Important Information for staff and clients

Plan for opening up our practice:

From Monday 1st June 2020 we are officially open again, with strict policies and procedures in place. Urgent/essential clients can be seen in clinic before the June opening date. 

*Management of face to face interventions in clinic during phase two of COVID-19 Pandemic management:

Following the Prime Minister’s statement on 10th May 2020 regarding the movement of England to the second phase of COVID-19 pandemic response, and communication from NHS England chiefs signalling a re-opening of some non-COVID healthcare pathways, we are seeing patients increasingly seeking physiotherapy intervention and asking for face to face treatments. We recognise that access to physiotherapy will be important to getting people with injury and illness back to work as part of efforts to re-start the economy.

We, as a clinic, are following stringently a pathway provided by our professional bodies, based on recent government guidance, that enables us to work within the legal, regulatory, and professional frameworks that govern safe physiotherapy practice in the context of England’s second phase of COVID-19 pandemic management.

*Our responsibilities – risk assessments and safety of clients and staff:

Our priority is to maintain the safety of our patients, our staff and the wider public, as well as protect the reputation of our practice and profession at this time.

We have conducted a full risk assessment of our working environment and put in place measures to mitigate risk and fulfil our legal and regulatory obligations.

We are following Public Health England (PHE) COVID-19 Infection Prevention and Control (IPC) guidelines.

We are providing and using personal protective equipment (PPE) and have systems and policies in place that govern its use.

We maintain a “virtual first” approach with remote consultations, which remain standard practice during this period.

For each individual client, we will undertake a risk assessment and make a clinically reasoned decision for offering EITHER a face to face OR remote consultation for that session and each of their planned contacts. We will document rationale for these decisions.

We will engage our clients in discussions regarding the rationale for remote or face to face consultations. If both parties deem it necessary to proceed with face to face care, the client will be made aware of all current risks associated with this approach, and they must give their consent which will be documented.

*The workplace/environment:

Following a detailed risk assessment, the following plans are in place to minimise risk of virus transmission:

The main clinic entrance door will be blocked open so no clients are touching the door handle. They will also be able to wait outside the clinic if they wish until the therapist is ready for them. This will be agreed prior.

We will have a one way system through the clinic so the rear door will used for all clients to exit. Staff will open/close all doors within the clinic to avoid clients touching door handles.

Clinic toilets will be closed to clients. Staff use only. We have 4 toilets in the clinic so there will be no crossover of use by staff. There will be a maximum of 2 therapists in the building at any one time, and maximum of one client with a therapist (no other people allowed in to accompany the client). Appointments spaced so that there will never be a cross -over of clients/more than one client in any area at any one time.

One staff member per clinic room. Therapists will, where able and appropriate, maintain the 2 metre distancing between themselves and the client. ie subjective assessments and visual/observational objective assessments.

Between sessions all surfaces will be washed and wiped down with disinfectant clinical wipes, including plinth, door handles, chairs, desk, any equipment used. Time will be left between clients to allow for this.

Deep clean of whole interior of building twice weekly.

Contactless payment or remote payment only.

Adequate airflow through clinic with open windows.

*PPE for clients and staff:

On entering the waiting area, clients will be asked to use the disinfecting hand gel to thoroughly cleanse their hands (poster displayed showing how to use properly) and will then take and put on one of our face masks (single use).

All therapists will be wearing full PPE – face masks, visors, disposable aprons and gloves (latter if preferred by client -but handwashing and gel use before and after every client will remain standard practice).

All PPE meets essential standards as advised by PHE.

All PPE will be disposed of in lines with guidance, using double bagging and leaving 72 hours before placing in main disposal unit.

All therapists are fully trained in proper donning and doffing plus disposal of PPE.

The treating therapist will be responsible for making sure the client is wearing their own PPE appropriately.

*Staff uniform and additional laundry considerations:

All staff will put their uniform on in clinic and remove in clinic before leaving. All uniform will be put in carrier bag on removal to take home and washed immediately on a 60degree wash cycle. All staff will have clean spare uniform in clinic in case required.

We will not be using any couch covers in clinic. We will be using clinic paper towels to cover surfaces clients are lying on and then fully wipe down/disinfect after the session. Pillow cases will be changed between every client and bagged/washed that same day at 60degrees wash cycle OR waterproof pillows will be wiped down/disinfected between clients.

*Procedures for client bookings – “virtual first” approach:

All clients will be screened remotely first – either via video call or telephone.

Where appropriate, virtual/video consultations will be offered as a first step for assessments and treatments.

Where this is not appropriate, and it is agreed the client needs to come into clinic, a full risk assessment will be conducted pertaining to that clients’ potential for bringing COVID19 into clinic. If the risk is deemed high they will not be allowed to come in. This will be based on a series of screening questions, which will also be repeated on the day of the appointment, gaining information relating to symptoms, household members, other people outside of the household the client has been in contact with over a stated period of time.

All therapists will also need to complete the COVID-19 screening questions on a daily basis. Any risk detected of a therapist transmitting the virus will deem them unable to come into clinic.

All clients must demonstrate that they fully understand the potential risks of virus transmission, in spite of all the procedures in place at the clinic, and especially if they are in the high risk group. It must be agreed between both therapist and client that the risk to health of not treating them in clinic would outweigh the risk of getting the virus. All detailed discussions will be documented. All consent will be documented. We will not be asking clients to sign documentation in clinic due to risk of transmission through shared pen use – any forms that require signing will be distributed electronically to clients for return via email.

We are confident that the risk to clients and staff of contracting the virus from within our clinic premises is very low due to the stringent policies and procedures in place.

*Triaging/clinical reasoning:

As experienced physiotherapists, we will be using sound clinical judgement as to whether a client’s symptoms/presentation require them to come into clinic. Each client will be considered on an individual basis, but we do have a flow chart that we follow as guidance from our professional bodies. In essence, the client’s in-clinic treatment must be deemed “essential”, in so far that virtual/online consultations are not adequate/appropriate; i.e pain/dysfunction is impacting on daily life and not being controlled/eased with self-management nor pain medication.