Are you an Osteopath trained abroad who wishes to practice in the United Kingdom and you do not know where to start?
Let’s have a look together at what you should do.
The information reported below cite frequently the General Osteopathic Council (GOsC) website. Please refer to it as the official source of truth when considering to work as an Osteopath in the UK.
If you are an Osteopath trained abroad who wishes to practice in the United Kingdom you should bear in mind that a great deal of patience and balanced nerves are required. It might be a long process to be recognised, but it is important not to get frustrated. However, you can do it, as long as you firmly believe in it.
The purpose of this article is not to replace the information provided by the General Osteopathic Council(GOsC), whose site accurately guides you through the registration process. By contrast, I aim to support and give some suggestions based on my personal experience to Osteopaths who want to start this process as I have already done. According to this, I cannot ensure you will be able to get your registration easier only by reading this article: there are no specific rules on how to do the application correctly or wrongly and the most important thing is to follow thoroughly the GOsC information. However, this article might solve some of the most common doubts which are popping up now in your mind as has already happened to mine one year ago. Oh yes, I told you, the application took me one year and you should be prepared to be patient. Do not panic! :)
Let’s begin…
1) The General Osteopathic Council (GOsC) is the regulator of the practice of Osteopathy in the United Kingdom. Therefore, Osteopaths must be registered with it to practice in the UK.
How to register for the GOsC? Here you can find all the information you are looking for: HOW TO REGISTER WITH THE GOsC.
I will share what has been my story as an applicant from a country (Italy) that is part of the European Union and will summarize the MAIN PROCEDURES I have gone through.
2) To determine if you can be registered the GOsC will need to assess your QUALIFICATION, WORK EXPERIENCE and LIFELONG LEARNING to ensure these are equivalent to the UK standards. The UK standards are set out in the Osteopathic Practice Standards.
The Osteopathic Practice Standards are the collection of the standards of conduct, ethics and competence required of osteopaths to ensure high-quality care for patients.
It is very important to read and have a deep knowledge of the Osteopathic Practice Standards to understand what requirements are expected from you. Qualifications, work experience and lifelong learning you present should be able to demonstrate you have covered the 4 parts of the Osteopathic Practice Standards (OPS), which are:
How will you demonstrate you have covered them? See Appendix 2 in the next section.
3) To begin your registration you should provide to the Registration and Overseas Applications Officer the following:
contact details
proof of nationality – a copy of your passport
proof of qualification – a certified copy of your professional osteopathic qualification or, if you don't have a qualification, evidence that you have practised as an osteopath for at least one of the last 10 years.
a certified copy of your academic transcript, which outlines the results you achieved for each module studied
a course guideline/handbook which outlines the modules studied, specific to osteopathy
evidence that you are registered with the regulatory body in your country (Certificate of Current Professional Status or equivalent).
these completed form
N.B.: All the documents provided must be in English or they must have a certified translation (Ask your University / School to provide you with an English version of the documents you need).
Along with the above documents you will be asked to provide proof of your English Language proficiency. I like to mention it now because providing proof of your English language ability might be a process that will take you as long as the registration itself. Do not underestimate it and start it as soon as you can!
You must be able to demonstrate English level C1 of the Common European Framework of References for Languages. There are several English language tests you can take, however, the IELTS remain the preferred GOsC testing system.
The table (which is on the GOsC website) shows the main English language testing systems which meet the required GOsC standards.
You must take the Academic Test (not the General Test) and achieve 7.0 overall WITHOUT ANY ELEMENT BELOW 7.0.
Once again, do not underestimate this part and take the IELTS exam as soon as possible because without it you cannot get registered for the GOsC even if you have finalized the rest. Dear friend, it might be tough but do not panic. :)
I do not know the level of English you start from, but in my case, I had to take the exam twice.
In the beginning, my English level was level 5 (CEFR level B1). I have attended a full-time course focusing on both General English and IELTS for 3 months. After that, I tried the IELTS Test for the first time and the results were a huge improvement but still not enough: Overall Band Score 6.5/ CEFR Level B2 (Listening 6.0, Reading 7.0, Writing 6.0, Speaking 7.5). At this point, I figured out I could improve Listening and Reading on my own, doing a lot of IELTS simulation tests, but I needed a specific Writing Course to achieve the score I needed. It is out of doubt that the Writing part is the most difficult one. It is unlikely you will pass this section unless you follow a specific IELTS writing course. It is not only a matter of how you are fluent in English but it is mostly related to specific writing and academic techniques you should use. Therefore, I booked an IELTS writing course (Writing task 1 course and Writing task 2 course) for 4 weeks to boost my skills before trying again the exam.
After 6 months after my first IELTS Exam and after the GOsC’s application was submitted I tried the exam again. My result was a success this time: Overall Band Score 7.5/CEFR Level C1 (Listening 8.5, Reading 8.0, Writing 7.0, Speaking 6.5).
N.B.: The Academic IELTS Test does not define how much of a good English speaker you are, it is a mix of English knowledge, academic techniques, strategies and skills you can learn. Therefore, do not get frustrated if you do not pass it the first time, just try as many simulations as you can and do not give up. ;)
4) How to begin?
The process of registration: It is in the applicant’s interest to provide as much information as possible to the GOsC to demonstrate that there are no substantial differences between the applicant’s qualification, professional experience and lifelong learning to the standards required of UK qualified registrants.
To do this, the main things you should first start working on (without forgetting the English language test) are the followings:
PROOF OF QUALIFICATION: You can submit the Diploma or the Certificate of course attendance.
Both of them are documents your University/School should provide you withACADEMIC TRANSCRIPT: it is the taken exams’ list to outline the results achieved for each module studied.
It is a document your University/School should provide you with.COURSE GUIDELINE / HANDBOOK: it is an accurate description of the Osteopathic Course you have attended.
It must describe in detail the course’s modules and their main points, indicating also the number of hours that each module contains.
The programme documentation must provide information about how the acquisition of skills relating to the Osteopathic Practice Standards is achieved in the course. It must also give evidence regarding teaching and learning strategies, assessment strategies and how students progress through the program.
It is a document your University/School should provide you with, but you might have to add more information to it to make it clearer and more accurate.
Remember, the more accurate it is, the better. Don't take anything for granted. All the information provided needs to be explicit and not implicit.
The Course Guideline/Handbook must also provide enough information about the Clinical Internship you have attended during your course. It must state how the Clinical Internship is organised (teaching and learning strategies, assessment strategies and how students progress through the program) and how many clinical hours it consists of.APPENDIX 1: this is the document where you show your professional experience and your lifelong learning. Do it with dedication and attention (and lots of love)!
APPENDIX 1 is divided into 3 main sections, THE PROFESSIONAL CAREER HISTORY, THE LIFELONG LEARNING OR CONTINUING PROFESSIONAL DEVELOPMENT (CPD) and THE PROFESSIONAL REFERENCE FORM.
Let’s analyse each part in detail.A) The Professional Career History
It is a fundamental part and it must be as much accurate as possible. However, there is no specific way to do it and any referral to show that you meet the Osteopathic Practice Standards would be great.
It might also be useful to describe a variety of different patients going from neuromusculoskeletal or musculoskeletal presentations to cases involving referral to another health professional or where techniques were or became contraindicated.
For each job you report, it might be good to provide a general presentation of the position you have covered and to describe your main duties, your caseload, the length of your visits and all the relevant information connected with it.
Then, each patient’s presentation you quote should include the followings :
1) THE CASE HISTORY
It should include the following:
THE PRESENTATION OF THE PROBLEM: symptoms, site, radiations, onset, events/changes, investigations, the effect on the patient’s life, daily pattern (aggravating/relieving/no affecting factors), previous history.
Do not forget to mention the CLINICAL TEMPORAL PROFILE:speed of onset: acute / sub-acute / chronic
duration: acute / sub-acute / chronic
symptom picture: focal / multi-focal / diffuse
progression: recovering / stable/progressive / fluctuating/unmasking)
INFORMATION ABOUT PATIENT’S LIFE in order to approach the biopsychosocial aspects of the patient: occupational status and job description, family structure, activities/sport.
GENERAL HEALTH: weight/height and recent changes, sleep patterns, serious illnesses, operations/investigations, past accidents/traumas, medications.
SYSTEMIC HEALTH: relevant patient information about the gastrointestinal system, cardiovascular system, ventilatory system, dermatological conditions, genitourinary system, gynaecological conditions, and family health history.
PATIENT’S UNDERSTANDING OF THE PROBLEM AND HIS/HER EXPECTATIONS AND GOALS (pain relief? coping strategies? support? quick fix? etc.)
2) THE EXAMINATION
It should include the description of the data collected during the OBSERVATION, ACTIVE and PASSIVE MOVEMENTS, OTHER TESTS (peripheral neurological test, orthopaedic test, other special tests, etc. ) and the PALPATORY FINDINGS.
To outline your Communication skills (part 1 of the OPS) it might be very important to report:
if and how you have accurately described to the patient how the examination works and the need to be undressed
if and how you have gained consent for the examination
if and how you have proposed the patient to wear a gown/shorts/remain dressed and if he/she felt uncomfortable getting undressed
if and how you have informed the patient of his/her right to have a chaperone if needed
if and how you have informed the patient of his/her right to stop the examination whenever he/she felt uncomfortable
3) THE CLINICAL REASONING
It is the analysis and explanation of the mechanisms implicated in the patient presentation ruling out potential FLAGS. It has to be supported by evidence from the history of the patient and the examination.
To outline your ability to be safe during your practice (part 3 of the OPS) it is mandatory to consider and report:
possible physiological dysfunctions to rule out any disease and provide an accurate Differential Diagnosis (It can be useful to use the medical acronym “VINDICATE” for explaining the Differential Diagnosis).
Potential RED, YELLOW, BLUE, BLACK, ORANGE, etc., FLAGS
how you have managed hypothetical flags (for example: a case involving referral to another health professional/a case involving psychosocial distress management, etc.)
4) THE DIAGNOSIS
It should be based on the history of the patient, the examination and the clinical reasoning. It is a working diagnosis and it might change, as well as the treatment plan itself, over the time frame you have reported due to the patient’s reactions to the treatment and all the factors which can affect the symptomatology itself. Just describe it as accurately as possible :)
5) THE TREATMENT PLAN AGREED UPON WITH THE PATIENT
It should be based on the data collected and the patient’s expectations and goals.
It might be important to describe:
SHORT TERM PLAN
MEDIUM-TERM PLAN
LONG TERM PLAN
discussed with the patient and the PROGNOSIS you gave.
6) THE TREATMENT
It should involve the description of THE METHOD OF OSTEOPATHIC INTERVENTION:
how you have gained the patient’s consent to the treatment and how you have kept the ongoing consent.
It might be important to annotate how you have obtained it and if you have discussed with the patient the BENEFITS of the proposed treatment, the RISKS, the ALTERNATIVE OPTIONS available and the possibility NOT TO BE TREATED at all (use the medical acronym B.R.A.N.)which techniques you have used (remember to use the B.R.A.N. acronym to describe how you have obtained the patient’s consent for HVT techniques)
if you have suggested any advice
if you have prescribed any exercise
if you have used any special precaution
if there was any contraindication to the treatment
how the patient responded after the treatment
B) The lifelong learning or continuing professional development (CPD)
It consists of the description of relevant continuing professional development or lifelong learning that you have undertaken as verified by a regulatory or professional body or professional referee.
Do not underestimate this part, it is a very relevant section. The GOsC hugely takes into consideration how many CPDs you have covered during your career because it is the main way to demonstrate how you have kept yourself constantly updated as an Osteopath. Here numbers matter: report as many CPDs as you can.
It is a fundamental part and it must be as much accurate as possible. However, once again there is no specific way to do it but I would be happy to share how I have done it.
For each CPD presented it might be functional to outline:
Which OPS the course/CPD covers
A brief description of the course/CPD itself (what is the CPD’s purpose? How is it structured? Is it theoretical or/and practical? Does it have a final examination? etc.)
What the learning outcomes are
C) The professional reference form
For each outlined activity a reference is required and you should ensure that all people listed as contacts on the APPENDIX 1 form are prepared to provide a reference verifying that the activity has taken place.
There are two sections, one must be completed by the applicant while the other one by the referee.
In the applicant’s section, you should provide information about the activity you have mentioned in APPENDIX 1, giving information about your experience (how long you have worked there and information about the venue, your main tasks, your methods, the results and the learning outcomes). Then, the referee should fill in the other part.
N.B. For the CPDs an English certificate of attendance as a reference will be enough. In case you do not have it, the same reference form should be completed.
APPENDIX 2: this is the document where you try to demonstrate each OPS by referencing examples from one or more of your qualifications, work experience and lifelong learning or CPD. It is in your interests to complete this form as accurately as possible because it represents the explanation of how your qualifications, work experiences and CPDs map to the equivalent UK standards.
This mapping document should be completed by the applicant by referencing wherein the documentation of each standard is evidenced.
To simplify your work, it might be useful to complete all the previous documents having in mind Appendix 2 so that when filling Appendix 2 the mapping is already in place and straightforward.
Once you have collected all the documents you will send them to the Registration and Overseas Applications Officer and wait around 3 weeks for receiving a detailed review of your application, completed by the GOsC assessors.
If you made it this far, first of all, congratulations! This is the first big step together with the English Test, and now you only have one more big step to go :)
4) What happens after you receive the GOsC’s review?
There are two options:
a) Your training and experience are considered equivalent to UK standards and the GOsC will send you an application pack
b) Substantial differences between your training, work experience, lifelong learning and UK Standards are determined and you will be asked to consider a choice of compensation measures. These are either:
- Attitude test
- Period of Adaptation
If you have to consider a choice of compensation measures, whatever will be your decision, be prepared to spend some money since both alternatives are expensive.
ATTITUDE TEST (£ 1600)
It has 2 parts:a Questionnaire (more information can be found here: Further evidence of Practice Questionnaire - FEPQ)
an Assessment of Clinical Performance, which is a practical examination conducted in English of 2 patients in a clinical setting
PERIOD OF ADAPTATION (cost depends on the Osteopathic Educational Institution you contact)
It is a period of supervised practice and/or academic training which can last up to three years and it is intended to make up for significant differences which have been identified in the application. It is completed when an institution is satisfied that the applicant has met the requirements of the Osteopathic Practice Standards.You will need to arrange for your period of adaptation yourself by contacting an Osteopathic educational institution (OEI). You can find the list of the latter here: Training Courses.
Once the Period of Adaptation is completed, the Osteopathic institution will need to confirm to the GOsC in writing whether or not the applicant has addressed the deficits identified in the GOsC record of assessment to meet the Osteopathic Practice Standards.
Now…
IF YOU ARE NOT LUCKY ENOUGH TO GAIN THE REGISTRATION STRAIGHT AFTER YOUR APPLICATION PLEASE DO NOT GET FRUSTRATED. There could be several reasons why you have not been accepted but they might not be related to your ability as an Osteopath.
As a matter of fact, my application was not successful and I will share with you my Period of Adaptation of 6 weeks, which ended with a final assessment exam.
Even though the GOsC considered varied post-graduation work experiences and the numerous supporting references I provided as my strengths and the assessors took into consideration the several clinical examples I used to support my cases, they identified some substantial differences. I provided a limited number of CPDs and limited information about what specific training (Clinical Internship) I received during my training.
Obviously, I could not change the number of CPDs I had attended, but I could have described more accurately the Clinical Internship I had attended during my course (hence why my suggestion is to be as more accurate as possible).
Unfortunately, once the application is submitted you cannot add any further documents or give more information about a specific section. What is done, it is done!
Digested my initial frustration, I decided to choose the Period of Adaptation as a compensation measure.
If I needed to pay for something I wanted to pay for learning something :)
5) MY PERIOD OF ADAPTATION
I have completed my Period of Adaptation at the University College of Osteopathy. It consisted of 6 weeks of attendance (3 full days per week) at the Clinic of the UCO. In addition, I have performed a final assessment, which consisted of the examination of 3 patients (2 new patients, 1 ongoing patient).
Finding a suitable institution took me a while. I have received the GOsC’s review on the 15th of April 2019 and I have started my Period of Adaptation at the University College of Osteopathy on the 23rd of September 2019.
I have contacted all the institutions mentioned by the GOsC, some of them do not provide this type of service anymore, others did not reply and in general, all of them were slow to reply. At the end of the day my choices were narrowed down between the London School of Osteopathy and the University College of Osteopathy and when I was finally defining the details of my POA with the UCO was already July and the starting date was postponed to the new academic term.
My Placement at the UCO was terrific. It has been fundamental and hugely beneficial for improving my professional skills and for understanding what working in line with the OPS means. Peer learning has been one of the most enjoyable parts of my experience. I have had the chance to share opinions and approaches with lovely students who have helped me to better understand the requested methodology. Moreover, I found very interesting the Tutorials that some Tutors used to carry out at the end of the Clinic day. It has been a significant opportunity to learn theoretical and practical skills from experienced Tutors, and to understand better how to safely work in the UK.
What would I suggest to get the most out of this placement?
BE PROACTIVE! Do not be shy, ask as many questions as possible to Tutors and students to create connections and boost the benefits of the placement experience.
It might be very easy to feel lonely at the Clinic because everyone is busy and it is unlikely that someone will come to you if you are not proactive. Therefore, the more you try to be part of the “Clinic life” the more you benefit from it.
6) Once your training and experience are considered equivalent to the UK Standards, the GOsC will send you a REGISTRATION PACK. You must submit ALL the following documents:
- A completed registration application form
- A health reference
- A character reference
- Evidence of your ability to communicate in English (if you have not provided it yet)
- A criminal record check from your country of residence
- Enhanced check for Regulated Activity
- The fee payment
Once you are registered and before you start to practice, you should ensure that you are covered by Professional Indemnity Insurance with a minimum cover of £5 million.
On the GOsC’s website (Professional Indemnity Insurance) you will find a list of insurance intermediaries that can offer insurance which meets the requirements.
Let’s make some calculations…
Below you can find a list of the main expenses you have to bear in mind once you want to apply to the GOsC for work in the UK. They might be changed and all the data reported is based on my own experience.
Applying for the GOsC registration: £690
IELTS exam: £175 (you may have to add the cost of attending the English Course)
GOsC attitude test: £1600
GOsC period of adaptation: hardly less than £1600
DBS check: around £60
Criminal record check from your country: it depends. Italy: around £ 80 + official translation around £100
GOsC entry fee: £320
Insurance: hardly less than £400
If you made it this far until the end of the post THANK YOU VERY MUCH!
I know that the process seems to be very long, but with a good spirit and a positive attitude, I can assure you it is a life-changing experience.
DISCLAIMER: This Blog post is not, by all means, a comprehensive and exhaustive list of instructions you should perform for registering with the GOsC. All the information here is based on my personal experience and every application is unique and personal. Always refer to the GOsC website for official documentation and the latest updates, since regulations and procedures are subject to change over time.
If you have specific questions or want to know more about my personal journey I would be very happy to share it with you over a cup of coffee. :)