Private practices and the independent sector - coronavirus FAQs

Physio First  and the CSP have collated advice for members, which we hope will enhance but does not replace that provided by Public Health England (PHE) and the relevant government departments. 

See also Government and financial support to businesses and self-employed members.

Face-to-face or remote consultations

In addition to the FAQs below we strongly encourage you to read our Remote service delivery options content.

Face-to-face or not?

(Last updated: 1 June 2020)


Are insurance companies supporting remote consultations?

(last updated 29 April 2020)


Context for the remaining FAQs

These faqs have been developed in conjunction with Physio First.  You can access more coronavirus guidance on the Physio First website.  Please also refer to our 'Workplace and employment FAQs' and to the Government guidance on businesses and premises that must close.

What is the Covid19 position between practice principals and self-employed associates?

The advice in relation to any question between practice principals and self-employed colleagues about COVID-19 is almost always the same:

  • whether a practice principal or a self-employed person, both are businesses i.e.
    • the practice principal is a business selling physiotherapy to the public.
    • whereas a self-employed associate is a business selling physiotherapy services through the other’s business.
  • this means that what governs the relationship is the self-employed associate agreement i.e. it is all in the contract.
  • if there is no written agreement then this creates ambiguity, which is problematic but as in all business relationships, almost everything can be resolved if each party understands the other’s point of view.

As both are in business the most important thing to do is to talk about things i.e. with Covid-19 there are no winners. If the practice principal’s business has had to close, the self-employed associate’s business cannot trade and if the self-employed associate is not available, the outcome will be similar. So, we are all in the same boat!

So, in answer to the question posed, if one or both businesses has to close, income will reduce or be eliminated, which means that both will most likely have to suffer the loss until things change.

(Published in conjunction with Physio First)

Last updated: 29 April 2020 


 Coronavirus and your team 

What if one of my employed members of staff is pregnant?

Women who are less than 28 weeks pregnant should practise social distancing but can continue working in a patient-facing role, provided the necessary precautions are taken. The latest guidance indicates that wherever possible healthcare workers who are less than 28 weeks pregnant should avoid caring for patients with Covid-19 or suspected Covid-19.

Women who are more than 28 weeks pregnant, or have underlying health conditions, should avoid direct patient contact. Employers should therefore look at how they can redeploy anyone in this group to work more flexibly and in a different capacity, maximising homeworking opportunities.

Updated guidance from the Royal College of Obstetricians and Gynaecologists entitled 'Coronavirus: Infection in pregnancy – Information for Healthcare Professionals’  can be found along with other guidance on the RCOG website.  This gives comprehensive guidance for all healthcare professionals to use.

 All pregnant members of staff should have an existing risk assessment. This should be urgently reviewed on an individual basis and adjustments should be made where possible. This may include working remotely or redeployment to a lower risk area, allocating different duties, changing hours of work and also considering working from home.

The Health and Safety Executive guidance for pregnant workers includes information on what an employer's risk assessment should cover to keep staff safe. If you cannot alter a pregnant employee's working conditions, or hours of work, or offer suitable alternative work, you must suspend the employee on full pay. It is normally up to the pregnant employee to decide when they wish to start their maternity leave. However, if they are off sick with a pregnancy-related illness or suspended on health and safety grounds in the last 4 weeks before their expected week of childbirth then they can start their maternity leave and pay automatically.

(Published in conjunction with Physio First)

(Last updated: 29 April 2020 )


What happens if I tell my staff to self-isolate?

If someone becomes unwell in the workplace with a new, continuous cough or a high temperature, they should be sent home. All staff should follow the guidance from Public Health England regarding self-isolation and what to do if they show symptoms of the disease.

The advice remains that you should self-isolate for 7 days if you live alone and have developed symptoms. If you live within a family unit and anyone within the household has symptoms, then isolation should be for 14 days. For more information, see NHS England's coronavirus content. Information from this document states the following:

  • Staff members that are in isolation and therefore not at work, those who follow advice to stay at home will be eligible for statutory sick pay (SSP) from the first day of their absence from work
  • Employers should use their discretion concerning the need for medical evidence for certification for employees who are unwell. This will allow GPs to focus on their patients
  • If evidence is required by an employer, those with symptoms of coronavirus can get an isolation note from NHS 111 online, and those who live with someone that has symptoms can get a note from the NHS website

For more information, please refer to the gov.uk website guidance:

Guidance for employers and businesses on coronavirus (COVID-19)

(Published in conjunction with Physio First)

Last updated: 29 April 2020 


What if an employed member of staff is symptomatic of COVID-19?

If an employed member of staff has suspected coronavirus, they should be sent home and advised to follow the self-isolation advice from Public Health England. 

  • Staff should contact the practice and update them on their symptoms. Those who follow advice to stay at home will be eligible for statutory sick pay (SSP) from the first day of their absence from work
  • Employers should use their discretion concerning the need for medical evidence for certification for employees who are unwell. This will allow GPs to focus on their patients

For more information, please refer to the gov.uk website guidance:

Guidance for employers and businesses on coronavirus (COVID-19)

(Published in conjunction with Physio First)

Last updated: 29 April 2020 


What if an employed member of staff needs to care for a dependent?

If a dependent has been asked to self-isolate, the employed member of staff will have also been given the same instruction and will follow the sickness advice for self-isolation. For anyone living in a family unit or the same household the isolation period is 14 days for everyone within the household. 

As schools have closed, some children will have the ability to attend hub schools if their parent is classed as a key worker. For a list of key workers, and further information please see the gov publication Closure of educational settings: information for parents and carers

You should also refer to your current ‘dependents leave policy’, which may provide for some paid leave alongside a period of unpaid leave/holiday. Other alternatives are to discuss alternative ways to work which may fit around childcare.

(Published in conjunction with Physio First)

Last updated: 29 April 2020 


Can my employed members of staff still work for me? 

Yes, if they are able to support with new approaches to work remotely and see urgent cases only on a face to face basis

(Published in conjunction with Physio First)

Last updated: 29 April 2020 


Coronavirus and practice management

How can I procure PPE and what PPE should I be using if I need to see an urgent or essential patient face to face?

If you determine a patient requires an essential/urgent face-to-face patient consultation it is vital you use the correct PPE.  See the latest PPE recommendations from the Government.   

In the first instance, you should attempt to source your own PPE through normal stockists, as you would generally procure consumables.  Additional stock has been provided centrally to specific distributorsHowever, securing PPE is becoming increasingly challenging in places.  New measures are in place to ensure distribution of PPE.  These measures vary by both country and locality, depending upon local systems and centrally determined level of need.  Each nation has its own pandemic influenza stockpile, which it has allocated to its own providers.

Therefore, it is difficult to give specific advice about where an individual private physiotherapist can source PPE but the information below may be helpful.

UK-wide advice

  • If you have been commissioned to provide an NHS service by a CCG/Local Authority you should contact them.
  • Contact the individual patient’s GP to request PPE in order for treatment to go ahead.  Discuss your reasoning for seeing the patient in relation to the consequential impact on care needs if treatment does not go ahead.
  • Contact your local NHS Trust or community provider for ‘mutual aid’.  Again, discuss the potential impact on their service should your treatment not take place.
  • PPE EXCHANGE is a website matching PPE needs with those who have stock.  This is not an official website but some organisations have been using it. 

England

  • Contact your Local Resilience Forum. They have been provided with pandemic supplies of PPE for local distribution to health and social care providers, based upon most pressing clinical need and in line with published guidance.  Specific criteria apply but vary according to local decision-making - see Local Government Association (LGA) FAQs.  
  • A Parallel Supply Chain has been established to support the usual NHS Supply Chain and has replenished the stock of specific wholesalers. An e-commerce portal to allow primary and community care providers to acquire PPE via Royal Mail is in development.  Currently this is invite-only to CQC registered community care providers.  However, this is a phased implementation therefore it is possible it will open to additional providers over time. 

Scotland

  • NHS National Services Scotland has established a helpline to support PPE distribution via a triage centre: 0300 303 3020.  This then directs to local hubs of PPE or may help you source PPE.
  • You can raise a specific PPE supply issue via a central Scottish Government email (open to healthcare professionals and the public).      

Wales

  • The distribution of PPE stock is co-ordinated by NHS Wales Shared Services Partnership who will distribute the supply to health boards or Joint Equipment Stores/Community Equipment Stores that service local authorities.
  • Approach your local Health Board or Local Authority organisation for support.  
  • Work is ongoing to broaden availability of PPE outside NHS/Social care settings.

Northern Ireland

  • Health and Social Care Trusts have been instructed to recognise the need of “informal carers” for PPE to safeguard against requirements for formal packages of care.  It is possible they may extend this to private practitioners under a similar premise.  Contact details for each Trust are included in Covid-19: guidance for domiciliary care providers in Northern Ireland.   

It must be noted that there is no explicit route identified in any available central guidance for private practitioners to access PPE.  In the absence of formal arrangements, the above may be able to offer some support.  To protect yourself, the patient and the wider public, you must not go ahead with treatment if you cannot acquire the appropriate PPE. 

The CSP continues to work with all governments to lobby for sufficient PPE in all settings across the United Kingdom. 

(Published in conjunction with Physio First)

Last updated: 29 April 2020 


Should I close my practice if a patient is found to have COVID-19?

If it is absolutely necessary for you to see a patient with COVID-19 or suspected COVID-19 face to face in your practice as an urgent case,  you should follow the latest Government guidance on environmental decontamination

And follow latest guidance on decontamination of reusable equipment

(Published in conjunction with Physio First)

Last updated: 29 April 2020 


Who should I tell if I close the practice completely (i.e. not even offer remote consultation and face to face for urgent cases)?

If you need to close your practice due to Covid-19 you have a duty of care to your patients and must inform them of your closure.  You must make sure you have communicated any appropriate safety netting advice for the clinical condition for which you were treating them. You should also let them know the reason for closure and signpost them to public facing information about Covid-19.  Your patients should be following all current government advice related to social distancing and self- isolation.

(Published in conjunction with Physio First)

Last updated: 29 April 2020 


What should employed members of staff do if my practice has to close?

Determine whether employed members of staff could be redeployed to undertake some tasks from home such as completing CPD courses. They may also be able to utilise tele-health/skype consultations with patients if you intend to use this option. See the CSP guidance on supporting alternative delivery.

If it is not possible to provide any work during the COVID-19 pandemic restrictions then employees will still need to be paid unless it is covered in the contract or agreed otherwise. 

You may be able to claim back wage costs for ‘furloughed’ employees from the government’s Coronavirus Job Retention Scheme.

(Published in conjunction with Physio First)

Last updated: 29 April 2020 


 Can my employed members of staff work for another organisation during this time i.e. The NHS?

Yes, with your agreement. The employee remains employed by you during the furlough period so all contractual terms remain in force. So if the contract allows secondary employment then this is permitted. Even if the contract does not normally permit it, or is silent on the matter, then subject to the awareness and/or agreement, ideally in writing to protect all parties, then they can work elsewhere. 

There is no suggestion that working in the NHS will be treated any differently to any other secondary employment during furloughed status. 

Can they stop/start the furlough scheme?

Employers can only claim back wage costs for furloughed staff in three-week blocks.  

Otherwise, the change of status of employees is subject to existing employment law and as such has to be a matter of agreement between employer and employee.

How do they continue benefits with their existing employer e.g. pension arrangements?

As the employee remains employed and the employment contract therefore remains in place, all contractual benefits should therefore equally remain in place during furlough periods. No detail has yet been issued regarding specific arrangements for pension payments but the assumption would be that such arrangements would have to be made. 

(Published in conjunction with Physio First)

(Last updated: 29 April 2020 )


What if the practice can’t meet any contractual obligations (e.g. NHS or corporate contracts) because of the disruption?

Most contracts have a force majeure clause to help a practice if it cannot meet its contractual obligations, because of something happening outside their control; known as a force majeure event.

COVID-19 can amount to a force majeure event. If, because of issues with COVID-19, a practitioner is ill or the practice has to close, the practice can claim that they have been prevented from meeting their obligations because of a force majeure event.

(Published in conjunction with Physio First)

(Last updated: 29 April 2020 )


Will my insurance cover me/my practice?

The CSP PLI scheme is not business insurance and provides cover (subject to the terms and conditions of the policy) for the following:

  • Medical Malpractice Insurance. 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. 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

We advise you to get in contact with your business insurance provider to confirm whether you are covered for loss of earnings or business disruption due to COVID-19.

If you chose to redeploy to the NHS at this time the NHS employer's vicarious liability will cover you for any tasks and activities you are required to do as part of your temporary role.

(Published in conjunction with Physio First)

Last updated: 29 April 2020 


Will my Business Interruption Insurance Policy cover me for Covid19?

Businesses are encouraged to check the terms and conditions of their specific policy and contact their providers.

However, we are aware of significant concerns from members with regards to their ability to claim. We understand that concerns include insurers rejecting claims based upon:

We are working with Physio First and the CSP insurance broker Greybrook Hallam to understand how we might best pursue this issue. 

When enquiring about what your policy covers or indeed how insurers are interpreting your cover, remember that your insurance broker acts for you, so do make them your first point of enquiry.

Graybrook Hallam have provided the following advice in the meantime:

Members should consider a personal accident or illness policy to protect their own incomes whilst unable to work or refer to their clinic insurance for potential covers that may apply due to closure.  Some clinic insurers may include closures due to an outbreak of a “Notifiable Disease” at the premises, others may specify the nature of the disease which COVID 19, as a new virus, is unlikely to be included.  Helplines are also available under some clinic policies to help with Health & Safety issues and contingency planning if current locations become untenable.

Steps you can take in the meantime: 

Step 1. 

Business insurance policies are broken into sections covering different types of events, which means you might have a section for damage to your property and another for injury to customers.

If you are covered at all, then the Business Interruption section of your policy will be the relevant one for coronavirus (note we are focusing on general cover for the business itself; some businesses will have other types of more specialist cover with its own sections and terms, such as Group Personal Accident or Health Insurance for your employees).

You can find this section by looking at your policy schedule to see if the Business Interruption section is included, then follow this into your policy wording to see what it covered and if there are any extensions applicable or restrictions to this cover.

Step 2. 

Read the policy wording to see if you have cover against coronavirus COVID-19
Typically, business interruption cover can protect against virus outbreaks and diseases like coronavirus. 

To find out if you’re covered, you need to:

  • Look for a list of specific diseases that are covered. Generally the insurers list of covered diseases will include: Acute Encephalitis, Acute Poliomyelitis, Anthrax, Chickenpox, Cholera, Diphtheria, Dysentery, Legionellosis, Legionnaires Disease, Leprosy, Leptospirosis, Malaria, Measles, Meningococcal Infection, Mumps, Ophthalmia Neonatorum, Paratyphoid Fever, Bubonic Plague, Rabies, Rubella, Scarlet Fever, Smallpox, Tetanus, Tuberculosis, Typhoid Fever, Viral Hepatitis, Whooping Cough or Yellow Fever.
  • Look through this section for any applicable cover relating to ‘Notifiable Disease’ (without a specified list) or contagious and/or infectious disease. You may find this under the ‘Extensions’ section of your policy wording.

Coronavirus COVID-19 has been labelled by the government as a ‘Notifiable Disease’, which means if your policy covers these diseases (without a specified list), you may have some cover in specific scenarios.

Step 3 

Read the wording to determine how broad your cover is and in what scenarios it applies
Even where coronavirus can be covered (as a Notifiable Disease, for example) your Business Interruption section won’t cover you simply because the virus exists, and certain events will need to happen before your insurance kicks in, such as:

  • Your business being closed by the government or a local authority.
  • The Notifiable Disease is present at your premises or within a specified distance of your premises (refer to your individual policy wording for the specifics to your policy).
  • Insurance policies, and particularly the Business Interruption section, will be in place to potentially provide cover for loss of income or profit (depending on your policy) should your business be closed.

If you’ve suffered a reduction in customers due to coronavirus or COVID-19, it’s unlikely there will be cover in place for this. Similarly, if there is a delay with suppliers or stock, it’s unlikely that cover will be in place to recover these costs or any money lost as a result of the delays or cancellations.

It’s also worth considering that the ‘normal’ risks involved in running a business, such as accidents, and thefts, could also increase as a result of the coronavirus outbreak, particularly if your business is operating with fewer staff, or if police forces are stretched and crime rates increase.

It’s worth making sure your business insurance is up to date and covers you against these ‘everyday’ risks.

(Published in conjunction with Physio First)

Last updated: 29 April 2020 


What are the CSP doing to lobby on my behalf?

The CSP is working with Physio First the professional network for private practitioners  to pursue issues for members that are small businesses and who are not eligible for any of the existing government schemes to help business at this time.  You can view a letter sent to the Chancellor on 8 April 2020 by Physio First and 17 other membership organisations on the Physio First website.

(last updated 29 April 2020)


 

 

How can private practitioners apply to work in the NHS?

Please see our guidance on Working temporarily in the NHS.  Also be reassured that if you chose to join the NHS they will hold vicarious liability for however you are asked to work in any setting or context.

Also See the FAQs on upskilling and re-deployment  

(last updated 29 April 2020)


I have additional business questions. Where can I find answers to these?

Physio First is the CSP professional network for private practitioners. It is a membership organisation but at this time they have generously made business advice for any private practitioner accessible on their website   

(last updated 29 April 2020)


 

Animal physiotherapy

I treat animals - what can I do during COVID-19 restrictions?

Please visit the coronavirus FAQs section of the Royal College of Veterinary Surgeons (RCVS) website. This clearly sets out the circumstances in which you can treat animals at this time.

The Association of Chartered Physiotherapists in Animal Therapy (ACPAT) has produced guidance about urgent cases that might require a face-to-face consultation, and non-urgent cases. This guidance is in line with the advice from RCVS, the British Veterinary Association (BVA) and the Government. 

(last updated 14 May 2020)


Additional sources of support

  • You may have insurance to cover you for sickness absence. It is worth checking your own insurance policies. 
  • Visit the Government or FSB website for further information about matters pertaining to your business. 
  • For support and friendship from our Physio First community join and participate in our private forum on LinkedIn. 
  • Keep reading these FAQs as they are updated and as things change we will be talking to Physio First regularly. 
  • The CSP Members’ Benevolent Fund (MBF) - for those experiencing financial hardship please consider approaching the MBF, a registered charity which supports past and present members of the CSP who are experiencing financial difficulty or hardship. 

(Published in conjunction with Physio First)

Last updated: 29 April 2020 
 

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