British School of Osteopathy Bethnal Green
The Bethnal Green Health Centre is set amidst the noisy traffic and bustling crowds of London, just off a main road and a few minutes’ walk from Bethnal Green tube station. At the time of writing it was also undergoing major building and improvement works. These were to provide new facilities including separate treatment rooms for services such as the BSO’s osteopathy clinic, which ran one afternoon a week for patients of this busy NHS GP practice.
At the time of writing, the Bethnal Green Health Centre was temporarily operating from a series of portakabins, with BSO clinic tutor Danny Church and his team of senior osteopathy degree students organising their sessions from a tiny back office, and using the GPs’ consulting rooms for treating patients.
“Osteopaths need to be able to adapt to working effectively with patients in different settings, so this is very good experience for our students,” explained Danny Church cheerfully. “And it’s the same for everyone working here – it’s important for students to interact and become part of the wider health care team. They get to see, for example, the pressurised environment that many GPs have to work in, including having to make decisions about patients within a very short consultation time. For the future of osteopathy as a profession, increased understanding between osteopaths and the NHS can only be a good thing.”
“The treatment I’ve had, and the exercises I’ve been given to do have kept me walking, and have kept my pain bearable,” said one regular patient. Retired, she was keen to avoid having an operation, but did not want her problem left untreated. “I’d never heard of an osteopath or been to one before,” she continues. “Someone was telling me how much it costs privately — I think it is brilliant that this is free on the NHS, and the students have all been marvellous.”
GPs working at the Bethnal Green Health Centre referred patients like her with relevant complaints to the weekly osteopathy clinic. Many of them, living in this predominantly non-affluent part of London, would have been unable to access private health care, and also had little or no prior knowledge of osteopathy. But if there were any initial concerns amongst the GP team about take-up these were dispelled: at the time of writing there was a four-week waiting time for osteopathy appointments. This may partly have been due to the far longer waiting lists for anyone referred for physiotherapy at the nearby Royal London Hospital.
A young woman with collapsed foot arches was one of the first patients to be referred to the new clinic.
“Osteopathy relieves some of my pain. It gives me reassurance and hope that something can be done for me and that the pain will go,” she said. “It’s very good, and I tell everyone about it, but I should keep my mouth shut, because now the clinic is so busy!”
“I’ve got three teams of students working in pairs, seeing three patient lists each week,” explained Danny Church. “But we could easily fill up a whole day’s worth of appointments.”
Indeed, a file of patient referral letters sat on the desk whilst students busied themselves making decisions about who would see individual patients as they arrived. The aim was to try and provide continuity of treatment wherever possible for returning patients, and to evenly distribute first-time patients.
“Working here means you have to take a very different approach to managing a patient’s treatment from when you work in the BSO’s general clinic,” said student John Singleton. “You can’t just tell them to come back and see you next week because the waiting list is so long, so you have to think differently about how you are going to work with and treat your patients.”
Patients included many who do not speak English, and who thus needed to come with a translator, presenting students with important challenges and experience in terms of taking medical case histories. The Bethnal Green Health Centre also serves a local Somali community, some of whom, as survivors of war, have experienced trauma such as rape or torture and who have complex psycho-social problems.
“Some of them can become quite open to talking about their experiences after a while, but it can be normal to spend a first consultation just sitting and listening and maybe holding their hands,” said Danny Church. “As osteopaths, what we do is not just about manipulation: patients are coming to us for a therapeutic intervention. You have to make your diagnosis, then it’s about doing what will help them, and that’s not always necessarily going straight into manual therapy. Sometimes giving people time to talk and acknowledging what they are saying can be very important.”
There is also a large Muslim community locally. As patients, they often needed to be treated by students of the same gender, and often had little or no prior experience of touch or manipulation in a health care setting. This meant they could initially be nervous about osteopathy.
“One older woman who was referred to us with a long history of back pain had never been touched by anyone before apart from her mother or husband,” said Danny Church. “Initially she was very wary about being treated, but we began with gentle soft tissue massage, and as she experienced pain relief she became more confident about coming to see us, and now comes for regular ‘maintenance’ appointments.”
“I’ve learned that when patients seem as if they are being ‘off’ with you, it’s often simply because they are scared!” said student Lisa Ives. “They are scared of the unknown, and they are scared of their pain and what it might mean.”
One patient treated drove for a living, but was experiencing severe neck and shoulder pain which had left him only able to work for a few hours a week.
“He was extremely sceptical about osteopathy, and initially I thought he might not commit to regular appointments,” said Danny Church. “But after a course of treatment he was able to resume his normal working pattern, and he ended up thanking the student who treated him regularly with a bunch of flowers. I think a lot of his initial resistance was due to his fear that no one would be able to help him, and that he would have to give up work altogether: he was his family’s main breadwinner.”
As the afternoon clinic progressed, the BSO students were guided by their tutor as they treated patients with a huge range of complaints. Some of them had chronic pain, and had a long history of GPs visits, hospital referrals, surgery, physiotherapy and more.
They included a middle aged women who said that six months ago she had such severe back and leg pain that she could barely get out of bed. Desperate, and on very strong painkillers, she was willing to try anything when her GP referred her for osteopathy. “The pain is still there, but it’s so much more bearable. I can go out, I’m much more active, and I’ve even started swimming and going to the gym. I think it’s great that this is available on my doorstep and in my local community.”