On Tuesday 21st April 2020, CSP Northern Ireland staff held a virtual meeting for members in Northern Ireland on the impact of COVID-19 in physiotherapy.
This was an opportunity for members to pose questions to the panel in order to alleviate concerns or gain clarity on issues surrounding working within the profession during the current coronavirus pandemic. Members were also able to share knowledge with each other using the platform’s chat function whilst the meeting was ongoing.
The meeting was hosted by Hayley Downey (Campaigns and Regional Engagement Officer), with Euan McComiskie (Professional Adviser), Claire Ronald (Senior Negotiating Officer) and Tom Sullivan (Public Affairs and Policy Manager) answering members' questions. They were supported by Hilary McErlean (administration Officer) and Siobhan McCauley (Chair of the CSP Northern Ireland Board).
At the beginning of the meeting, participants were asked to provide feedback via Mentimeter on how they were feeling managing the impact of COVID-19, and the graphic below shows that the key phrases emerging were ‘uncertain’, ‘overwhelmed’ and ‘anxious.’
Following an hour of Q&A and discussion, participants were asked how the call had helped them managing COVID-19 in their workplace, and feelings of worry and anxiety were replaced with terms such as ‘useful,’ ‘reassured’, ‘support’ and ‘clarity.’
The key issues that emerged from the meeting are summarised below.
CSP PPE Advice Summary
The CSP is following all PHE’s advice on PPE; https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control. However, the CSP takes the view that certain chest physiotherapy techniques intended to increase the strength and effectiveness of someone’s cough as part of an airway clearance regime are AGPs. After seeking expert clinical opinion, the CSP advises that additional physiotherapy interventions are potentially AGPs. These include:
- Manual techniques that may trigger a cough and the expectoration of sputum e.g. expiratory vibrations, percussion, manual assisted cough
- Use of positive pressure breathing devices e.g. IPPB; MI-E
- Intra/extra pulmonary high frequency oscillation devices e.g. The Vest, MetaNeb, Percussionaire
- PEP and oscillating PEP devices
- BubblePEP
- Open suctioning, including nasopharyngeal or oropharyngeal suction
- Manual hyperinflation (MHI)
- Saline instillation via and open circuit / endotracheal tube
- Inspiratory muscle training, particularly if used with patients who are ventilated and disconnection from a breathing circuit is required
- Diagnostic interventions that involve the use of video laryngoscopy that can result in airway irritation and coughing
You will find all of our most up to date information on PPE on our website; https://www.csp.org.uk/news/coronavirus/clinical-guidance/ppe-faqs.
The department of health has set up a new e-mail contact point for health and social care staff to raise PPE concerns. The e-mails address – Covid19PPE.queries@health-ni.gov.uk will be checked every day and the anonymity of staff using it will be protected.
Rehabilitation / Mobilisation
- We are not saying that mobilisation/exercise/rehabilitation is an AGP
- We are saying that minimum PPE needs to be in place depending on your patient/setting as per PHE guidance
- We are saying that there may be individual clinical circumstances/patients where physios feel that the minimum recommended in this guidance is insufficient
- In these circumstances they need to carry out and document a risk assessment for each individual session and discuss this with line manager, infection control as appropriate
Redeployment and childcare
These were two of the other questions raised in advance of the meeting. For general advice we recommend looking at CSP advice on redeployment and also look at the FAQs complied by the department of health in NI
https://www.csp.org.uk/news/coronavirus/workplace-employment/upskilling-redeployment/faqs
Private practitioners
Physio First and the CSP have collated advice for members, which enhances but does not replace that provided by Public Health England (PHE) and the relevant government departments.
It contains advice and information on Face-to-face or remote consultations, remote service delivery options, coronavirus and practice management issues and additional sources of support.
Government financial support to businesses and self-employed members
The government has announced a range of financial support measures for people in business. The Nibusinessinfo.co.uk website has information on financial support for businesses, including the Small Business Grant Scheme and non-domestic rates.
https://www.nibusinessinfo.co.uk/business-support/coronavirus
Lack of Financial Support for the Self-Employed, recent Graduates and Directors of Limited Companies
The CSP is acutely aware of a range of issues raised by private practitioners in regard to a lack of financial support for businesses and their employees and the impact of these financial restrictions on their future. The CEO of the CSP and the Chair of PhysioFirst agreed the contents of a letter sent to the Chancellor on Thursday 9 April forcefully making the point that these individuals are less able to access the current financial grants and support, putting both their families and businesses at serious jeopardy asking ask him to urgently to reconsider the details of the financial support packages that have been made available.
A copy of the letter can be accessed via the PhysioFirst website at the address below:
https://twitter.com/PhysioFirstC/status/1247922179695620097/photo/1
In addition the CSP has had conversations on these specific issues with politicians, party representatives and other professional body colleagues including the podiatrists and dentists and small business organisations.
It is encouraging that the Minister for the Economy stated last week to the NI Assembly Economy Committee that she is,
“acutely aware that there are others across Northern Ireland facing financial hardship which have not been able to access any of the existing national or regional grant schemes. We are working out how best we might assist them.”
Additional representations will be made to the Treasury on specific proposals to support private practitioners and that this will on a UK basis on behalf of all private practitioners. More detail on that will be forthcoming to members via the CSP centrally and Physio First in the near future.
Insurance
Some categories of CSP membership include some insurance cover. More information can be found at https://www.csp.org.uk/professional-clinical/professional-guidance/insurance but a summary of cover is as follows:
- Medical Malpractice Insurance (MMI). This covers claims for personal injury to your patients arising from your work e.g. failing to assess and treat properly or harming your patient with your treatment
- Public Liability Insurance (PLI). This covers non-personal injury claims that are not associated with your treatments e.g. slips, trips and falls coming in and out of your clinic
The CSP insurance does not cover business continuity insurance (BCI). Those in private practice may well have separate BCI with other providers so discussions should occur with those providers and not the CSP. The CSP cannot make legal representation on our members’ behalf in respect to BCI. Even if the member has BCI with Graybrook Hallam, with whom our PLI and MMI policies sit, we cannot support our members in that respect.
For further comments or queries you can contact us on – northernireland@csp.org.uk