MD, PhD, FMedSci, FSB, FRCP, FRCPEd

The UK Professional Standards Authority for Health and Social Care (PSA) tries to promote the health, safety and wellbeing of patients, service users and the public by raising standards of regulation and voluntary registration of people working in health and care. They are an independent body, accountable to the UK Parliament.

In July 2014, the PSA audited all 75 of the cases that the General Chiropractic Council (GCC) had closed at the initial stages of its fitness to practise (FTP) process during the 12 month period from 1 June 2013 to 30 May 2014. The final verdict of the PSA’s audit seems devastating. Here is a short excerpt from the conclusions of its report:

The extent of the deficiencies we found in this audit (as set out in detail above) which related to failures across every aspect of the casework framework, as well as widespread failures to comply with the GCC’s own procedures, raises concern about the extent to which the public can have confidence in the GCC’s operation of its initial stages FTP process.

In summary, the particular areas of failures/weaknesses identified in our audit include:

  • Ineffective screening on receipt of ‘complaints’ and inconsistent completion and updating of risk assessments
  • Customer service issues, including failing to respond to/acknowledge correspondence promptly, failing to provide clear information about the FTP process and failing to provide updates about progress and outcomes within reasonable timeframes
  • Inadequate investigation of cases through failures to gather or validate relevant evidence or to do so promptly – sometimes as a result of inconsistent and ineffective use of case plans and case reviews
  • Deficiencies in the evaluation of information by decision-makers and weaknesses in the reasoning provided for decisions, including failures to address all the relevant allegations and/or reaching decisions on the basis of insufficient evidence
  • Poor record keeping and various data protection breaches or potential breaches
  • Ineffective systems for the sharing of relevant information between the Registration and FTP teams, leading to inappropriate action being taken in some cases
  • Widespread non-compliance with internal guidance and procedures.

We have also concluded that the steps taken by the GCC, in particular the processes it introduced in its procedure manual in February had not at the time of the audit resulted in consistent improvement in the quality of its casework.

What does all of this mean?

The GCC’s website informs us that this organisation regulates all chiropractors in the UK to ensure the safety of patients undergoing chiropractic treatment. The GCC is an independent statutory body established by Parliament to regulate the chiropractic profession. We protect the health and safety of the public by ensuring high standards of practice in the chiropractic profession. The title of ‘chiropractor’ is protected by law and it is a criminal offence for anyone to describe themselves as any sort of chiropractor without being registered with the GCC.  We check that all chiropractors are properly qualified and are fit to practise.

The conclusions of the PSA audit seem to indicate nothing less than this: the GCC is not fit for purpose!

I have often said that the regulation of nonsense must inevitably result in nonsense – but I did not expect to get a confirmation from the GCC in this fashion.

6 Responses to The UK General Chiropractic Council: fit for purpose?

  • Unbelievable.

    But don’t forget that this isn’t surprising. Remember what the Professional Standards Authority said in its Performance Review Report of 2013/2014 regarding the GCC’s fitness to practice process needing improvement. In particular, see pages 40 to 55 on the report:

    The GCC met the majority of the Standards of Good Regulation during 2013/14, but did not meet four of the Standards for fitness to practise. These were the fourth, sixth, eighth and ninth standards. We also found inconsistent performance against the tenth standard. These related to: failing to have a system which enables the regulator to assess risk throughout the lifetime of a case and, where appropriate, refer a case to an interim orders committee; failing to progress fitness to practice cases in a timely manner; the Investigating Committee’s failure to make adequate decisions about the fitness to practice of registrants; and the failure to ensure that all fitness to practice decisions are communicated to relevant stakeholders.

    10.3 However, our 2013/14 performance review identified a number of new concerns, which are summarised below:
    * A failure to consistently carry out and record risk assessments or its decisions about applying for interim orders (see paragraphs 10.29–10.30)
    * The timeliness of the progression of cases through the GCC’s fitness to practise process, and the development of a ‘backlog’ of cases awaiting a final panel hearing (see paragraphs 10.36–10.37)
    * Ongoing concerns about the quality of the decisions of the GCC’s Investigating Committee, following external audit reports in 2012 and 2013 (see paragraphs 10.41–10.42)
    * The adequacy of the GCC’s system for promptly notifying stakeholders of final fitness to practise hearing outcomes (see paragraphs 10.46–10.49)
    * Two data security breaches, one of which was reported to the Information Commissioner’s Office (see paragraph 10.52).

    It was reported by the GCC thus:

    The General Chiropractic Council (GCC) welcomes publication by the Professional Standards Authority (PSA) of its Performance Review Report 2013/14.

    The GCC is pleased to have met the PSA’s expectations in respect of our governance and standards and in respect of our education, training and registration functions. We also welcomed the PSA’s recognition that we have successfully addressed the issues that they raised with us in their 2012/13 report.

    We share the PSA’s views that our fitness to practice process still needs improvement, and we have already implemented plans to address the outstanding issues raised by the PSA. However, we are unable to make all of the changes that we want until our legislation is changed. We have raised necessary proposed alterations with the Department of Health, and we await their response.

    It’s also worth remembering that the GCC was taken to court by the PSA last year for being too lenient on a disciplinary matter.

    Then there was the Independent Review of General Chiropractic Council Fitness to Practise Cases 2010 – 2013

    Note that over three years only 13 allegations of inappropriate treatment appear (page 20, figure 12), and that there were only five allegations of dishonesty and ten of financial deception (page 25, figure 19).

    One can only wonder about what’s going on, whether the GCC are better at protecting their registrants than the public and how long they will be allowed to continue like this.

    • Alan Henness :
      Having perused the reports by the PSA it seems that all healthcare regulators have deficiencies, not just the GCC. This of course in no way justifies or excuses any under-performance by the GCC who obviously need to improve their act. I’m surprised though that you seem unhappy that there have only been ’13 allegations of inappropriate treatment…’. Are you saying you know of more than this? Or do you wish there to be more than this?

      • Bill Kusiar said:

        Having perused the reports by the PSA it seems that all healthcare regulators have deficiencies, not just the GCC. This of course in no way justifies or excuses any under-performance by the GCC who obviously need to improve their act.

        Agreed – it certainly doesn’t.

        I’m surprised though that you seem unhappy that there have only been ’13 allegations of inappropriate treatment…’. Are you saying you know of more than this? Or do you wish there to be more than this?

        No. Just highlighting the numbers. A comparison with health regulators might be interesting.

  • If you let the Tooth Fairy regulate herself, the result is not likely to be that there is no Tooth Fairy.

  • @ Edzard

    Will you do a follow-up blog on the new PSA report on the GCC?

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