There are three routes to register with the GCC as a chiropractor:
a. UK graduates who hold a chiropractic qualification recognised by the GCC
b. Applicants from within the European Economic Area who are applying under the EU General Directive 2005/36/EC
c. Applicants with an overseas qualification that is not recognised by the GCC.
Our focus here is on the third group – applicants with an overseas qualification that is not recognised by the GCC.
There are three principles that we have used in the development of the revised form of the TOC:
a. our responsibility as a regulator to enable our registrants and potential registrants to meet good standards of practice in order that we might better protect patients and the public
b. our wish to ensure that all our registrants and potential registrants actively engage with our standards of good practice as set out in The Code.
c. our acknowledgement that chiropractic as a profession has a history of setting standards for practice and education which have broad international comparability.
These principles have influenced the assessment process within the TOC itself as well as our broader approach to applicants from overseas.
We have developed an Evidence of Practice Questionnaire to be used a part of the assessment process. This gives us an insight into how the individual practises chiropractic but it also emphasises to individuals the importance of the Code and their need to use it as the basis of their standard of practice within the UK. To complete the Evidence of Practice Questionnaire applicants need to engage with The Code.
Additionally, chiropractic as a profession has a history of self-regulation and the promotion of standards of education and practice. Chiropractic authorities are predominantly based in those parts of the world where English is the first or a main language. There is an international coordinating body (Councils on Chiropractic Education International - CCEI) which sets chiropractic accreditation standards as the basis of a minimum framework from which other accrediting bodies can further develop their own accreditation standards. Four other accrediting organisations across the world – in Europe, the USA, Canada and Australasia – have developed their own standards based on these international standards.
Our development work for the revised form of the TOC compared our accreditation standards – the Degree Recognition Criteria – against the accreditation standards of the other accreditation agencies to identify where there are differences.
Outcomes of comparing the GCC’s Degree Recognition Criteria (May 2010) and the various accreditation standards and competences required by the worldwide chiropractic authorities
Comparison between the GCC’s Degree Recognition Criteria (May 2010) and the Councils on Chiropractic Education International - International Chiropractic Accreditation Standards (2009)
Comparison between the GCC’s Degree Recognition Criteria (May 2010) and the Council on Chiropractic Education Australasia’s Competency Based Standards for Entry Level Chiropractors (2009) and Educational Standards for First Professional Award Programs in Chiropractic (2009)
Comparison between the GCC’s Degree Recognition Criteria (May 2010) and the Council on Chiropractic Education (United States of America) Standards for Doctor of Chiropractic Programs and Requirements for Institutional Status (2007) and Accreditation Manual (2013)
Comparison between the GCC’s Degree Recognition Criteria (May 2010) and the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards Standards for the Accreditation of Doctor of Chiropractic Programmes (2011) and Accreditation Policies (2006 – 2011)
Comparison between the GCC’s Degree Recognition Criteria (May 2010) and the European Council on Chiropractic Education Accreditation Procedures and Standards in First Qualification Chiropractic Education and Training (December 2013)
We did this because:
a. all previous applicants to join the register holding overseas qualifications not recognised by the GCC (except one who applied through the EC route) graduated from chiropractic programmes recognised by one of the other worldwide chiropractic accrediting authorities
b. individuals who have taken the previous version of the TOC usually gain a pass although this is sometimes on the second or third attempt
c. our analysis of the fitness to practise cases considered by the GCC suggests that there are no specific risks associated with individuals who gained their chiropractic qualifications from educational establishments overseas
d. we wished to develop a proportionate approach to regulation using right-touch principles.
The comparison of the different worldwide chiropractic authorities’ accreditation standards and competences and the GCC’s Degree Recognition Criteria (2010) revealed a significant degree of similarity between the different sets of standards in relation to the outcomes of the degree programme as well as requirements related to the nature of the degree programme and programme providers.
The differences that were identified are shown in box 1 below.
Box 1: Overview of the main differences between the GCC’s criteria and those of the other regulatory authorities - proposed focus for the content of the assessment process
· The involvement of patients and carers as partners in the care process and providing feedback on their care and its outcomes, as well as patient involvement in education – in the teaching, learning and assessment of students as well as in programme evaluation
· The use of research evidence in influencing practice
· Applying continuous quality improvement in practice
· Identifying and understanding the implications for the provision of chiropractic care for a patient on clinically relevant medications, whether prescribed or bought
· Evaluating the chiropractic care given and modifying the care plan as a result, including ceasing care
· The role of chiropractors in the healthcare system in the UK and their relationship with other healthcare professionals
· The nature of professional accountability and ethics in the UK context and the duty to protect and promote the interests of patients, including professional boundaries, raising concerns about others and the various GCC requirements (eg the Professional Indemnity Insurance Rules)
· UK legislation including: the Equality Act 2010, the Data Protection Act 1998, the Children Act 2004, Mental Capacity Act, Health and Safety at Work Act 1974, Ionising Radiation (Medical Exposure) Regulations 2017 , Safeguarding regulations.
· The use of wellness care and how this relates to the need to evaluate and review plans of care.
We recognised that if we were to take a proportionate approach to the assessment of applicants with overseas qualifications, then these differences should form the focus for our assessment in the TOC. We addressed some of these differences in the design of the Evidence of Practice Questionnaire and they also guide the content of the TOC interview – the second stage of the process.