Stiofan Mac Suibhne presentation on the proposed scope of practice schema for the NZ osteopathic profession. Overview of the legislative framework and demographic changes driving the healthcare agenda.

2. 9.30 Registration
9:50. Welcome and Opening Remarks (EF)
10:00 Session 1 – Disciplinary Processes Overview (ML)
11:00 Morning Coffee
11:15 Session 2 - Revised Scope of Practice Scheme (SMS)
12:30 -1:15 Lunch
1.15 – 2.00 Session 3 – ACC Treatment Data (EF)
2:00 – 2:45 Session 4 – ePortfolio - CPD and Recertification (SMS ).
2:45 Afternoon Tea
3:00 – 4:00 Session 5 The knowledge, skills and attitudes for paediatric practice (EF)
4:00 – 4:15 Q&A
4.15 Finish

3. Stiofán Mac Suibhne

4. (1) The principal purpose of this Act is to
protect the health and safety of members
of the public by providing for mechanisms to
ensure that health practitioners are
competent and fit to practise their
professions.

5. (2) This Act seeks to attain its principal purpose by providing, among
other things:
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for a consistent accountability regime for all health professions
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for the determinationfor each health practitioner of the scope of
practice within which he or she is competent to practise
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for systems to ensure that no health practitioner practises in that
capacity outside his or her scope of practice
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for power to restrict specified activities to particular classes of
health practitioner to protect members of the public from the risk
of serious or permanent harm
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for certain protections for health practitioners who take part in
protected quality assurance activities
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for additional health professions to become subject to this Act

6. Section 12
Qualifications must be prescribed
(1) Each authority must, by notice published in
the Gazette, prescribe the qualification or
qualifications for every scope of practice that
the authority describes under section 11.

7. Registered osteopaths are primary healthcare practitioners
who facilitate healing through osteopathic
assessment, clinical differential diagnosis and treatment of
dysfunctions of the whole person.
Osteopaths use various, recognisedtechniques to work with
the body's ability to heal itself, thereby promoting health
and wellbeing.
These osteopathic manipulative techniques are taught in the
core curriculum of accredited courses in osteopathy. The
ultimate responsibility for recognition of practice lies with
the Osteopathic Council of New Zealand.

8. 
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The body is a unit.
Structure and function are reciprocally interrelated.
The body possesses self-regulatory mechanisms.
The body has the inherent capacity to defend itself and repair itself.
When normal adaptability is disrupted, or when environmental changes
overcome the body's capacity for self-maintenance, disease may ensue.
Movement of body fluids is essential to the maintenance of health.
The nerves play a crucial part in controlling the fluids of the body.
There are somatic components to disease that are not only
manifestations of disease but also are factors that contribute to
maintenance of the diseased state.
Implicit in these philosophies is the belief that osteopathic intervention
has a positive influence on the above

10.  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 consul an osteopath?
 Why would another healthcare practitioner refer to an
osteopath?
 Scope of practice = work in progress
 OCNZ must specify SoP duty to consult

11.  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.

12. 
Techniques vs philosophy
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Evidenced based vs Belief - based / experiential
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Structural vs Cranial
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Totality belief system vs regulated healthcare
profession
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Place of AT Still – legacy of the aphorisms
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CAM vs Manual Medicine – Orthodoxy /
Heterodoxy?

13. 
Personal / Professional SoP - Differentiated
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Evolution or Extinction?
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Modernising = Medicalising?
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Broad-based with porous boundaries
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Life long learning vs apprenticeship
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Tensions and limitations of binary discourse
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Can’t please all of the people all of the time

14.  Single Scope of Practice is unrealistic.
 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.

15.  Additional scopes of practice required to formally recognise
skills acquired in post pre-professional training through postgraduate study.
 Need to reform the pre-professional training pathway and
determine minimum skill set to commence professional life.
 Formal training ought not to stop at the point of
registration. Externally recognised hierarchy of knowledge
 Public register ought to allow patients / third party refers to
identify practitioners with advanced standing in certain
areas of practice

16.  Act does not prescribe a terminology for scopes of practice:
Vocational & Extended Scopes of Practice
 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

17.  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.
 Need to align the osteopathic scope of practice with the
strategic direction.
 Globalisation and workforce mobility
 Life long learning

18. 
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Patient centred
Protection of title
Informative to other Healthcare Professionals
Broadly defined
Simple as possible
Allows acquisition / incorporation of PG learning
Inclusive
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General Osteopathic Scope
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Vocational SOPs
Extended SOPs
Special Purposes SOPs

19. 
Osteopaths are primary healthcare practitioners
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Osteopathy is a person-centred form of manual medicine
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Osteopaths conceptualise health and disease within a broad holistic
bio-psycho-social and environmental context
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Osteopathic practice may be situated within the continuum of
healthcare - wellness
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The competent practice of osteopathy requires broad diagnostic
competencies
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Osteopaths work with patients from across the lifespan

20. 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.
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Child health / Paediatrics
Gerontology
Occupational Health
Pain management
Rehabilitation
Sports injuries

21. 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.
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Western Medical Acupuncture
Osteopath Prescriber
Injection therapies
Advanced Diagnostic Competencies

22. 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.

23. 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.

24. 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 salutagenesisin practice.
Option A

25. 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

26. 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.

27. 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.

28. Osteopaths work across the lifespanand 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.

29. 
A person is the product of dynamic interaction between bio, psycho,
social and environmental factors.
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An inherent property of this dynamic interaction is the capacity of the
individual for the maintenance of health and recovery from disease.
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Many forces, both intrinsic and extrinsic to the person, can challenge this
inherent capacity and contribute to the onset of illness.
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The musculoskeletal system significantly influences the individual’s
ability to restore this inherent capacity and therefore to resist disease
processes.
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The patient is the focus for healthcare.
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The patient has the primary responsibility for his or her health.

30. 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.

31. 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.

32. 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.

33. 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

34. 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.

35. 
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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

36. 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.

37. 
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.
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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.
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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.

38. 
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.
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Protection of Title: Osteopaths registered in the Vocational
Gerontology Scope of Practice are entitled to use the title of
Osteopathic Gerontology Practitioner

39. 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

40. Themanagement of pain is key professional interest for
many osteopaths.
Although osteopathy was initially conceptualised as a drugfree 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.

41. 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.

42. 
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?
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Seeks to maximise health within a structural-functional
continuum make osteopaths particularly well suits to
working with older patients.
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Protection of Title: Osteopaths registered in the Vocational
Gerontology Scope of Practice are entitled to use the title of
Osteopathic Gerontology Practitioner

43. 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

44. 
Psycho-social Aspects of Pain
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Introduction to Pain
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Introduction to Pain Management
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Pain Assessment
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Neurobiology of Pain
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Biomedical Pain Management
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Pain in Special Circumstances
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Musculoskeletal Rehabilitation
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Cognitive Behavioural Therapy
Post Grad Diploma

45. 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.

46. 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:
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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).
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Clinical educators / clinical preceptors; in pre-professional teaching clinics or
practice based settings
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Research – undertaking or directing research activities
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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.
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Policy development and regulation
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Visiting Osteopathic Presenter / Educator

47. 
Consultation on Gerontology / Pain
Management SOP Gazette notices
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Building partnerships with stakeholders –
Interdisciplinary learning pathways
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International considerations – USA
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Integrate with CPD / Recertification