Overview of the development and structure of the NZ Osteopathic Scope of Practice

1. Stiofán Mac Suibhne
OCNZ Project Officer

2.  The changing demographic –Western societies are graying.
 Increased demands on resources may mean reduced public
sector involvement in direct service provision.
 Reduced doctor time will require maximising the services
delivered in primary care by allied health professionals.
 Osteopathic skill set becoming dated. Need to align the
osteopathic scope of practice with the strategic direction.
 Globalisation and workforce mobility
 Life long learning

3. OCNZ Statutory duty to determine scope.
Facilitate leadership on scope issues
Professional Bodies: AOA, BOA, ISOP, OSNZ.
Australian (NZ) Osteopathic Council
Senior students & faculty from Unitec
NZ Ministry of Health, ACC
Podiatry Nursing Medicine Psychology

4.  Osteopathy is a maturing and diversified profession –
needs to be reflected in vocational scopes.
 No clear relationship between training pathways and
competency in practice: Vocational / Extended Scopes.
 30% of NZ Osteopaths were using needling techniques
in practice without standards / minimum training
requirements being determined.
 ACCORB accreditation standards specify no minimum
requirements for paediatric practice.

5.  Osteopathy is a weak brand – we need a USP
 Field of manual medicine is crowded.
 Osteopathy is defined by its philosophy not technique.
 Mission creep / Healthcare Ecosystem (professional identity and
post modernism)
 Stakes a claim for Osteopaths and their role in the healthcare
system.
 The formless no scope scope of practice is not serving us well.
 The formless scope or a restricted scope statement is a form of
prohibition.

6.  Techniques vs philosophy
 Evidenced based vs Belief - based / experiential
 Structural vs Cranial
 Totality belief system vs regulated healthcare
profession
 Place of AT Still – legacy of the aphorisms
 CAM vs Manual Medicine – Orthodoxy /
Heterodoxy?

7.  Highly restricted view of practice
 Unintentionally placing many osteopaths outside the SoP
 Technical and practitioner centric
 Failed to communicate skill set
 Curriculum focus rather than practice focuses
 Why would a patient consult an osteopath?
 Why would another healthcare practitioner refer to an
osteopath?
 Scope of practice = work in progress
 OCNZ must specify SoP duty to consult

9.  Need to reform the pre-professional training pathway and
determine minimum skill set to commence professional life.
 Single Scope of Practice is unrealistic.
 Additional scopes of practice required to formally recognise skills
acquired in post pre-professional training through post-graduate
study.
 Formal training ought not to stop at the point of registration.
Current approach to CPD entirely unsatisfactory.
 Need an externally recognisaible hierarchy of knowledge.
 Public register ought to allow patients / third party refers to
identify practitioners with advanced standing in certain areas of
practice

10.  Act does not distinguish between general / extended /
vocational SOP
 Reference to other NZ healthcare professions
 Acknowledging the realities of a maturing profession
 Osteopathy at a junctional point
 Low quality CPD / lack of career pathways
 Diverse pre-professional training pathways
 Clinical complexity

11.  Patient centred
 Protection of title – do we create additional titles?
 Informative to other Healthcare Professionals
 Broadly defined
 Allows acquisition / incorporation of PG learning
 Inclusive
 General Osteopathic Scope
 Vocational SOPs
 Extended SOPs
 Special Purposes SOPs

12. Advanced standing and post graduate study / specialisation in areas of practice that
remain within the general scope of practice.
There is a continuum of skills / knowledge from novice to expert. Pre-professional
training prepares osteopaths to commence practice.
Means of addressing issues of clinical competency for referrers / best fit of practitioners
: patient.
Currently there are means of credentialling practitioners.
Failure of professional associations to develop clinically focused special interest groups.
Osteopathic invisibility
 Child & Infant health (Paediatrics)
 Gerontology
 Occupational Health
 Pain management
 Rehabilitation
 Sports science

13. An extended scope of practice is required when it is explicit
that pre-professional training does not prepare a registrant for
competent practice.
These areas are excluded from the general scope.
 Western Medical Acupuncture & Related Needling Techniques
 Osteopath Prescriber (Reform of the Medicines Act)
 Injection therapies (Prolotherapy? Requires prescribing rights)
 Advanced Diagnostic Competencies

14.  Interdisciplinary – using existing resources
 Formal Learning & Learning in Clinical Settings
 Accessibility – mixed mode delivery
 Creative learning pathways
 Defining / Refining Capabilities
 Patient safety
 Career Development
 Responding to changing healthcare environment
 Liberal CPD Regime for Vocational SOP Holder

15.  Osteopaths are primary healthcare practitioners
 Osteopathy is a person-centred form of manual medicine
 Osteopaths conceptualise health and disease within a broad holistic
bio-psycho-social and environmental context
 Osteopathic practice may be situated within the continuum of
healthcare - wellness
 The competent practice of osteopathy requires broad diagnostic
competencies
 Osteopaths work with patients from across the lifespan

16. Osteopaths are primary healthcare practitioners. Central to
the competent practice of osteopathy is an understanding of
the role of the primary care team and referral routes within
primary care and to hospital based service.
Rogers, F., D'Alonzo, J., GE. , Glover, J., Korr, I., Osborn, G., Patterson, M., et al.
(2002). Proposed tenets of osteopathic medicine and principles for patient care.
J Am Osteopath Assoc, 102, 63-65.

17. Osteopathy is a person-centred form of manual medicine
informed by osteopathic principles. Osteopathic medicine is
not confined to historical osteopathic knowledge; rather
osteopathic philosophies and concepts inform the
interpretation and application of interdisciplinary knowledge
and the basic medical sciences.
Osteopathic medicine is an evolving field of knowledge and
incorporates new concepts as our understanding of health
and disease progresses.

18. Osteopaths treat people and conceptualise health and
disease within a broad holistic bio-psycho-social and
environmental context. Most osteopaths have a particular
interest in conditions of the neuromuscular system and the
management of pain.
Osteopaths seek to prevent disease, promote health and give
patients control over their health by applying the principles
of salutagenesis in practice.
Option A

19. Osteopaths treat people and conceptualise health and
disease within a broad holistic bio-psycho-social and
environmental context.
Osteopaths have a particular interest in conditions of the
neuromuscular system and the management of pain.
Osteopaths seek to prevent disease and promote health by
empowering patients through sharing knowledge on lifestyle
choices that improve health outcomes.
Option B

20. Osteopathic practice may be situated within a continuum
healthcare and wellness, with osteopaths applying evidence
based approaches to the management of named pathologies
and conditions through to promoting wellbeing through
supportive treatment.

21. The competent practice of osteopathy requires broad
diagnostic competencies. Osteopaths employ broad
diagnostic competencies and a differential diagnosis is
required to determine if a structural diagnosis and the use of
osteopathic manipulative treatment (OMT) are appropriate.
Although osteopathic practice is often defined by OMT, the
practice of osteopathy it is not limited to a structural
diagnosis and OMT. Whilst there may well be a somatic
component to disease, OMT may not be a suitable or
principal modality in every presentation.

22. Osteopaths work across the lifespan and may treat
individuals from birth to old age, or deliver services in group
settings.
Professional knowledge may be applied in a range of settings
not limited to clinical practice, such as health promotion,
education and research, health policy and healthcare
management.

23.  A person is the product of dynamic interaction between bio, psycho,
social and environmental factors.
 An inherent property of this dynamic interaction is the capacity of the
individual for the maintenance of health and recovery from disease.
 Many forces, both intrinsic and extrinsic to the person, can challenge this
inherent capacity and contribute to the onset of illness.
 The musculoskeletal system significantly influences the individual’s
ability to restore this inherent capacity and therefore to resist disease
processes.
 The patient is the focus for healthcare.
 The patient has the primary responsibility for his or her health.

24. A person is the product of dynamic interaction between bio, psycho,
social and environmental factors. The human body functions as unit,
with structural and function being reciprocally interrelated between all
systems and levels of organisational complexity. Alterations in the
structure or function of any one area of the body influence the integrated
function of the body as a whole.
An inherent property of this dynamic interaction is the capacity of the
individual for the maintenance of health and recovery from disease.
Osteopathic medicine views health as the natural state of the body. The
health of the individual is determined by complex, self-regulating
homeostatic systems that are strongly influenced by the structure of the
individual. These regulatory systems are capable of compensatory
alterations in the face of disease, yet can be self-healing and restorative
when their function is optimised.

25. Many forces, both intrinsic and extrinsic to the person, can challenge
this inherent capacity and contribute to the onset of illness. A realistic
view of health focuses on wholeness, understanding and situating the
person in his or her context, and appreciating his or her efforts to
maximize health status and cope with disease or disability. Osteopaths
recognise that each individual is uniquely vulnerable to stressors that
place him or her at risk for loss of health. Illness represents the body’s
inadequate, self-regulatory responses to challenges from the internal
and external environment.

26. The musculoskeletal system significantly influences the individual’s
ability to restore this inherent capacity and therefore to resist disease
processes. Historically orthodox medicine has conceptualised health and
disease primarily in terms of internal organs and their disturbances, the
musculoskeletal system being relegated to a secondary role as an organ
system that is primarily related to locomotion.
Osteopathic medicine considers the musculoskeletal system to play a
primary role in health and disease. Derangements in the musculoskeletal
system are common and represent significant public health concerns.
Abnormalities in the structural system affect its function and that of
related circulatory and neural elements. The interventions directed to the
musculoskeletal system include osteopathic palpatory diagnosis and
manipulative treatment, therapeutic and recreational exercise, and
physical therapy modalities.

27. The patient is the focus for healthcare. Osteopaths are trained to focus
on the individual patient and resit reducing the focus to the abstractions
of presenting symptoms, body parts and named disease entities.
The relationship between clinician and patient is a partnership in which
both parties are actively engaged. The osteopath is an advocate for the
patient, supporting his or her efforts to optimize the circumstances to
maintain, improve, or restore health

28. The patient has the primary responsibility for his or her health.
Although the patient-osteopath relationship is a partnership, and the
osteopath as a healthcare professional has obligations to the patient,
ultimately the patient has primary responsibility for his or her health.
The patient has inherent healing powers and must nurture these through
diet and exercise, as well as adherence to appropriate advice in regard to
stress, sleep, body weight, and avoidance of substance misuse.

29. In order to apply for registration in a vocational scope of practice
the osteopath must hold a prescribed qualification, be registered
in the General Osteopathic Scope of Practice and have held an
annual practising certificate for three years.
Suitably qualified overseas applicants will be considered if they
have been registered and practising as an osteopath in an
overseas jurisdiction for 3 years. Review if elective pathways.
Vocational scopes of practice are drawn from key areas of
osteopathic practice and will allow registrants to pursue career
development aspirations and hopefully improve the quality and
relevance of professional development activities.
The healthcare needs of the population are changing and it is
important that the scope of practice framework is such that it
guides the development of relevant professional knowledge and
skills.

30.  In the midst of the demographic changes it is important that
healthcare provision considers the needs of older patients and
seeks to work with then to maximise their health and quality of
life.
 If the healthcare system is to rise to the challenge of meeting the
healthcare needs of an ageing population it is important that
healthcare professionals develop the necessary skills and
knowledge to help maintain independence and health seeking
behaviours in older patients.
 A vocational scope for gerontology will signal to older patients
that the osteopath has a particular interest and advanced
knowledge base that supports this area of their practice.

31.  The centrality of the patient to models of practice within the
osteopathic paradigm, a conceptual framework that places
the patient within their own context and seeks to maximise
health within a structural-functional continuum make
osteopaths particularly well suits to working with older
patients.
 Protection of Title: Osteopaths registered in the Vocational
Gerontology Scope of Practice are entitled to use the title of
Osteopathic Gerontology Practitioner

32. Postgraduate Certificate in Health Science in Older Adult: Health and Wellness (AK3484) 60
points
The PgDipHSc provides you with the opportunity to undertake an approved course of study
to advance your specialty discipline, knowledge and scholarly development. This
programme comprises three 20-point papers, which can contribute 120 points towards a ,
Master of Health Science or Master of Health Practice.
Core Papers:
Contexts of Ageing
Cognitive Health in Ageing
Research Methods
Reflective Practice
Electives:
Exercise Physiology
Science for Advanced Practice
Enhancing Muscular Performance
Applied Human Movement Studies
Motor Control in Rehabilitation
Concepts of Rehabilitation
Participation in Health
Stroke Management

33. The management of pain is key professional interest for
many osteopaths.
Although osteopathy was initially conceptualised as a drug-free
therapeutic system, in the intervening years more
effective and less toxic drugs have emerged and professional
knowledge of such developments is required.
In addition pain management as an area of practice has
developed a rich body of interdisciplinary knowledge and
practice.

34. This vocational scope will allow those that have a particular
interest in working with chronic pain conditions to be
identified in the register and be given credit for their further
studies.
Protection of Title: Osteopaths registered in the Pain
Management Scope of Practice are entitled to use the title of
Osteopathic Pain Management Practitioner.

35.  The centrality of the patient to models of practice within the
osteopathic paradigm gives a framework that places the
patient within their own context. Ageing / death not
prominent within AT Still’s thinking?
 Seeks to maximise health within a structural-functional
continuum make osteopaths particularly well suits to
working with older patients.
 Protection of Title: Osteopaths registered in the Vocational
Gerontology Scope of Practice are entitled to use the title of
Osteopathic Gerontology Practitioner

36. The endorsement in Pain and Pain Management is open
to medical practitioners and allied health care
professionals and can be studied part-time / by distance.
It is designed to present an understanding of the
importance of pain to the individual and to society, and
how best to optimise its management.
It provides candidates with the necessary skills to better
understand and manage pain problems that pertain to
their particular discipline within health care. At Master’s
level, it provides a knowledge and understanding of
research methodology and its practical application

37.  Psycho-social Aspects of Pain
 Introduction to Pain
 Introduction to Pain Management
 Pain Assessment
 Neurobiology of Pain
 Biomedical Pain Management
 Pain in Special Circumstances
 Musculoskeletal Rehabilitation
 Cognitive Behavioural Therapy
Post Grad Diploma

38. As entry level / minimum standards have yet to be developed for
paediatric practice it would be previous for Council to develop a
vocational scope for this area of practice.
By determining a set of knowledge, skills and attitudes for
competent paediatric practice the Council will be meeting its
obligation to ensure competence frameworks are developed. This
will help ensure one of the most vulnerable patient groups is
protected.
Professional practice needs to be informed by risk management
strategies, be situated in contemporary understanding of normal
child development developmental and adequate knowledge of
congenital and developmental disorders in children.

39. The Osteopathic Council recognises that osteopathic practice is not limited to the
direct provision of clinical services to patients. Osteopaths may use their
professional knowledge in a wide range of settings:
 Direct non-clinical relationships with patients; such as in group exercises
programmes, health promotion activities or health care systems administration
(ie working for ACC as a case manager or doing clinical audit).
 Clinical educators / clinical preceptors; in pre-professional teaching clinics or
practice based settings
 Research – undertaking or directing research activities
 Teaching – faculty working in the tertiary sector on professional qualifications
leading to registration as an osteopath or other regulated health profession and
post graduate osteopathic / health science programmes.
 Policy development and regulation
 Visiting Osteopathic Presenter / Educator

40.  Gerontology / Pain Management SOP notices Gazetted
 Next up Rehabilitation.
 Rx Injection Therapy, Paediatrics
 Building partnerships with stakeholders – Interdisciplinary
learning pathways
 International considerations – USA
 Integrate with CPD / Recertification