Private practices and the independent sector – coronavirus FAQs

Physio First and the CSP have collated advice for members intended to enhance but not replace the guidance provided by Public Health England (PHE) and the relevant government departments. 

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

Please also refer to our FAQs on personal protective equipment (PPE).

Reopening your services

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

Patient contact: making safe decisions

(Last updated: 1 June 2020)

Virtual triage

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 could 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 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: 27 July 2020)


 

Insurance

Are insurance companies supporting remote consultations?

(Last updated: 29 April 2020)


Is my public liability insurance affected by the Covid-19 pandemic?

Members can be reassured that the CSP's PLI scheme provides cover for medical malpractice and professional indemnity liabilities subject to the terms and conditions of the policy. This means no special restrictions or conditions are contained within the policies relating to Covid-19. However, we direct members to be clear on the following:

  • The policies do not operate where members practice illegally. This includes not adhering to PHE guidance on PPE.
  • In situations where members are returning to practice after lockdown, they would be expected to introduce and follow all of 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

(Last updated: 16 July 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 Covid-19 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 


Informed consent

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.

Please also see our template Consent form for face-to-face consultations during Covid-19 which was developed with PhysioFirst.

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 web-pages or in e-mails.

For example, you may describe your clinic/visit Covid-19 adaptations and processes in e-mails 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 our 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 checked and updated 18th June 2020)


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 is that you should self-isolate for 10 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 self-isolation advice.

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

    (Published in conjunction with Physio First)

    Last updated: 10 August 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 


     

    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 distributors.  The PhysioFirst publication 'Guidance for opening up our practices' also includes a list of suppliers at the end.

    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.  Also 

    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 


     

     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 Covid-19?

    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 


     

    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

    Animal Physiotherapy & Rehabilitation Working Practices statement from ACPAT

    The UK's coronavirus alert level has now been downgraded from four to three. ACPAT’s position is now therefore that animal physiotherapy and rehabilitation should be able to return to managing all types of cases, no matter the urgency. 

    Limiting client contact and maintaining social distancing and appropriate PPE should still apply. We will still be recommending following the RCVS and Public Health England guidance until this changes, which is likely over the next couple of weeks. The RCVS flow chart is still current, recommending that you effectively support the case in person whilst abiding by the appropriate physical distancing guidance for work places to protect your team and the public.

    You should still take care to risk assess for yourself, your team, clients and the public. Your risk assessment should also include consideration of movement of people to, from, and around the premises. Please continue to document your risk assessments, mitigation actions and informed consent as per CSP standards.

    The CSP still requires us to uphold their standards of assessing and managing risk, and establishing and maintaining a safe environment. If you employ or engage others to work in your practice with you, you should understand your additional duty of care as an employer for the health and safety of staff and ensure all staff are trained and competent in new procedures.

    A ‘Virtual First’ approach is still recommended as it enables practitioners to triage, risk assess and gain as much information as possible without client contact. This ‘Virtual First’ approach may take the form of a video consult, phone call, email, online forms, and/or messages. It is clear that we should still be prioritising cases which are emergencies, urgent, or essential to maintaining the health and welfare of an animal. ACPAT cannot make clinical decisions on behalf of its members; the clinical decision making and risk assessment process rests with the individual physiotherapist, who must decide for themselves whether to see a client face-to-face or not.

    We have a number of resources for members to provide guidance to facilitate clinical judgements, evaluate PPE needs, and determine the prioritisation of cases. These can be found in the Member’s Area of the website under “Policies & Procedures.”

    Please refer to the Government guidance on the NHS 'test and trace' service as it appears you may not have to self isolate after coming into contact with a person that has tested positive for Covid-19 if PPE is being worn in accordance with current guidance on infection, prevention and control.


    (last updated 19 Jun 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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