Guidance for Face to Face consultations

Last updated 14.01.21

Face to face appointment or not?

Message from CSP and Physio First to private practitioners

We know it’s been a challenging past year and that these are particularly difficult times for private practice, whether you are working in MSK, neuro, paediatrics, care homes or domiciliary care. This is alongside the challenges faced by health and care services as a whole.

Impact of the new lockdown on the delivery of Private Practice services

Following recent announcements about further lockdowns in all four countries the Government advice is clear about the continuation of healthcare services. Physio First advises that we continue to follow the clear flowchart guidance.

  • Triage every patient carefully
  • Do continue to consider and offer virtual treatment as your first option where possible
  • See a patient face to face if deemed essential following a conversation with your patient
  • Follow all risk assessments for Covid safe environments for yourself, your patients and any staff
  • As an HCPC registrant, you need to do all you can to minimise risk to yourself, colleagues and patients
  • Patients and the public should expect you to be open about your approach to infection control, so be ready to explain how you are following relevant guidance

This is applicable to all four countries.

Where a clinic is based in a gym that has had to close then any member will need to have a conversation with the landlord/gym owner to see if there is any way their clinic can remain open. All advice regarding classes remains the same. Pilates can continue if an integral part of a Physiotherapy treatment i.e. there are individual patients notes with full details and treatment goals recorded etc.

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:

Last updated 06.01.21

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 see here for full guidance.

Last updated 10.11.20

Should I be wearing enhanced PPE due to the new variant of Covid-19?

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). 

The evidence review has not identified a change in the mode of transmission between the variants and previous circulating strains of COVID-19, and therefore a consensus agreed that there are no changes to the recommendations set out in the IPC guidance at this stage. 

The Scientific Advisory Group for Emergencies (SAGE) has also advised that there is currently no evidence of any association between the new variant and increases in transmission in particular settings and that there is no evidence for differences in routes of transmission or different survival on surfaces.

  • PPE should continue to be worn as per current IPC guidance, with FFP3s to continue to be worn for AGPs. This position is being kept under close review. COVID-19 measures in the workplace should be robustly implemented and adhered to, including reinforcing physical distancing, optimising ventilation, greater patient mask use and enhanced decontamination/cleaning (especially frequently touched surfaces). Local assurance should be obtained for optimised compliance with IPC measures.
  • Emerging evidence and data on variant strains will be continually monitored and reviewed, and the guidance amended accordingly if needed.

Last updated 14.01.21

I am in an area or country back in lockdown, can I continue to practice?

The answer is “yes”. There is no area or country in UK where 121 healthcare is restricted. All triaged face to face contact in clinic or domiciliary situations can continue, following all current guidance on Covid screening, risk assessment, consent procedures and the wearing of PPE.

Last updated 10.11.20

Test and Trace update

We are hearing reports that physiotherapists are being asked to self-isolate despite wearing the appropriate PPE. We are actively seeking clarification from PHE and NHSE/I and have raised our concerns. In the meantime, 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.

  • Please find the full FAQ's and links to each jurisdiction here.

Last updated 24.09.20

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 10.11.20

Can I offer sports massage during lockdown?

Physiotherapists are able to continue to offer sports massage as part of their physiotherapeutic management of a patient within a healthcare context.  However, please be clear that this is different to standalone sports massage that would not be classed as a healthcare intervention. You can check your local/national restrictions to check whether close contact services are open in your area.

Where close contact services are closed, student members who have additional PLI with us to allow them to practise as a sports massage therapist should not be practising at this time.

Last updated 10.11.20

Can I delegate sports massage to my massage therapist / support worker?

Members must not attempt to seek loopholes in the current government guidance as a means to offer services that should otherwise cease during lockdown. This includes considering whether delegating activities such as sports massages to other staff remains appropriate during lockdown. The physiotherapist must understand that they are accountable for their decision to delegate and must be able to justify their reasons for doing so. Where members are implicit in disregarding the legal conditions of lockdown and seeking ways to circumvent these, there may be potential criminal and regulatory consequences. 

Members are reminded that while negligent acts and omissions will be covered by the CSP PLI scheme (subject to policy terms and conditions), a deliberate disregard of good practice guidelines could be seen as reckless. This may affect your indemnity cover under the CSP’s insurance scheme and thus the ability to seek support from the CSP scheme's insurer should any claim arise against you.

Last updated 10.11.20

Can I continue with my exercise class in an area of lockdown?

Local or national lockdowns are in place throughout all of the UK. Such changes are predominantly aimed at our social interactions and do not impact on the delivery of healthcare. Where gyms are closed and indoor exercise classes have stopped, physiotherapy-led classes aimed at general fitness and wellbeing should also cease. Where gym classes remain open, classes such as Pilates can also be open. Classes to address acute or immediate healthcare needs can continue even when other gym type classes are prohibited. All classes must be risk assessed, including the risk of asking patients to travel, to exercise indoors and to mix with others. This risk must be weighed up with the intended health benefit to the patient and clearly documented, in case your decision making is called into question. Virtual approaches or one-to-one treatments may reduce this risk and should be considered first.

Last updated 30.11.20

Do I need a QR code for my physiotherapy practice?

England are to introduce a system whereby designated venues in certain sectors must have a system in place to request and record contact details of their customers, visitors and staff.

This applies to those who work in hospitality, the tourism and leisure industry, close contact services and local authority facilities. It does not include healthcare services although you can use it if you wish. However, it will apply to physiotherapy clinics who employ sports and massage therapists in areas of the UK where they are allowed to work. Most members should therefore continue to use their existing processes to collect test and trace data.

For full details, please click here.

You can also find further relevant guidance here:
 

Last updated 10.11.20

Does it have to be the registered physiotherapist who carries out virtual triage?

Initial contact and triage assessment should be conducted via remote means during the pandemic. This will include screening questions to establish whether the patient is experiencing symptoms of COVID-19, has been tested as positive or has household members with the same. In order to decide whether to see a patient face-to-face you should consider the risk to the patient, yourself and others in your clinical setting or the patient’s household. It is also advisable to explain the specific protocols that have been put in place to address risk and ensure safety.

This part of the virtual triage can be delegated to non-registered members of a healthcare team. What dictates the appropriateness of delegation is the extent of risk, complexity and uncertainty in a situation and the competence of the person to whom the task is being delegated. Screening for COVID red flags is a relatively routine process and your staff could simply follow a checklist. You may therefore decide that this is an appropriate task to delegate to competent reception staff. You should be clear that as a registered practitioner you are accountable for the decision to delegate COVID screening to reception staff and therefore responsible for ensuring they are competent (in that they have received appropriate training to ensure they are adequately knowledgeable and skilled to carry this out). You should keep a record of training undertaken. 

The second part of the virtual triage / assessment is the clinical triage; your assessment of what the presenting complaint is, whether it is appropriate for physiotherapy and whether the expected benefits to this outweigh the risk of the patient attending. This should be carried out by the physiotherapist and a record of the clinically reasoned decision kept.

Last updated 04.08.20

Quarantine on return from overseas

Rules on self-isolating following travel vary across the UK and Crown Dependencies.

When you arrive in the UK, you must travel directly to the place you are staying and not leave until 14 days have passed since you were last in a non-exempt country or territory. This is known as ‘self-isolating’.

The 14-day period starts from the day after you leave a non-exempt country or territory. A non-exempt country or territory is any country or territory that is not on the travel corridors list.

For full guidance, please see here

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

Last updated 10.11.20

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.

Please click here for an example of a template for consent to treatment. 

Last updated 18.06.20

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 13.11.20

Does my PLI cover me to treat patients from other countries remotely?

From 1 July 2020 the CSP PLI scheme has restrictions on the extent of indemnity provided to members for telemedicine and other virtual technologies provided to people outside the United Kingdom.

Telemedicine and other virtual technology consultations which is provided from the UK by members who are ordinarily resident and based in the United Kingdom, to people who are also physically based in the UK at the time they receive the consultation, is covered by the PLI scheme subject to policy terms and conditions.

For the extent of cover provided to people who are based outside the UK you must read the Policy Terms and Conditions. Some overseas countries require specific legal registration in order to deliver any healthcare activity by telemedicine or other online platform. We know it can be difficult to find details of overseas regulatory requirements, but it is your responsibility to make your own enquiries in the relevant country and to register if required. If you do not comply with any legal or regulatory obligations in territories that require it, you will be uninsured.

You have a duty of care to your patient when providing individual advice and/or intervention to patients over the telephone, internet or by any other digital means. The standard of care you must provide is that same as that for face to face interactions with patients, and no lesser standard of care is permitted.

Telephone and online consultations may be open to exploitation as part of alleged attempted insurance fraud activity. It is important that you undertake an appropriate assessment of the patient, obtain consent for treatment, and document your intervention in the same way as for a face to face appointment, including keeping proper appointment records.

Last updated 08.07.20

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?

For full details and to follow the High Court action by the FCA to challenge the non-payment of Business interruption Insurance click here to visit the FCA website to follow their statements as we await final clarification. 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 10.11.20

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.

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 grant will be increased from the previously announced level of 40% of trading profits to 80% for November 2020. This therefore increases the total level of the grant from 40% to 55% of trading profits for 1 November 2020 to 31 January 2020.

The Government are providing broadly the same level of support for the self-employed as is being provided for employees through the Coronavirus Job Retention Scheme in November due to its extension. And then the Job Support scheme in December and January.

The second grant will cover a three-month period from 1 February 2021 until 30 April 2021. The Government will review the level of the second grant and set this in due course.

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

The online service for the next grant will be available from 30 November 2020. HMRC will provide full details about claiming and applications in guidance on GOV.UK in due course.

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 10.11.20

Are Private Physiotherapy Practices eligible for the business rates holiday for retail, hospitality and leisure businesses?

Although the guidance given to local councils around the eligibility for this relief does not specifically mention Physiotherapy clinics in its examples of “Medical Services” it deems not eligible for this relief (it gives the examples of doctors, dentists, vets, osteopaths and chiropractors only). The eligibility for this relief will ultimately be decided by local councils themselves and how they interpret this guidance. Whether this will be directly related to what your property is registered as with your local council for business rate purposes varies from local authority to local authority. Currently we are aware that many of our members physio businesses have not been eligible for this relief but some have been.

We encourage members who feel they do/should qualify for this relief to get in touch with their local council directly to make their case.

You can find the guidance issued to local councils on this here.

The government guidance on closing certain businesses and venues can be found here.

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 10.11.120

I am a company director and receive my income through PAYE and dividends, am I classed as self-employed or employed in relation to the schemes that the government has put in place to support workers?

It has been confirmed by the government that if you are the director of your own company and pay yourself through PAYE and dividends you can be furloughed, however, you are only able to claim 80% of PAYE income through the Coronavirus Job Retention Scheme for employed workers. Where furloughed directors need to carry out particular duties to fulfil the statutory obligations they owe to their company, they may do so provided they do no more than would reasonably be judged necessary for that purpose, for instance, they should not do work of a kind they would carry out in normal circumstances to generate commercial revenue or provides services to or on behalf of their company.

You are unable to claim anything for dividend payments through the Self-Employment Income Support Scheme.

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 10.11.20

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.

  • Income Tax payments due in July 2020 under the Self-Assessment system may be deferred until 31 January 2021. The deferment is optional. If you are still able to pay your 2nd payment on account on 31 July 2020 you should do so.
  • 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
  • 3-month filing extension for businesses. Businesses are being given an additional 3 months to file accounts with Companies House to help companies avoid penalties as they deal with the impact of COVID-19. Companies will have to apply for the 3-month extension for it to be granted, those citing issues around COVID-19 will be automatically and immediately granted and extension. Applications can be made at https://beta.companieshouse.gov.uk/extensions

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 10.11.20

What is the Coronavirus Business Interruption Loan Scheme and how do I access it?

Please note: members looking to borrow between £2,000 and £50,000 are advised to apply for the Bounce Back loan that the government is providing lenders with a 100% guarantee on. For more details on this loan please see our FAQ - What is the Bounce Back loan and how can I apply?

The temporary Coronavirus Business Interruption Loan Scheme supports SMEs with access to loans, overdrafts, invoice finance and asset finance of up to £5 million and for up to 6 years. The government will also make a Business Interruption Payment to cover the first 12months of interest payments and any lender-levied fees, so smaller businesses will benefit from no upfront costs and lower initial repayments.

The government will provide lenders with a guarantee of 80% on each loan (subject to pre-lender cap on claims) to give lenders further confidence in continuing to provide finance to small and medium-sized businesses.

The scheme will be delivered through commercial lenders, backed by the government-owned British Business Bank.

You are eligible for the scheme if:

  • Your business is UK based, with turnover of no more than £45 million per year
  • your business has a borrowing proposal which the lender would consider viable, if not for the coronavirus pandemic
  • you can self-certify that your business has been adversely impacted by coronavirus

The scheme is now open for applications until 31st January 2021.

The full rules of the scheme and guidance on how to apply is available on the British Business Bank website.

All major banks are offering this scheme so to apply please speak to your bank as soon as possible to discuss your business plan.

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 10.11.20

What is the Bounce Back loan and how can I apply?

The Bounce Back Loan scheme will help small and medium-sized businesses to borrow between £2,000 and £50,000. The government will guarantee 100% of the loan and there won’t be any fees or interest to pay for the first 12 months. Loan terms will be up to 6 years. No repayments will be due during the first 12 months. The government will work with lenders to agree a low rate of interest for the remaining period of the loan.

You can apply for a loan if your business:

  • is based in the UK
  • has been negatively affected by coronavirus
  • was not an ‘undertaking in difficulty’ on 31 December 2019

You cannot apply if you’re already claiming under the Coronavirus Business Interruption Loan Scheme (CBILS). However, if you’ve already received a loan of up to £50,000 under CBILS and would like to transfer it into the Bounce Back Loan scheme, you can arrange this with your lender until 31 January 2021.

The scheme is delivered through a network of accredited lenders and has been extended until 31st January 2021. More information about the scheme can be found here.

Last updated 10.11.20

How have the insolvency rules changed and how may this help protect my business?

The government has announced a temporary suspension of the “wrongful trading laws” which form part of the Insolvency Act 1986. The wrongful trading laws can cause directors to be personally liable for their company’s creditor debts if they have knowingly made transactions in and out of the business with the knowledge that the company is insolvent. The temporary suspension of wrongful trading provisions for company directors is to remove the threat of personal liability during the pandemic, this will apply retrospectively from March 1.

The government has made clear though that “all of the other checks and balances that help ensure directors fulfil their duties properly will remain in force.

Last Updated 06.04.20

How do I claim under the Small Business Grant Fund (SBGF) and Retail, Hospitality and Leisure Grant Fund (RHLGF)?

The Business Secretary announced at 5pm on 1st April 2020 that the funding for these grants, a total of  £12billion, had been released to local councils for distribution to eligible local businesses. Initially the government had reported that local councils would be in touch with eligible local businesses themselves. However, this no longer appears to be the case and many councils are asking local businesses to apply for the grant by completing an online form on their local authority website.

The main reason for this is because the local councils do not have the bank account details of many local businesses to be able to pay the grant into. This is particularly true of businesses who receive 100% small business rate relief and those businesses who do not pay their business rates via direct debit.

Therefore, we are encouraging all members with eligible businesses to check their local authority website and fill in an online application form.

The SBGF is available to all UK businesses who occupy property and are in receipt of small business rate relief (SBRR).

Some members may be eligible for the RHLGF at the discretion of their local council. More details about this can be found in our Business Support FAQ “My business premises have a rateable value of over £15,000 and I am not entitled to small business rate relief (SBBR), am I eligible for a cash grant of up to £25,000 for retail, hospitality and leisure businesses?”

Last updated 02.04.20

Can workers be ‘furloughed’ under the Coronavirus Job Retention Scheme if they are off sick?

The guidance from the government states that “employees on sick leave or self-isolating should get Statutory Sick Pay (SSP) but can be furloughed after this”. This suggests that you cannot put an employee on furlough until they have come off sick leave. The guidance does not explicitly deal with employees who become sick whilst on furlough, however it does say that employees will retain their entitlement to SSP. Since this is likely to be lower than furlough pay, there is likely no incentive for them to declare themselves sick to their employer. Should a more generous company sick pay policy be in place, it may be that this is agreed to be suspended during the period of workers being furloughed.

The published government guidance on the Coronavirus Job Retention Scheme for employers can be found by clicking here

Last updated 06.04.20

Can furloughed workers continue to accrue holiday allowance and continuous service while they are furloughed?

Yes, as they remain employed. You could agree with employees that no contractual holiday – beyond the statutory minimum of 5.6 weeks per year – will accrue during furlough. However, employees will retain their right to accrue annual leave under the working time regulations.

Last updated 06.04.20

What are the details of the extension to the Coronavirus Job Retention Scheme (CJRS) from 1st November?

If you cannot maintain your workforce because your operations have been affected by coronavirus (COVID-19), you can furlough employees and apply for a grant to cover a portion of their usual monthly wage costs where you record them as being on furlough.

The Coronavirus Job Retention Scheme will remain open until 31 March 2021. From 1 November 2020 you can claim 80% of an employee’s usual salary for hours not worked, up to a maximum of £2,500 per month.

You can claim for employees who were employed on 30 October 2020, as long as you have made a PAYE RTI submission to HMRC between the 20 March 2020 and 30 October 2020, notifying a payment of earnings for that employee. This may differ where you have made employees redundant, or they stopped working for you on or after 23 September 2020 and you have subsequently re-employed them. The government will review the scheme in January 2021.

All employers with a UK bank account and UK PAYE schemes can claim the grant. You do not need to have previously claimed for an employee before the 30 October 2020 to claim for periods from 1 November 2020.

Employers can furlough employees for any amount of time and any work pattern, while still being able to claim the grant for the hours not worked.

Employers can continue to claim for periods ending on or before 31 October 2020 until the deadline on 30 November 2020. You might need to contribute towards the cost of your furloughed employees’ wages for these periods. For periods from 1 November 2020, you will only need to pay for the cost of employer NICs and pension costs.

More details can be found here.

Last updated 13.11.20

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.’’