Guidance for Face to Face consultations

Last updated 15.07.21

Face to face appointments - UPDATE

Message from CSP and Physio First to private practitioners

This past year has been particularly challenging for all who work in health and care services.

We anticipate that most services are now successfully managing to offer patients the treatments they need, whether face-to-face or remotely. We envisage that, for some patients, remote consultations will remain a popular choice but accept that, for many, face-to-face treatments are most beneficial.

We urge you to continue to do all that you can to minimise risk to yourself, colleagues and patients. Therefore, do keep using virtual triage to carry out your Covid-19 screening and risk assessment as part of infection prevention control measures.

Your risk assessments will vary depending on your local context and the vulnerability of your patient cohort, as well as the national picture. However, you should feel more comfortable to book to see patients face-to-face if that is a patient's agreed preference. Click here to read the detailed guidance and please note the flowchart has been removed.

This is applicable to all four countries.

As further changes for health and care services across the UK are announced, be assured we will continue to update our guidance. 

We have listed a few resources down below for face to face consultations to assist with individual decision making:

This guidance remains current during the easing of restrictions in all 4 countries. Last updated 15.07.21

I am confused about which pathway my patient is on when I read the new PHE IPC guidance. What is the advice from CSP and Physio First?

Following the publication of the updated IPC guidance on August 21st there has been some confusion about which pathway we should follow for private physiotherapy MSK treatments.

The three pathways described in the main body of the document, high, medium and low risk, clearly describe each but appear to be contradicted by the triage tool in appendix 1. We have sought clarity on this from PHE who have advised that the triage tool should be completed and if ‘No’ is the answer to all of the questions, the practitioner is directed to the low risk pathway definition to assess whether these criteria are also met. If not, they move to the medium risk pathway. As the vast majority of our patients seeking private MSK treatment will not have had a negative test within the last 72 hours we believe most of our patients fall in the medium risk pathway. Please complete your own risk assessment. The guidance does not make any distinction between vaccinated and non-vaccinated patients. 

Please see here for the full guidance (last updated 01.06.21).

Last updated 15.07.21

Do we continue to wear full PPE?

We have a legal and ethical duty of care to protect staff, patients and visitors and to minimise their risk therefore, pending further guidance from Public Health England Infection Prevention and Control teams, the current PPE guidance remain in place until further notice.

The most recent guidance was issued on June 1st and you can find it here. This guidance does not make any distinction between vaccinated and non-vaccinated patients.

The CSP have sought clarity on this issue from Public Health England and have received this response which will shortly be published as an update to their IPC guidance.

A peer review has been undertaken by an expert group of clinicians to assess the new variant strains (SARS-CoV-2 VOC-202012/01 and UK VOC122020/02). 

Last updated 15.07.21

Can we insist on patients wearing masks in England and do we know how this will affect Test and Trace?

It is the view of CSP and Physio First that masks wearing should remain routine for both the therapist and the patient during treatment sessions. From Monday 19th July 2021, in England we cannot insist on this as it is not the law, we can only request that they protect the therapist that is treating them. If they refuse, we can only mitigate the risk of spreading the virus by wearing PPE and not spending too much time in close proximity, routine cleaning between patients (no set time) and any other risk management strategies in your particular clinic.
 
In practical terms, a physiotherapist would only have to give details of patients seen if they themselves tested positive and had seen a client list within the time frame NOT wearing PPE. If the therapist is wearing PPE, then your contacts do not include your patients.

Last updated 15.07.21

Can we reduce the time for cleaning in between patients, if so how long?

There has been no specified time for many months. We suggest that basic cleaning routines continue as this would be good practice in any situation.

Last updated 15.07.21

Test and Trace update

If you are contacted by a contact-tracing agency, we recommend you start by determining the setting of the contact. A confirmed COVID contact from a social interaction will require you to self-isolate, even if no symptoms are experienced.

If the contact relates to your professional setting, we recommend that you make it clear that you are a regulated healthcare professional, working in a healthcare setting that is following robust risk assessment and mitigation processes, including the use of PPE, in line with government guidance for our setting. 

We would also encourage you to try to keep your social contacts and professional contacts separate by turning off Bluetooth on your phone while at work and using different contact details for social and professional contacts. In this way, it may be easier to determine the context of any potential Covid contact, reducing the likelihood of you being asked to self-isolate.

Test and Trace will be changing but we do not know what this will look like, also we do not know if it will include individuals having the double vaccinations and not having to isolate. At the moment restrictions or healthcare provision does not distinguish between those having vaccines and those choosing not to. There are also local differences in Test and Trace and if pushed by them to share your patient details for any one period and they choose not to take your PPE into consideration then your duty would be to inform the authority of your patient details.
 
The evidence we can find about this is here i.e. what is the latest Govt Guidance: COVID-19 privacy information - updated 1 March 2021, which just restates the duty to collect patient data and to submit it as appropriate. This is also commented on in a helpful (but earlier) BMJ publication “Covid-19: Rules on sharing confidential patient information are relaxed in England.” 

Last updated 15.07.21

What if I am told to self-isolate by a contact tracer when I believe the contact was a patient and I had been wearing PPE?

We have been hearing of some private practitioners being told to self-isolate without there being appropriate recognition that they are healthcare professionals and may have been wearing the correct PPE.

We have worked with the other professional bodies and liaised with PHE, NHSE, Health Protection Scotland and local Health Protection Teams (HPT). We are reassured that private practitioners should be managed as healthcare professionals with regard to test and trace processes, and so if the private practitioner can demonstrate they have followed PHE’s PPE guidance they should not be managed as test and trace contacts.

Private practitioners should firstly raise any concerns with their local HPTs which will consider the individual circumstances of a private practitioner’s context of the contact and whether other exposures were identified, and thus what action needs to be taken.

We have prepared a template letter for you to share with your local health protection teams (HPTs) should you be approached to isolate when you have been working as a healthcare professional in a Covid safe environment. 

Last updated 15.07.21

Quarantine on return from overseas

From 4am Monday 19 July you will not need to quarantine on arrival in England or take a day 8 COVID-19 test, as long as you:

  • have been fully vaccinated under the UK vaccination programme
  • have not been in a red list country in the 10 days before you arrive in England

Fully vaccinated means that you have had your final dose of an approved vaccine at least 14 days before the date you arrive in England.

For full guidance, please see here

You should follow separate advice if you need to self-isolate in:

Last updated 15.07.21

Are there any COVID-19 considerations I need to think about as part of gaining informed consent for my patients to proceed with a Face to Face physiotherapy appointment?

Yes. Informed consent means that there is evidence of information exchange and shared decision-making between you and your patient, so that the patient is able to make their own decision to agree to treatment based on receiving information that is relevant to them. In the current situation, that will also include a patient agreeing to a face to face appointment and understanding what the impact of COVID-19 has on their expectations of treatment and the clinic/visit processes. Informed consent cannot be evidenced by a tick in either a box or a template.

There must be evidence that demonstrates the information exchanged and/or conveyed to your patient, and any discussion that have taken place as a result of any questions that the patient has asked, which must now include things related to COVID-19. Remember: Disclaimers and declarations that seek to require patients to sign that they absolve you of your duty of care to them are legally invalid. There is no guarantee any such wording will protect you from any legal claim arising at a future date from an alleged failure on your part to discharge your duty of care to your patient, and/or any health and safety workplace legal obligations you may have. Similarly, whilst you can expect patients to provide honest, accurate and complete information to the best of their knowledge when they attend for treatment, it is unreasonable for you to seek to hold patients liable for any harm caused to others caused as a result of the information they provide. You have a professional duty to explain to patients how you are adapting your practice and your clinic/visit environment in the light of COVID-19 to ensure a safe working and clinical environment for both staff and patients.

You are not expected to know everything about COVID-19, but you are expected to draw on relevant advice and guidance from Government and professional sources to understand the implications for your particular scope of physiotherapy practice. You must keep records of what adaptations you have put in place and/or your risk assessments, in case you are ever called upon in the future to justify your decision to see a patient face to face and describe what measures were in place at that time. Remember, there will be a variety of information sources that can be used to evidence the information about COVID-19 provided to patients, some of which will be open access and some of which may be contained within individual clinical records. For information that is open access, you must ensure that, if you have responsibility for them, you manage version control of documents and that you retain accessible copies of information contained in webpages or in e-mails. For example, you may describe your clinic/visit COVID-19 adaptations and processes in emails to patients, website information, clinic policies and procedures and information displayed in waiting areas. You may also wish to include information about specific COVID-19 requirements in patient information leaflets or appointment letters that are sent to patients.

You can use the CSP 7- Factor checklists as evidence of your risk assessment in adapting your clinic and justifying the decisions made to see patients face to face. Within individual clinical records, you must keep a record of any COVID-19 screening questions and/or assessments made as part of a virtual or face to face appointment. Your clinical record of any face to face appointment must record what PPE was used and/or was not available. As is already required, your clinical records must include evidence of relevant clinical findings, decisions made and actions taken, information provided and questions raised by the patient. Your record must also include your clinical opinion, details of any advice, treatment and intervention provided, warnings given and plans for progress, monitoring and follow-up and discharge from care.

Last updated 15.07.21

Do you want to promote your online physio service alongside your face to face clinic?

On Thursday 10th September 2020 Physio First hosted a webinar presented by Gerard Greene on 'Providing and promoting your online physio service alongside your face to face clinic'. 

Members learnt how to:
•    Develop, maintain and build an online clinic
•    Continue their online clinic alongside their bricks and mortar clinic
•    Utilise zoom interviews, YouTube and social media live events to promote your clinic

Gerard Greene combines teaching and research with working in his specialist pelvic health physio clinics in Birmingham. His clinics specialise in female and male pelvic health Physiotherapy in addition to MSK/sport. Gerard has built up his online clinic and courses through lockdown and beyond and is generously sharing his experience with Physio First members. 

We would like to thank Gerard Greene, Lorna Saunders and Gemma West for their time, efforts and contributions towards this event. 

If you missed this event or would like to rewatch it, you can log in to watch the full webinar here

Is the PLI cover provided within my CSP membership affected if I return to some face to face following all risk assessment and clinical reasoning?

Last updated 13.05.20

CSP PLI Scheme for Members

Firstly, we can confirm there are no changes currently to the terms of the policies. That means no special restrictions or conditions are contained within the policies relating to COVID-19. 

The two policies comprising “PLI” are:

  •  Medical Malpractice (covering clinical negligence)
  •  Public Liability (covering non treatment related accidents) 

Both are designed to cover the legal liability of eligible members for claims brought against them arising from their alleged negligence within the scope of physiotherapy practice. 
In situations where members are returning to practice after lockdown they would be expected to introduce and follow all the precautionary measures required and recommended to ensure the safety of themselves, patients and staff. The PLI scheme does not provide Employers Liability insurance so members with employed staff should seek separate guidance on this class of insurance. Because COVID-19 is a novel virus where the body has no natural immunity and for which there is currently no vaccine available, additional care is required to reduce the risk of exposing patients to infection. 

Members may therefore become legally liable if they fail to risk manage treatments and their clinical environment to safeguard patients for example with insufficient PPE, sanitisation, social distancing and other reasonable safety measures. Informed consent should now include reference to COVID-19 and compliance with any legal obligations. The policies do not operate where members practice illegally. Members delivering services through a corporate entity such as a private limited company or partnership should consult their business insurance advisers on how their commercial policies may be affected. 

Last updated 13.05.20

The Covid-19 Vaccine

The vaccination programmes will be managed by the health departments in each UK country. The CSP is supportive of non-NHS capacity being used to help deliver it. Further advice on this will be made available as governments clarify their plan. Last updated 13.01.21

When will I be able to receive the vaccine?

This will depend on where you live, work or learn. Vaccinations have started and health and care practitioners are in the higher priority groups, although over-80s are the top priority.

England

Under new NHS operational guidance, NHS hospitals will act as vaccination hubs for both NHS workers and healthcare professionals working in the independent and voluntary sectors. Booked slots are being proposed where possible.

NHS employers will manage the call-up of NHS staff, while local Clinical Commissioning Groups (CCGs) will collate non-NHS names for call-up.

Some CCGs have already started contacting larger independent providers for details of staff requiring vaccination. Details of how other non-NHS practitioners can register with CCGs will vary by locality.

Members are advised to check their local CCG websites next week for further information on local arrangements.

For physiotherapists who regularly visit patients in care homes, homes will be asked to provide the names of those who regularly work on their premises to treat their residents. We would therefore advise you to speak to the manager of the home to ask if they can add you to their list.

Wales

The Welsh Government has agreed that all healthcare workers, across all sectors, should receive the vaccine in line with the Joint Committee on Vaccination and Immunisation (JCVI) advice.

Health Boards are responsible for vaccinations and will call up NHS staff. The target date for rolling out vaccinations to HCPs is mid-February. The arrangements for calling up non-NHS practitioners are yet to be announced.

Northern Ireland

The Chief Medical Officer (CMO) is responsible for the coordination of the vaccine roll-out in Northern Ireland. HSC staff should access vaccination through their employer organisation.

The Executive’s vaccination policy statement does not distinguish between sectors, but to date no arrangements have been put in place to enable non-HSC clinicians to book vaccinations. The CSP is continuing to raise this with the department.

Scotland

The National Programme team in Scotland is aware of the needs of frontline healthcare workers in all sectors and they are drawing up procedures to ensure that these groups are called forward for vaccination in line with JCVI guidance. At this stage we do not know when this will be finalised but it on their workplan.

For updated news on how to get involved in the vaccination programme and how to access the vaccine as frontline workers, please check the CSP website here

Last updated 13.01.21

Can I support a Covid-19 vaccination programme when it is rolled out?

Yes. As part of UK-wide efforts to deliver a Covid-19 vaccination programme when it becomes available, physiotherapists may be asked to provide vaccination clinics for their local populations. You can register your interest to participate in the English roll-out on the NHS Professionals website

However, you need to be clear on some specific issues before agreeing.

Last updated 20.11.20

Is this within the physiotherapy scope of practice and therefore covered by my CSP PLI?

Where you are providing Covid-19 vaccines as part of a vaccination programme or stand-alone vaccination clinic you would not be undertaking this as a physiotherapy activity but rather as a capable individual who is well placed to contribute to a local programme. You can do this but you must be clear that it is not in the context of physiotherapy practice. In this situation you would not be covered by your CSP PLI.

However, anyone enlisted to support the Covid vaccination programme will be employed by the NHS either as part of their substantive role, via a staff bank or NHS Professionals. All members contributing will therefore be covered by their employer’s insurance; your employer holds the liability for your work. To be clear, you should have some documentation that shows your employer requires you to undertake Covid-19 vaccination as part of your role.

Last updated 13.01.21

What training should I have undertaken to offer vaccinations?

You do not need to be a prescriber or a qualified injection therapist to deliver vaccinations by subcutaneous and/or intramuscular injection. However, you must ensure that you have the knowledge, skills and competence to do so. If you are employed and your organisation is asking you to participate in this activity, they are responsible for providing you with the necessary training.

Last updated 20.11.20

How would this work in private practice and/or if I am self-employed?

Some private practitioners may be asked to administer vaccinations where they are already contracted to deliver services on behalf of GPs. You should either be directly employed by the Primary Care organisation or have a clear contract for services.

However, private physiotherapists cannot offer vaccinations as a private service as it is not possible to obtain wholesale stocks of vaccines.

Last updated 20.11.20

What about the impact on my physiotherapy workload?

It is appropriate that physiotherapists use their capabilities to support the wider NHS workforce, but it is important that organisations take account of the impact this may have on patients accessing physiotherapy services.

It will be an organisational decision as to which service takes priority, and how staff are deployed to deliver services

If you are employed in NHS services and you are asked to allocate working time to provide vaccination clinics, you should consider the interruption this may have on your physiotherapy workload.

Last updated 20.11.20

Vaccine Update - Crown dependencies

Guernsey, Jersey and the Isle of Man are following the same approach as the UK. Physios and physio support workers across all sectors are in the second tier of priority for vaccinations. The CSP has asked the public health authorities in the crown dependencies to clarify arrangements for members across all sectors. Updates will be posted here.

Guernsey: Eligibility for the Vaccine | States of Guernsey - COVID-19 (gov.gg)

Isle of Man: Isle of Man Government - COVID-19 vaccine delivery

Jersey: COVID-19 vaccine programme (gov.je)

Last updated 13.01.21

Covid-19 business support

Last updated 29.07.21

Is there any update on Business Interruption Insurance?

Aviva amends stance on business interruption claims after CSP and Physio First pressure

 

This breakthrough in Aviva's position follows sustained pressure from CSP and Physio First, working with James Hallam Insurance Brokers, to provide extensive evidence in support of our members' claims.

Members affected by a qualifying claim will start to receive letters from Aviva from 23 July, explaining the new position and giving details of what they will need to do next.

Click here to read the full letter from James Hallam.

Last updated 29.07.21 

What if my business interruption insurance is not with Aviva and arranged through Graybrook Hallam?

You will have seen that we published news about Business Interruption clinic policies purchased through James Hallam on Friday 23 July 2021. Click here to see the full bulletin and a news article by Insurance Times here

If you are experiencing challenges to your BI claim, which is not provided by Aviva, please contact the professional advice service team: professionaladvicese@csp.org.uk at CSP and they may be able to help you.

They will need the following details:

  • Your CSP membership number
  • Your insurance provider
  • The underwriter for the policy
  • The broker you used (if applicable)

Last updated 29.07.21

Did Physio First do anything to lobby the government?

Please click here to read a joint letter sent to the Chancellor on 8th April 2020. 

Last updated 08.04.20

Have Physio First done any lobbying about rate relief for small businesses?

Physio First and the CSP are part of an alliance of professional and trade bodies that has called on the Chancellor of the Exchequer to extend rate relief to professionals operating through small businesses. To read the letter please click here. 

Last updated 13.05.20

Will my business interruption insurance policy cover me for Covid-19?

See FAQ above with news about policies with Aviva arranged by James Hallam. For full details and to follow the High Court action by the FCA to challenge the non-payment of business interruption Insurance for a range of other policies click here to visit the FCA website to follow their statements as we await final clarification for many policies. 

Going forward we all probably know now the value of business interruption insurance will depend upon the terms and conditions of the specific policy. All post Covid 19 policies are likely to be drafted in a way that tightens up the protection for the insurance provider. So, it is essential to really understand them, which means spending time reviewing and discussing them with your insurance broker.
 
Whilst it may not always be true, it is likely that the amount of cover will increase with the cost of the premium. In addition, insurers will be working very hard to try to ensure that they are not as exposed as they were. So, there are likely to be clearer exclusions for events such as Covid 19. This begs the question as to what to do? Certainly, the answer has to come from your discussion with your broker to include the value of saving contingent sums of money to cushion any such future catastrophe insurance cover that they may have to offer.   

Last updated 29.07.21

I’m Self Employed, what support is available for me after the 5th November?

The Self-Employment Income Support Scheme Grant has been extended in the form of two grants, each available for three month periods covering November 2020 to January 2021 and February 2021 to April 2021. And now another from May 2021 to end September 2021 which is the 5th grant available.

To be eligible for the Grant Extension self-employed individuals, including members of partnerships, must:

  • have been previously eligible for the Self-Employment Income Support Scheme first and second grant (although they do not have to have claimed the previous grants)
  • declare that they intend to continue to trade and either:
    • are currently actively trading but are impacted by reduced demand due to coronavirus
    • were previously trading but are temporarily unable to do so due to coronavirus

The extension will last for six months, from November 2020 to April 2021. Grants will be paid in two lump sum instalments each covering a three-month period.The first grant will cover a three-month period from 1 November 2020 until 31 January 2021. The Government will provide a taxable grant covering 55% of average monthly trading profits, paid out in a single instalment covering 3 months’ worth of profits, and capped at £5,160 in total.

The grants are taxable income and also subject to National Insurance contributions.

Claim the fifth grant if you think that your business profit will be impacted by coronavirus (COVID-19) between 1 May 2021 and 30 September 2021. 

You’ll need to confirm that you meet other eligibility criteria when you make your claim. You should make your claim on or after the personal claim date HMRC has given you.

Please continue to check here for updates.

As Physio First we are trying to make finding the information as easy as possible. Whilst we will update each FAQ as quickly as we can, please check against Govt rules before taking any action – see link here

Last updated 29.07.21

Is there any other help for businesses and individuals who are struggling to afford to pay tax at this time?

There are a few ways in which the government are helping individuals and businesses who are struggling to pay tax at this time. They are as follows:

  • Deferring Value Added Tax (VAT) payments for 3 months from 20 March 2020 until 30 June 2020. This is an automatic offer with no applications required. Business’ will not need to make VAT payments during this period. Taxpayers will be given until the end of the 2020/21 tax year to pay any liabilities that have accumulated during the deferral period. 

UPDATE: On 24 September 2020, the Chancellor announced that businesses who deferred VAT due from 20 March to 30 June 2020 will now have the option to pay in smaller payments over a longer period. Instead of paying the full amount by the end of March 2021, you can make smaller payments up to the end of March 2022, interest free.You will need to opt-in to the scheme, and for those who do, this means that your VAT liabilities due between 20 March and 30 June 2020 do not need to be paid in full until the end of March 2022. Those that can pay their deferred VAT can still do so by 31 March 2021.

  • Time to Pay extended. HMRC have scaled up their Time to Pay offer to all firms and individuals who are in temporary financial distress as a result of COVID-19 and have outstanding tax liabilities such as Income Tax or Corporation Tax. These arrangements are agreed on a case-by-case basis and are tailored to individual circumstance and liabilities. If you have missed a payment or fear you might miss your next payment due you can call HMRC’s dedicated helpline: 0800 0159 559

As Physio First we are trying to make finding the information as easy as possible. Whilst we will update each FAQ as quickly as we can, please check against Govt rules before taking any action – see link here

 Last updated 29.07.21

Resources to help you connect with your patients in virtual consultations

Guidance for virtual consultations

Our Physio First team have been looking into the many and varied ways in which our members can continue to support their patients while following government guidelines.

We have collated advice and resources to help you connect with your patients in virtual consultations. Download a copy of our e-booklet.

Last updated 02.08.20

​Returning to the NHS

Last updated 08.04.20

Is returning to the NHS all about face to face work?

What if you are in a vulnerable group yourself

The NHS FAQ states:

“This isn’t only about clinically treating patients – there is also a need to provide a calm and stoic presence whose ripple effect is felt way beyond any health or social care setting. Many members of the general public are anxious and need reassurance. Your expertise can help in so many ways, so even if you fall into a group which is considered to be at increased risk, you can still offer valuable support through a variety of roles in secondary, community and primary care.’’