need to know how many hours they are being asked to waive.

What form of evidence is acceptable?

The following details some forms of evidence that the GCC is likely to accept. In some circumstances that Registrar may ask to see evidence of a specific course that you booked.

Long term illness

A medical report or letter from the medical practitioner responsible for your care, confirming the nature of the illness, the date you became ill and when you may be able to undertake CPD and complete your report.

Personal circumstances

An original medical report as outlined above. A certified copy of the death certificate in case of bereavement

Family illness

A medical certificate or letter from the medical practitioner responsible for the care of the patient, confirming the nature of the illness.

Maternity/ Paternity

A letter confirming the period of leave from your employer, documentation showing maternity/paternity pay, or a GP letter.

RCC First Aid CPD evaluation report 2019/2020

RCC CPD evaluation report 2018/2019