Abstract

Chiropractic has been in existence for over a hundred years, appearing in America at a time when the statutory regulation of medicine was taking effect. Its early history is coloured by encounters with adverse regulatory laws and by internecine squabbles between different sub groups attempting to secure regulation favourable to themselves. It rapidly spread across the world, where it encountered many different regulatory environments. The experience of chiropractic in these environments is examined.

In the UK chiropractors have sought favourable statutory regulation since 1925 when they felt threatened by the promotion of the first Osteopaths Bill. Their experiences as they have pursued this goal are recorded, including an unsuccessful attempt to register as a profession supplementary to medicine. Their greatest hurdle was in securing the unity of the profession when a new wing of the profession appeared in the early 1980s that many refused to recognise as chiropractic. In spite of strong mutual suspicion and distrust, the profession united under a group formed specifically to pursue regulation and secured the Chiropractors Act (1994). The requirements set by government to achieve the Act are examined, as are those that have been subsequently imposed to secure the commencement of the Act.

Early Regulation

Chiropractic was born in the State of Iowa at the end of the last century, at a time when the statutory regulation of medicine was taking effect throughout America. If DD Palmer, founder of chiropractic, had been in practice some five years earlier, he would have been eligible for grandfathering in as an Iowa medical practitioner. Typical of the situation in America was the State of New York, which had no medical licensing law from 1844 to 1891 (Wardwell, 1992), so chiropractic's early history is filled with stories of its encounter with new laws that challenged its very existence and threatened its development until the passage of favourable chiropractic regulation.

Chiropractic's first attempt at statutory regulation was a Bill presented to the state legislature of Minnesota in 1905 by followers of Solon Langworthy, one of Palmer's first students. It was broad based and very unrestrictive, but was killed off with the help of Palmer, who went in person to Minneapolis to appeal to Governor Johnson to veto it (Wardwell, 1992). Palmer wanted chiropractic to restrict itself to the chiropractic adjustment alone. The Bill's definition of chiropractic included too much of what Palmer called 'Mixing', 'A chiropractor who comprehends the Principles of this Science will have no use for adjuncts. Just in proportion as he lacks knowledge and confidence (the two go together) he will use remedies, become a mixer. The more he mixes the less he has for chiropractic.' (Palmer, 1910).

This first experience illustrates the hard lesson that not every chiropractor is enthusiastic about regulation and that not every chiropractor can agree what should or should not be embraced within the law.

In spite of this set back, the promoters of chiropractic regulation pressed on. The first state to enact a Chiropractors Bill was Kansas in 1913, although it proved unworkable; the first to issue a Chiropractic license was Arkansas, two years later. Today more than 65,000 chiropractors practise in 56 nations (FACTS Bulletin, 1995) and nearly 97% operate under some form of statutory regulation. Most are satisfied with that regulation.

Why Seek Regulation?

Social historian Walter Wardwell provides some answers to the question of why chiropractors want regulation, 'In addition to the concern for the public's welfare and for the guild-type benefits which all professions seek for their members, a new profession primarily wants official recognition legitimising its work. This not only helps attract clients but it confers legal standing on the profession with all the rights and privileges pertaining thereto.' (Wardwell, 1992).

Individual chiropractors will primarily be concerned with the impact of regulation on their own practice. Guild-type benefits are those placed first on Wardwell's list. Today's established professions started mainly as guilds, some going back many hundreds of years. They were usually formed in response to an external threat such as economic competition or taxation. They enabled a group of artisans such as merchant tailors, fruiterers or barbers and surgeons to form themselves into 'Worshipful Companies' or guilds. During the last century the working class man fought against exploitation in a similar way, through the formation of Trades Unions.

An effective guild is one that can build up exclusive membership and financial reserves to win benefits and social esteem for its members. To do so most effectively it must ruthlessly secure legal monopolies so as to destroy all competition from outsiders. Modern guilds provide attractions such as member discounts for insurance, pensions and trade goods, keenly negotiated trade deals, mass marketing opportunities and a powerful lobby in the corridors of power. The more benefits a guild can offer, the more members will want to join, the stronger and wealthier it will become and the greater power will be exercised by its inner circle of leaders.

Wardwell's second point was the desire for official recognition. Everyone needs to be acknowledged to feel valued. It starts at home with desire for parental acceptance and goes on to enter all human relationships, extending to school and later to the work place, to the community and ultimately to the nation. If you are a member of a profession it will extend to securing professional recognition and then desiring to see your profession's reputation enhanced. Regulation for a new profession will literally 'legitimise' it, establishing its members within the community, making them feel more valued. In turn this brings greater opportunity for more clients and a healthier bank balance.

'Public Welfare' is the vehicle by which a self interest group can ensure it achieves its aims. Any health profession can present a very strong argument that can readily be adopted. The public needs to be protected against incompetence and against unacceptable professional conduct. To do so, standards must be established to define competence and sound professional conduct. To reach those standards of competence, levels of education must be established that will produce the right graduates. Those practitioners who feel that their standards are at one with those laying them down will be enthusiastic. The problem will lie with those whose practice or perspective differs from those who govern the standard. There will be some who, like DD Palmer, will see a different perspective to that of the group seeking to regulate the profession. Sometimes that group may belong to another guild. If that guild is the established medical profession then regulation will present a real threat.

The Five Regulatory Environments

The world's chiropractors today experience practice in five different regulatory environments (Copland-Griffiths, 1998). The most threatening environment is when the practice of chiropractic is contrary to existing regulations, usually those regulating the practice of medicine. The most comfortable for orthodox chiropractors is specific legislation, governed by their peer group, that not only gives them statutory registration but which prevents any unregistered person from calling themselves a 'chiropractor'. It will strengthen their position as a member of a chiropractic guild if the law prevents others from encroaching on their professional skills.

The five environments are:

• Illegal practice
• Common law practice
• Registration without protection of title
• Registration with protection of title
• Registration with protection of title and function

It is useful to examine how chiropractors have fared in each of these environments.

Illegal Practice

The year after DD Palmer opposed the Minnesota Chiropractors Bill he was jailed for refusing to pay a fine imposed on him for practising medicine without a license. He was the first of many. In 1921 over 450 Californian chiropractors walked to the jail house singing 'Onward Christian Soldiers' rather than pay their fines (Wardwell, 1992). DD Palmer's son, BJ Palmer, founded the 'Universal Chiropractic Association' in 1906, one of the first chiropractic guilds, primarily to assist its members in their legal defence. By 1927 the Association had defended more than 3300 actions.

In 1925 BJ came to Britain to bless the newly formed British Chiropractors' Association, established by 19 chiropractors who feared the newly proposed Osteopaths Bill would threaten the legal practice of chiropractic (Copland-Griffiths, 1991). In 1932 he returned to London, this time for the inaugural session of the European Chiropractors' Union, the year before Europe's first chiropractic martyr, Simon Mueller, was jailed in the canton of Zurich for the unlicensed practice of medicine.

Chiropractic is still illegal in Belgium, France and Spain. In France, whilst under threat of being prosecuted for the 'illegal exercise of medicine', chiropractors must register for VAT when eligible to do so. Insurance companies are discouraged from granting chiropractors professional indemnity insurance. In spite of this, chiropractic is beginning to gain some public sympathy. The result is that some medical manipulators with no training in chiropractic are advertising chiropractic services (FACTS, Bulletin, 1995). Until very recently there were six opposing French chiropractic associations, each from a similar educational and philosophical background, competing against each other to promote chiropractic regulation, which may be why French chiropractors have been so vulnerable.

Last year in Spain, after 50 years of turning a blind eye, the courts sentenced Penny Teshack of Malaga to six months imprisonment for 'practising medicine without a license, manipulating patients, diagnosing health problems and requesting x-rays from radiologists' (Gevers, 1998). Rather than face jail she closed her practice and emigrated to Scotland. What is interesting is that when she worked in her native Denmark she was licensed to practice and her patients received Danish Health Service reimbursement. Legality in one EC country does not bestow legality in another.

Common Law Practice

At present British chiropractors practise under common law, as do the Dutch. This is a comfortable situation for a profession to find itself in, as it does not impose legal responsibilities. However, this is not a risk free environment. Prior to the Euratom Treaty of 1984, which established minimum radiological safety criteria across Europe, there was a consultative period for interested parties. Although skeletal radiography is an integral part of orthodox chiropractic practice, it was quite by chance that a chiropractor heard of the process and warned the profession, giving two whole days to beat a submission deadline. As a result British chiropractors retained the right to take x-rays. Their Dutch colleagues have lost it. Fortunately this is the only significant encroachment against chiropractors in the European common law environment, but it illustrates what can happen when chiropractors are not in a position to determine their own scope of practice under the legal umbrella of regulation.

Where chiropractors practice in unregulated environments or under common law they are free to lay down minimum standards of professional practice, safety and competence and education. Most professional associations do so in order to protect the public and thereby the reputation of their profession. However, the King's Fund Working Party on Chiropractic, chaired by Sir Thomas Bingham, pointed out that this was inadequate, 'Voluntary arrangements of this kind do not work in practice. Voluntary registering bodies have no effective sanctions against unlicensed, untrained or professionally negligent practitioners. They cannot prevent such practitioners from continuing to practise even though it is against the interests of patients for them to do so. So long as membership of a registering body is not compulsory there can be no guarantee that practitioners who hold themselves out to be chiropractors have received adequate training.' (Bingham, 1993).

Where there is no regulatory framework it is difficult to maintain high educational standards. When standards are raised there will always be those prepared to find cheaper short cuts to training. In Japan only 55 chiropractors hold internationally recognised qualifications, yet more than 2000 use the title. Japan's folk medicine traditions provided a lucrative opportunity for entrepreneurial American chiropractors to peddle chiropractic seminars and certificates on an indiscriminate basis. In this confused situation, the Japanese Government appointed a study team to examine chiropractic and in 1991 it published a damning report. This prompted a coalition of groups under the Chiropractic Council of Japan and they subsequently produced guidelines for safe practice (FACTS Bulletin, 1995). Six years later, speaking to a World Federation of Chiropractic gathering, Japan's Minister of Health Junichiro Koizumi, acknowledged the value of chiropractic and promised to support the profession's attempt to secure registration (Chiropractic Patients' Association, 1997). This experience emphasises the importance of different groups joining to agree common standards and to protect themselves from adverse criticism. A divided profession is a vulnerable one, as French chiropractors have discovered.

Registration without Protection of Title

Registration without protection of title is the current environment of British physiotherapists, chiropodists and others who practise under the Professions Supplementary to Medicine Act (1960). Swedish chiropractors also have experience of this environment. Their Government's Commission on Alternative Medicine recommended 'regulation by qualification', recognising the orthodox 'Doctor of Chiropractic' qualfication as the bench mark. Those with the qualification could register, those without would not be eligible. 'This meets a considerable need for information as a sort of 'quality standard', primarily for the guidance of patients but also vis-a-vis the county councils which in future may want to employ, or otherwise make use of people with qualifications in manipulative treatment. As a further guarantee that the practitioner really has the qualification required for the profession, it is proposed that the professional designation 'registered chiropractor' is given legal protection whose infringement is made liable to a penalty: this should, too, be a safeguard for patients.' (Commission on Alternative Medicine, Social Departementete, 1987).

The Commission recognised the competence of chiropractors and recommended independent practice with full medical responsibility. It also proposed that registered chiropractors gain access to the National Health Service system. However, Sweden's years under common law ensured that its 118 eligible chiropractors remained outnumbered by over 1000 others whose qualifications fall short of international standards (FACTS Bulletin, 1995). Although patients can now secure the health service reimbursement of fees from registered chiropractors, continued confusion clouds the public's perception of chiropractic which still suffers from the prevailing reputation of the lowest common denominator.

The profession suffers the same fate in Germany. The 1939 Heilpraktiker Act regulates licensure and scope of practice for all non allopathic health practitioners. It allows protection of title for the heilpraktiker but not for the chiropractor. No attempt is made to differentiate between therapists with minimal diagnostic training and those with extensive training. This tars every heilpraktiker with the same brush and hinders interprofessional co-operation with established health professionals. Private health insurance cover is limited. There is no federal reimbursement for patients. As chiropractors have no protection of practice, many medical manipulators, physiotherapists and heilpraktikers practise 'chirotherapy' and genuine chiropractors are lost within this loose title. Only recently have chiropractors been granted permission to use their foreign academic and professional degrees in Germany, allowing informed members of the public to discern them from the plethora of chirotherapist heilpraktikers (FACTS Bulletin, 1995). This highlights the danger of registration under umbrella registration without protection of title.

Registration with Protection of Title

Registration with protection of title but not function is what the General Chiropractic Council will offer British chiropractors. Department of Health documents explained that the legislation did not 'seek to close the practice of Chiropractic or the use of Chiropractic techniques...other health professionals will therefore be completely free to use chiropractic techniques in the course of their practice and to tell their patients that they are doing so.' (Department of Health, 1994). The King's Fund Working Party were concerned with the potential criminalisation of osteopaths or physiotherapists if they were 'to carry on in any way some or all of the activities normally performed by chiropractors' (Bingham, 1993).

Norway's Chiropractors Act also protects the title but not the practice of chiropractic. It provides considerable benefits. Patients can secure partial fee reimbursement under the Health Service, subject to medical referral. Chiropractors can refer patients with musculoskeletal complaints to hospital or to private imaging establishments for scans or radiographs under the National Health Service. The drawback is the referral clause, which penalises the patients of medical practitioners opposed to chiropractic referral. There is nothing to stop them from choosing to refer their patients to registered physiotherapists at the expense of registered chiropractors. Chiropractors also feel angry as they watch their techniques being hijacked by physiotherapists and medical practitioners (FACTS Bulletin, 1995). There is nothing to suggest the frustration will not be the same in the UK when the Chiropractors Act has been fully commenced.

Registration with Protection of Title and Function

More than 61,000 chiropractors (93%) in 14 counties enjoy protection of title and function, although all permit medical practitioners to use chiropractic techniques. The difficulty with restricted function legislation is that it must necessarily define 'chiropractic' and the scope of practice to be encompassed. Definitions help to mark out the boundaries that will enable a court of law to determine whether another practitioner has strayed into chiropractic territory or whether a chiropractor has ventured beyond the legal limit.

One of the dangers of restricting practice was recognised by Wardwell, 'Since licensure requires some definition in the field of practice, legislation can legitimise the definition favoured by one sub-group at the expense of a less influential sub-group' (Wardwell, 1992). American chiropractic history is littered with the battle grounds of rival sub-groups in state after state. There are cases where legislation has been amended and reamended over and over again as each sub-group gains the ascendancy.

Chiropractic rivalry is usually between those who do not diagnose in the orthodox sense but detect 'spinal subluxations' that will lead to disease if uncorrected, and those who restrict their treatment to carefully diagnosed musculoskeletal disorders. The former will limit treatment to the 'chiropractic adjustment' whereas the latter will employ any adjunctive treatment they choose. Typical of the former is West Virginia's law, which states that the 'practice of chiropractic means the adjustment of the twenty four moveable vertebrae of the spinal column'. Typical of the latter is Texas, which broadens the use to 'adjustment, manipulation, or other procedures in order to improve subluxation or the biomechanics of the musculoskeletal system'. A definition can be so broad that even the use of other distinct approaches can be included. The definition of chiropractic in Colorado permits chiropractors to use acupuncture, whilst Louisiana and several other states expressly forbid it. Venipuncture, like urinalysis, is permitted in some states but forbidden in others. North Dakota's chiropractors 'may sign birth, death or health certificates.' Oregon makes provision for 'minor surgery and obstetrics' by chiropractors, who can also use local anaesthetics (Hendrickson, 1992).

At the other extreme, as Wardwell observed, 'where organised medicine could not prevent chiropractic licensure, it sought the narrowest possible definition of its scope' (Wardwell, 1992). Limitation of function can be a two-edged sword. It can curtail the ability of the profession to practise as it would wish.

There are other ways of curtailing chiropractic through restrictive legislation. After introducing a Bill into the South African Parliament of 1962, the chiropractic profession was met with open medical hostility and the Bill fell. A renewed attempt was made nine years later and succeeded. It provided a register for South Africa's 176 chiropractors, but then froze it so no new chiropractors could be admitted, effectively strangling the profession (Copland-Griffiths, 1991). Ultimately this ploy failed, but it illustrates the risks of being locked in restrictive legislation.

The New Zealand Act succeeds in side-stepping the need for a detailed description of scope. A Government Commission commented that 'what the Act does is to limit chiropractic, in that special statutory sense, to registered chiropractors only. It does not say that a chiropractor cannot use another form of treatment or examine and treat other parts of the body. If any limitation on what he can do is sought, it must be found elsewhere' (in other legislation). The Commission observed that 'by limiting the practice of chiropractic to properly qualified chiropractors, the intent clearly was to protect the public by excluding unqualified or unsuitable people from practice.' (Chiropractic in New Zealand, 1979).

Australia has to contend with numerous forms of chiropractor, osteopath and lay manipulator. Complex scope of practice clauses were avoided when they were all lumped together as 'chiropractors', with protection of the chiropractor and osteopath titles under various Chiropractors Acts in different states (Peters, 1985). In 1985 South Africa's chiropractic register was reopened under new legislation governed by the 'Chiropractors, Homoeopaths and Allied Health Service Professions Council'. Osteopaths must be registered with this Council. In both countries the public has problems discerning chiropractors from osteopaths and the osteopathic title has become partly subsumed by chiropractors, with the special identity of osteopaths weakened. On the other hand, physiotherapists in Australia and South Africa are protected by their own separate statutes.

In the EC, Denmark's 1991 Act offers protection of title and practice, permitting chiropractors to diagnose, treat and provide preventative care 'of biochemical disorders originating from the neuromusculoskeletal system'. Patients can refer themselves to a chiropractor and receive partial fee reimbursement under the Health Service. In return, chiropractors are subject to the National Health Complaints Board (FACTS Bulletin, 1995).

The Model Practice Environment?

Switzerland is regarded by many in the chiropractic world as offering the model practice environment. Whilst every canton sets its own qualifications and scope of practice, they all have much in common and an Intercantonal Chiropractic Commission governs chiropractors. Title and practice are protected, leaving chiropractic an independent and specific branch of scientific medicine, as in dentistry. The development of a high public and interprofessional trust has been encouraged by legislation that grants full professional rights over patient diagnosis and management. Patients enjoy full cover under all accident insurance companies, whether state owned, private or military schemes, and chiropractors may refer to hospitals for chiropractic, medical or physiotherapy treatment and for diagnostic imaging and laboratory procedures (FACTS Bulletin, 1995).

There are, however, a very small number of chiropractors who shudder at the Swiss experience. Freedom to practise some of the more esoteric forms of chiropractic is not denied, but nobody seems to want to practise them. Postgraduate pre-registration training and compulsory continued professional development has created a chiropractor with a strict biomechanical outlook based on strong scientific evidence. Everyone in Switzerland appears to be satisfied. Outside Switzerland a handful of dissidents shudder at what they perceive to be the abandonment of chiropractic's philosophical birthright at the expense of adopting the medical model of disease and disease management.

Criteria for UK Regulation

A profession is made up of individuals who will normally have a fairly uniform concept of what they do and how they go about it. This will not necessarily ring true for a new profession or one with differing evolutionary strands. In Britain the Department of Health has wisely laid down a set of criteria that must be fulfilled before a complementary health profession can secure government support for regulation. In February 1985, Junior Health Minister Lord Glenarthur introduced five requirements in a debate in the House of Lords:

• The profession must be mature
• It must have one governing body
• It must be based on a systematic body of knowledge
• It must have recognised courses of training
• It must be able to demonstrate efficacy. (Hansard, 1985).

In effect, this ensures that a profession can only move towards regulation if it is capable of speaking with one voice. A cohort of dissidents would have little difficulty in disrupting progress if too many individuals felt threatened by regulation.

Two years later, in November 1987, Lord Skelmersdale, another Junior Minister, added a sixth requirement:

• Legislative proposals must be soundly based on independent criteria which clearly safeguards the public interest. (Hansard, 1987).

It ensures that legislation is drawn up in the interests of the public, minimising some of the risks posed by self-regulated trade guilds. The body chosen to act independently and in the public's interest was King Edward's Hospital Fund for London. Members of their working parties into osteopathy (1989) and chiropractic (1991) were appointed after consultation with all strands of the profession and were composed of representatives of the public, the medical profession and the professions concerned. The working parties recommended the basis on which a complementary medicine profession should be selected for regulation and the form that regulation should take.

The selection criteria were laid down by Robert J Maxwell, Chief Executive of the King's Fund, in his introduction to the Working Party Report on Chiropractic, 'The Medical Act has come to provide the gold standard for recognition as a profession and for regulation in the public interest. It is high time that this is extended to those branches of complementary medicine that share certain key features with orthodox medicine. These features are:

1. that the therapeutic practice concerned rests on solid foundations in science and in examinable knowledge and skills;
2. that it can be demonstrated by objective standards to cure or alleviate pain and suffering when practised skilfully, and that it has the power to do harm in the wrong hands;
3. that there is a significant public demand for it; that the public requires help in differentiating reliable from unreliable practice, and would best be protected by publicly accountable self regulation by the profession concerned.' (Bingham, 1993).

The King's Fund's two reports paved the way for the Osteopaths Act (1993) and the Chiropractors Act (1994).

The British Experience

The British Chiropractic Association (BCA) has been pushing for regulation since the threat of the first Osteopaths Bill prompted its formation in 1925. Repeated efforts over successive decades to secure Department of Health advice were unsuccessful, until the early 1970's, when the profession was advised to apply for registration under the Council for Professions Supplementary to Medicine Act. This divided BCA members, but at a General Meeting of the Association a resolution was passed by a majority of one to proceed (Copland-Griffiths, 1991).

As predicted at the time, the application was rejected. Reasons were demanded of the Council for Professions Supplementary to Medicine but none were forthcoming. The Department advised reapplication. The BCA disagreed and stated that there was no way they could rectify any errors of omission or commission without knowing the grounds for refusal. Adoption of this policy vindicated the leaders who had encouraged the profession to call the Department of Health's bluff and it left them free to concentrate again on their ultimate objective of specific chiropractic legislation.

The opportunity arose in 1985. The Glenarthur Criteria were seen as the ideal stepping stone to most chiropractors, who knew nothing of McTimoney Chiropractic. John McTimoney was a chiropractic patient who, unable to travel to the  USA to study, had persuaded his chiropractor to train him on an apprenticeship basis. Learning a high velocity low amplitude thrust technique known as the 'toggle recoil', he adapted it as a chiropractic approach in its own right, claiming it as DD Palmer's 'original technique that was lost'. At his death in 1981 there were 14 friends and family who had learned the technique. His death prompted them to form the 'Institute of Pure Chiropractic' (IPC) and to revitalise McTimoney's small school in Oxford (Copland-Griffiths, 1991). The IPC later became the McTimoney Chiropractic Association.

In 1984 a breakaway group under the leadership of Hugh Corley, one of McTimoney's first pupils, formed the 'British Association for Applied Chiropractic' (BAAC), so that when the Glenarthur Criteria were established a few months later orthodox chiropractors were stunned to learn that there were now three governing bodies and not one.

A period of denial followed. Informal secret talks were held between influential members of the BCA and IPC. These foundered until the establishment of the King's Fund Working Party into Osteopathy forced BCA leaders into a pragmatic acceptance of McTimoney Chiropractic. Accommodation had to be made. Secret talks continued quietly until 1991, when the Chiropractic Registration Steering Group was formed to represent a united chiropractic profession. This was made possible by the brave decision of leading members of the IPC and BAAC to accept minimum educational standards that would be equivalent to those of the European Council on Chiropractic Education in force on 1st January, 1992. These standards would apply in their colleges within five years of legislation coming into force (Bingham, 1993). This concession enabled BCA leaders to survive a backlash from its members, who were enraged at what they perceived to be an irresponsible rejection of established international chiropractic standards. Leaders of the IPC, BAAC and BCA successfully weathered their internal storms, played down their differences and agreed criteria for appointing representatives to the King's Fund Working Party. They presented a united face to Parliament, kept their dissident members under wraps, and secured the passage of the Chiropractors Act, 1994.

Once passed, the Department of Health made it clear that there were five goals to secure before the Act could be commenced:

1. The General Chiropractic Council (GCC) must be financially secure. A viable business plan must provide assurances that the public purse will never be called upon to bale out the General Chiropractic Council.
2. The profession must continue to speak with one voice. Significant disunity would kill commencement.
3. The profession must agree standards of safe and competent practice.
4. The profession must agree standards of professional practice and conduct.
5. The profession must agree common minimum standards of education and training.

The profession responded with a levy of £500 to be raised across every association from every member. This secured the GCC's immediate financial future. Nine months after the passage of the Act, the Chiropractic Registration Steering Group (CRSG) published its document agreeing parameters for safe and competent practice (Atkinson, 1995). All associations already had compatible Codes of Practice and Conduct. The three associations, now joined on the CRSG by the Scottish Chiropractic Association (SCA), all subscribed to European Council on Chiropractic Education (ECCE) Educational Standards. The SCA had been formed by BCA members in 1972, keen to represent their Scottish identity and to respond to any differences in Scottish law. The newly united profession stood back and awaited action from the Department.

It came eighteen months after the passage of the Act. The Associations were invited to propose persons who would be selected on experience and ability. This prompted fears that the long established BCA members might be in a position to swamp the new Council, but informal whispers from the Department eased some of those fears.

Thirty months after the passage of the Act, the Department announced the membership of the designate Council. In its first year the Council sent out for consultation its standards of proficiency for safe and competent practice and a Code of Professional Practice and Conduct. It had the foundations of an indicative syllabus and accreditation documents. It had begun drafting rules for governing GCC machinery. It had a detailed business plan. Again, it had to wait upon the Department of Health before legal status was bestowed upon it, by order of the Secretary of State, on 14 August 1998.

The present, most difficult challenge, is that of marching time whilst the Department processes the set of rules which will govern GCC machinery. New legislation means that government legal departments have no time for old Private Members legislation. This places financial strains on the GCC, limits the appointment of a Registrar and makes ordinary chiropractors anxious.

Many rank and file chiropractors are still fearful of the unknown. They fear that they will be prevented from practising their own form of chiropractic - that they will be forced to abandon their philosophy or beliefs - that the financial costs of registration will prohibit them from earning a living - that their college will fall because students will opt for cheaper alternatives. The longer the chiropractic profession is forced to wait, the greater some of those fears may become. However, the long delays have freed the various wings of the profession to develop closer links, and familiarity has served to make friends out of enemies and trust out of distrust. The majority of ordinary chiropractors are now positively disposed towards their future under the General Chiropractic Council, even though a hint of apprehension remains.

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