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I had written a few GP referral letters in the first two years of clinic. This was an important process to go through as knowing how to write these letter is of utmost importance for appropriate patient care and safety.
OPS C3

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Watching CPD events before graduation gives a strong insight as to the learning that lies ahead. These CPD events provided to be very useful in helping my clinical applications whilst in year 4.
OPS B1, B3-B4

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Returning to study amongst COVID really illustrates some principles regarding keeping patients safe through understanding the wider context of the pandemic and thus keeping clinal spaces sanitised, hygienic and compliant with regulations.
OPS C4-C6

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The idea of treating babies terrified me to begin with. In terms of knowledge and competence, it was a different world to adult clinic. A lot more to learn and new ways to think and evaluate with a whole different set of red flags. The new knowledge and skills gained really added to my repertoire as an osteopath, and also allowed me to learn, think and analyse in different ways whilst allowing me to help those younger than 18 for the first time.
OPS B1-B4

Sourced from ESO leaning zone.

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Respecting your patients’ rights to privacy and confidentiality through letter writing.

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Respecting your patients’ rights to privacy and confidentiality through letter writing.

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I had to write a few letters during year 4 clinic. This was very good practice in terms of keeping to the stipulated guidelines and protecting patient information effectively. As several letters involved younger populations, it was even more important to protect the patient whilst also involving the mother/father (for consent etc).
OPS D5

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Supporting patients to care for themselves was a much easier principle to grasp in year 4.

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Supporting patients to care for themselves was a much easier principle to grasp in year 4.

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Sending patients exercises in a structured way provided to be a very valid way to help those care for themselves. This helped them in many ways from a more autonomous view upon health to helping them achieve results with reduced financial input.
OPS A5

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Through stressful times it is very important to make sure you are evaluating your own health at all times.

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Through stressful times it is very important to make sure you are evaluating your own health at all times.

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Using these resources allows others to evaluate your own health and thus keeping to the guidelines and ultimately ensuring that our patients get the best of us at all times.
OPS D11

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Opting for the specialists clinics really broadened my knowledge and skills with regards to osteopathy and how to tailor to individual needs.
OPS B1

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Multiple CEX examinations during year 4.

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Multiple CEX examinations during year 4.

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There were three of these exams, one in each term. They were very stressful but at the same time very rewarding. They provided a level of feedback you could not get anywhere else as I was being assessed with live patients in real time. These exams directly assess my ability to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to my patients.
OPS C1

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Upholding the professional standards applies at all times.

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Upholding the professional standards applies at all times.

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A stark reminder as to why it is important to uphold the reputation of the profession at all times through your conduct, in and out of the workplace.
OPS D7

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An example form used in clinic to gain consent in order to examine intimate/sensitive areas. This is such an important process to go through and is a form I will be using in my own clinic. Using a process like this and asking the patient to think about it in their own time makes the process more valid.
OPS A4

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Consent Form for exam - treament of intimate-sensitive areas Sep 2020 Final

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OPS B3

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Safeguarding is applicable at all times and to all ages.

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Safeguarding is applicable at all times and to all ages.

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The safeguarding lectures we had, alongside the supporting documents, gave us a firm grasp on what was expected and how to act if we are concerned about individuals. Another dimension added to our practice that allows us to keep patients out of harms way. Having these principles in our mind at all times is imperative as an osteopath.
OPS C4

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Screening for potential vascular events in the neck.

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Screening for potential vascular events in the neck.

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Analysing and reflecting on papers like these will really go a long way to potential saving lives in practice. It is fundamental to be able to screen for events like these when we categorise patients as "safe to treat". Another essential reason why reflection and analyse are so important to osteopathic practice.
OPS B4

Rushton, A., Rivett, D., Carlesso, L., Flynn, T., Hing, W. & Kerry, R., 2014. International framework for examination of the cervical region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy intervention. Manual Therapy, 19(3), pp.222-228.

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IFOMPT cervical framework final September 2020 (1)

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Adapting communication and navigating case history taking.

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Adapting communication and navigating case history taking.

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An example from my second CEX whereby I learned how to support the patient in expressing themselves whilst taking into account their particular needs and wants. Learning how to do this is an ongoing process that is constantly refined the more patients you see.
OPS A2

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OPS C5

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Aside from taking a very long time to complete and many battles along the road, I produced a piece of work I was proud of. There was no research on this area in relation to osteopathy with my study being the first of its kind.
In terms of the OPS, this process made me so much more aware of how to respect and recognise individuality, expectations, preferences and concerns. It also taught me the importance of information and providing it in a way that all patients understand. A bi-product of doing this piece of research also highlighted my own beliefs and expectations that I was harbouring with regards to clinic, patients and osteopathy. The process of completing this dissertation on my own has made me more OPS compliant and a better osteopath in a multitude of ways.
OPS A1-A3, A5, A7

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An excellent article outlining how to manage unconscious bias with regards to beliefs and values affecting patient care.

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An excellent article outlining how to manage unconscious bias with regards to beliefs and values affecting patient care.

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Reflecting on articles like these is vital in order to provide unbiased care. Using the strategies outlined, I started screening myself regularly to make sure I was not allowing prejudice to creep in my care.
OPS A7

Bucknor-Ferron, P. & Zagaja, L., 2016. Five strategies to combat unconscious bias. Nursing, 46(11), pp.61-62.

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A clinic tutor talking about a difficult case and keeping within the limits of ones own training and competence.

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A clinic tutor talking about a difficult case and keeping within the limits of ones own training and competence.

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This case presentation was presented to us precisely because of the presenters approach to the case. It was a complicated case which the tutor didn't feel she could take on at the time (having been qualified for only 2 years at the time) and thus she sought help from her mentor and did the required work to be able to take on the case with sufficient confidence and safety.
A very interesting and useful example of being able to recognise the limits to your competence and training and to either refer to someone more appropriate or take on the required work to be able to handle the case safely.
OPS B2

Slide sourced from ESO clinic tutor.

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Why it is important to complete notes in an accurate, timely and legible fashion.

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Why it is important to complete notes in an accurate, timely and legible fashion.

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This brief CPD course concisely illustrates the importance of the above clause. The reasoning behind why it is important to do so is what really consolidated this clause.
OPS C2

Ausmed.co.uk. n.d. Record Keeping and Documentation. [online] Available at: <https://www.ausmed.co.uk/cpd/articles/record-keeping-documentation>

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Good record keeping is an important aspect for health and social care professionals. An accurate written record detailing all aspects of patient monitoring is important because it contributes to the circulation of information amongst the different teams involved in the patient's treatment or care.

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Quizzes like these help consolidate  knowledge on new topics like maternity clinic. They provide very good insight as to our wider role and how we contribute to enhancing the health and wellbeing of our patients. Without this knowledge, we cannot know when to refer or keep patients safe.
OPS C6

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The end is near, a look at insurance options.

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The end is near, a look at insurance options.

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Professional indemnity insurance is a must and directly relates to acting with honesty and integrity in ones practice. Without insurance, patients could be put in harms way and would also mean I am acting dishonestly. The IO is  listed as my intended insurer on my GOsC application form.
OPS D1

IO. n.d. [online] Available at: <https://www.iosteopathy.org/for-osteopaths/membership/services-and-benefits-for-members/>

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Our members enjoy the security of knowing that we will fight for their fair and reasonable treatment should they need it. Members can also access a range of services developed to support them through every stage of their career.

Our membership team are happy answer any questions you might have, call us on 01582 488 455 or email enquiries@iosteopathy.org

Support - first class advice to support you

- For an additional premium Multi-Therapy Professional Liability and Public & Product Liability Insurance is available for purchase with £10 million cover (£5 million for first year graduates) tailored to the needs of osteopaths. The iO policy offers permanent run off cover for osteopaths even after the policy term has lapsed - a key benefit which we believe will be required of all policies in the future.

Medico-legal advice - Exclusively available to those who have purchased professional liability insurance with the iO. Our team of experts have a record of providing excellent legal advice.

Managing complaints - We have produced a Patient complaints guide to help you manage complaints. For those who have purchased professional liability insurance with the iO, we will also support you with complaints from patients or the General Osteopathic Council - exclusions apply.

24-hour legal helpline - For those who have purchased professional liability insurance with the iO, providing professional legal advice on any problem, business or personal, if you are a sole trader

COSSET (Confidential Osteopathic Support for Emotional Trauma) - Available experienced osteopaths at the end of a telephone line during out of office hours. A support service for those overwhelmed by a personal or professional worry. Please telephone 0800 136 619.

Unite - keeping you connected to the profession

Osteopathy Today (OT) - Our magazine contains the latest news, including updates on how we are working to develop the profession, CPD articles as well as debate and opinion pieces written by osteopaths. Published six times a year, OT is available to download.

ConnectiOns - Our fortnightly e-newsletter

iO Members forum - An opportunity to have your say on what's important to you and comment on the latest initiatives and developments in the industry.

iO Convention - Networking opportunities, a diverse programme of lectures and workshops and a celebration of the best in osteopathy at the iO Annual Awards.

Osteopathic Development group (ODG) - This national initiative is a collaboration of key osteopathic organisations designed to bring the profession together.

Develop - your career and clinical skills

CPD - articles, workshops and convention - In every issue of OT you will find a CPD article and quiz that will provide you with useful practical information which you can apply in your practice immediately. The annual convention hosts a weekend of clinical and business-based CPD. We also host a series of one day CPD workshops.

Clinical guidelines - Latest guidelines on a range of topics have been developed by the iO's professional development team and endorsed by NICE.

Webinars - Free access to timely and relevant webinars.

Promote - your business and the profession

Find an Osteopath - Every member can be listed on our website's online database promoting your practice to the public. You can add your own text and graphics and add website links.

Marketing and promotional material - Our marketing and promotion hub gives you access to a range of toolkits inclusive of posters, social assets and blogs to support you in the promotion of your practice and in turn, the profession.

Practice development resource library - A wide range of resources including copy for blogs and websites, template presentations that you can use to develop and promote your clinic. It also includes practical resources such as patient record cards and principle/associate agreements to name just a few.

Classified advertising - Access 70% of the osteopathic profession! iO members can advertise on our site free of charge, and your advert will be displayed for four weeks (unless you ask us to remove it sooner). Non-members can pay to place adverts by calling us on 01582 488455.

Advice on approaching healthcare professionals - Developed based on direct experience, we help you with advice on how best to build relationships.

Suppliers discounts - We have exclusive offers from a range of partners, to give you some great discounts.

Acupuncture Licensing in London - We have negotiated an exemption for iO members needing an acupuncture licence in London.

Osteopathic Opportunities - our online job opportunity board where you can advertise your details and look for osteopathic vacancies across the UK and internationally.

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Our members enjoy the security of knowing that we will fight for their fair and reasonable treatment should they need it. Members can also access a range of services developed to support them through every stage of their career.

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I am glad I read the standards early as I was not aware of how many angles this clause has in relation to wider practice. Reading them has etched them into my mind.
OPS D2

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The consequences of failing to be open and honest - failing duty of candour duties.

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The consequences of failing to be open and honest - failing duty of candour duties.

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A real life example that ended up in court. Reading the article provides detailed reasoning as to why it is so important to uphold this principle. It also gives me tremendous insight in terms of difficulties to avoid in the future.
OPS D3

Jmw.co.uk. 2020. Breach of the Duty of Candour:  First time prosecution. [online] Available at: <https://www.jmw.co.uk/services-for-you/clinical-negligence/blog/breach-duty-candour-first-time-prosecution>

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In the first criminal prosecution of its kind, University Hospitals Plymouth NHS Trust were recently found to breach the Duty of Candour, for failing to be open and transparent with a bereaved family.

What is the Duty of Candour?

The Duty of Candour is a statutory (legal) duty to be open and honest with patients or 'service users', and their families, when something goes wrong that appears to have caused or could lead to significant harm in the future, which is known as a 'a notifiable safety incident'.

The aim of the regulation is to ensure that health service bodies are open and honest with service users and other 'relevant persons' who are acting lawfully on their behalf, in relation to care and treatment.

The duty is contained in Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and applies to all health and social care organisations registered with the regulator, the Care Quality Commission (CQC) in England.

Following the occurrence of a notifiable safety incident, all registered organisations must:

Notify the relevant persons of the incidents. This should be done in person and provide an explanation of what's known at the time, what further enquiries will be made, offer an apology and be recorded in a written record that is kept securely.

The patient should be given reasonable support; this could be practical support such as providing an interpreter or emotional support e.g. counselling.

The patient must be provided with written notes of the initial discussion and of the notification, including details of further enquiries, their results and an apology. The organisation is also required to keep copies of all correspondence relating to the incident.

In this case, Elsie Woodfield died at Derriford Hospital in Plymouth after suffering a perforated oesophagus during an endoscopy.

The Care Quality Commission (CQC) brought an action against University Hospitals Plymouth NHS accusing it of not being open with Woodfield's family about her death and not apologising in a timely way.

Her daughter, Anna Davidson eventually received a letter apologising for her mother's death in December 2017. However she felt this lacked remorse and left many unanswered questions, making it "impossible to grieve".

This trust admitted its failings at court and pleaded guilty for breaching its duty under Regulation 20. They were ordered to pay £12,565 by District Judge, Joanna Matson.

Speaking afterwards, Nigel Acheson, the CQC's deputy chief inspector of hospitals, said: "All care providers have a duty to be open and transparent with patients and their loved ones, particularly when something goes wrong, and this case sends a clear message that we will not hesitate to take action when that does not happen."

Patients and their families place a large amount of trust in health and social care providers and it is therefore essential for them to feel confident that should anything untoward occur, they will be entitled to an open and honest response.

Furthermore, this allows a level of scrutiny to be applied, which provides an opportunity to consider the situation objectively, look at what could have been done better and implement any necessary changes to improve patient safety in the future.

A failure to comply with the Duty of Candour can not only lead to a breakdown in trust between patients and health service bodies but may lead to service users distancing themselves from vital services they require in the future.

In clinical negligence cases, many Claimants are simply looking for an apology. Failing to comply with the Duty of Candour can lead to further tensions between parties and prolong any future litigation process.

This may be the first prosecution of its kind, however, we are likely to see more cases being brought under these regulations in the future. This is a stark reminder to health service bodies that duties imposed under these regulations should not be taken lightly.

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Breach of the Duty of Candour: First time prosecution

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In the first criminal prosecution of its kind, University Hospitals Plymouth NHS Trust were recently found to breach the Duty of Candour, for failing to be open and transparent with a bereaved family. What is the Duty of Candour?

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Complaints can turn out to be beneficial for both involved.

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Complaints can turn out to be beneficial for both involved.

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Most associate complaints negatively. It is however important to note that complaints can turn out to be a good thing. It is imperative to lay out a coherent and transparent policy by which patients can use with ease.
OPS D4

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As a stipulation of the OPS, it is a requirement to be familiar with this act.
OPS D6

GOV.UK. n.d. Equality Act 2010: guidance. [online] Available at: <https://www.gov.uk/guidance/equality-act-2010-guidance>

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A real life example of when you are not clear about your pricing.

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A real life example of when you are not clear about your pricing.

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This scenario depicts why the OPS has the clauses it does. Clear and visible fees will reduce the likely hood of disputes emerging. A clear lesson to learn.
OPS D8

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Handover forms summarising patient information. 

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Handover forms summarising patient information. 

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This was a template used for the CCA returning patient. It provides excellent practice for the effectiveness of handover procedures in the future amongst colleagues and other healthcare professionals.
OPS D9

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A very important form to be familiar with. Forms like these allow us to follow correct referral procedures depending on the severity of the patient complaints whilst also considering the contributions of other healthcare professionals with  view to optimising patient care.
OPS D10

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A clear example of me following procedure as stated by the OPS and notifying the GOsC of any  information needed regarding registration whilst complying with procedure.
OPS D12

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Consent forms every new patient is required to sign.

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Consent forms every new patient is required to sign.

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jThese forms outline some key aspects of patients dignity and modesty such as the requirement to undress to a certain degree and the need for a chaperone etc. Using forms like these are so important to setting the expectations and beliefs of the patient, especially if they are new to osteopathy.
OPS A6

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Ausmed.co.uk. n.d. Record Keeping and Documentation. [online] Available at: <https://www.ausmed.co.uk/cpd/articles/record- keeping-documentation>

Bucknor-Ferron, P. & Zagaja, L., 2016. Five strategies to combat unconscious bias. Nursing, 46(11), pp.61-62.

GOV.UK. n.d. Equality Act 2010: guidance. [online] Available at: <https://www.gov.uk/guidance/equality-act-2010-guidance>

IO. n.d. [online] Available at: <https://www.iosteopathy.org/for- osteopaths/membership/services-and-benets-for- members/>

Jmw.co.uk. 2020. Breach of the Duty of Candour: First time prosecution. [online] Available at: <https://www.jmw.co.uk/services-for-you/clinical- negligence/blog/breach-duty-candour-rst-time-prosecution>

Rushton, A., Rivett, D., Carlesso, L., Flynn, T., Hing, W. & Kerry, R., 2014. International framework for examination of the cervical region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy intervention. Manual Therapy, 19(3), pp.222-228.