CoVid-19

Back to Practice Guidance

for Manual & Natural Therapists

Overview

Back to Practice dates for Maunal Therapies by region:

England:  13 July, 2020

Northern Ireland: 06 July, 2020

Scotland: Unknown

Wales: Unknown

This guidance is not static and this page will be updated regularly as government guidance also makes updates. 

Most Recent Update 09 July, 2020

 

Please note: this guidance is of a general nature and should be treated as a guide, and in the event of any confclit between applicable legislation(including health and safety legislation) and this guidance, the applicable legislation shall prevail.

The ongoing COVID-19 pandemic spread to the United Kingdom in late January 2020. As of 11 June 2020 there have been 291,409 confirmed cases(1) and 41,279 deaths of confirmed cases,(2) the world’s second-highest death-rate per capita.(3)

Since that time, many industries have been forced by the government to close their doors, including Manual and Natural therapists and practitioners. 

There has been much uncertainty among therapists as to what the future holds for the CAM industry and the number of contradictory guidelines from professional bodies has only caused more confusion.  Many of these guidelines have been created without liaison from the appropriate government bodies, and were based on the guidance for Frontline Healthcare workers working in a high-risk environment.

APNT has had independent liaisons with several appropriate UK government departments to design this guidance; including: Department of Health & Social Care , Public Health England , Department for Business, Industry, & Industrial Strategy , Cabinet Office

Outside of creating this guidance, We have also worked in lobbying government within the Integrated Healthcare Collaborative. You can click here to learn more about the work we have done in this group. (will open in a separate window)

The aim of this guideline is to provide clarity about the current state and for the evolving situation specific to our industry.  With that said, this guidance is exactly that; Guidance. The CAM industry is not regulated and there is no professional body that overrides the advice of the government or your local public health authority. There is a possibility that we may encourage you to take more precaution than what the Government may mandate, but this advice would be purely advisory for yours and the industry’s protection. 

This Guidance is not intended to override or replace government guidance, and you are advised to contact your Local Public Health Authority for advise in your specific area to keep up-to-date and practising under guidance that maintains your insurance validity. (Click to open search for your local Public Health Authority in a new window: England, Scotland, Wales, N. Ireland, S. Ireland ).  

This Guidance is designed to help you:

  • Feel confident going back into practice
  • Protect yourself and your clients from possible infection
  • Design a risk assessment for your personal circumstances
  • Have access to the relevant resources for practice and within your clinic

Who is this guidance for?

This Guidance is aimed at remedial and therapeutic therapists with a minimum Level 3 Qualification. This guidance is designed for all of APNT’s core therapies working on a 1-to-1 basis, including, but not limited to:

  • Therapeutic Massage
  • Remedial Massage
  • Pregnancy Massage
  • Sports Massage
  • Reflexology
  • Bowen Technique
  • Myofascial Release 
  • Yogatherapy (1 to 1)
  • Seated Acupressure

This Guidance is NOT intended for beauty therapists working in a spa setting, or movement therapies that induce heavy breathing or that work in group settings.

APNT Facebook Live - 28 June, 2020

Risk Assessment

Each therapists circumstance is likely to vary from the nature of their modality to the setting that they work in.  Someone who is working mobile or with clients who are deemed to be vulnerable will have a higher-risk situation than those working in a clinic with a controlled environment with non-vulnerable people.

The use of PPE etc will vary depending on your personal circumstances, therefore it is paramount that each individual therapist performs their own personal risk assessment for their environment as well as for each individual client.  This section of this guidance is designed to give you the confidence to do so.

Working with the public, you have a responsibility to protect people from harm. This includes taking reasonable steps to protect your clients and others from coronavirus. This is called a risk assessment and it’ll help you manage risk and protect people.

You must:

  • Identify what work activity or situations might cause transmission of the virus
    think about who could be at risk
  • Decide how likely it is that someone could be exposed
  • Act to remove the activity or situation, or if this isn’t possible, control the risk
  • You don’t have to write anything down, but it might help if you do. Especially for insurance purposes

We encourage you take practical measures, such as:

  • Putting in place social distancing measures where possible
  • Staggering shifts in multi-disciplinary clinics
  • Providing additional hand-washing and hand disinfectant facilities
  • Identify areas of high-traffic and hand contamination – such has stairways and bathrooms
  • Consider Natural Ventilation in the room

We highly recommend against waiting rooms and instead encourage clients to wait outside the premises and to be called in for their appointment.  

Appointment times should be staggered by a minimum of 30 minutes which should further remove the need for a waiting room.

A detailed client risk assessment needs to be done in addition to your regular consultation to determine risk to both you and your client and if treatment should be undergone. 

You should additionally check with your client the day of treatment to make sure nothing has changed in regards to symptoms.

There is a client Risk Assessment form in the Downloads section, but here we will walk you through the reasons or meaning for the questions and their answers:

Have you or anyone in your household ever been diagnosed with Covid-19?

If client or anyone in their household has previously been diagnosed with Covid-19, then significant research shows that there is a possibility they could be suffering with blood clots, so your pressure should reflect this possibility.

Have you or anyone in your household shown any of the following symptoms in the last 7 days?

If the answer to this question is yes, then the treatment can not continue until after 2 weeks of isolation with no symptoms in the household.  Your client notes should reflect this.

Have you or anyone in your family been advised by the government as being clinically vulnerable and to shield?

If the answer to this is yes and client is the vulnerable one, and social distancing is still in place, then treatment should only happen if you can demonstrate that the client  is considered to be in ‘high-level’ need of treatment where quality of life would deteriorate without treatment.  Both client and therapist are advised to wear a face covering in this situation.

If their family member is the vulnerable one, this does not mean you need to avoid treatment, but you should be aware that if social distancing is still in place, treating this person would be an elevated risk and both parties would be advised to wear a face covering. 

If the client chooses not to wear a face covering, this should be noted.

Even if social distancing is lifted, extra care should be taken when treating vulnerable or shielding clients.

Are you or anyone in your family currently suffering from: (clinically vulnerable list)

If the answer to this is yes, please follow the same advise as previous question.

Have you recently travelled abroad?

If travel was within 7 days, treatment should be avoided until after 7 days has passed.  This should be noted.

Have you noticed any new rashes on your body or feet?

Rashes on the body and feet have been shown to be related to severe cases of covid-19.  Although the research isn’t definitive, there have been links that if someone has these rashes and marks they may also be susceptible to post-covid blood clotting. 

For Massage, this should be deemed a potential contraindication and you should ask the client to consider getting GP clearance, first.

For other modalities such as Reflexology, extra care should be given and pressue should be very light. Yogatherapy should also take this into consideration.

Have you experienced any pain or cramping in your legs/calves?

If the answer to this is yes, then treatment is contraindicated for all therapies and client should be advised to get GP Clearance

Do you promise to contact your therapist immediately if you or anyone in your household develops symptoms associated with covid-19 within 7 days of your treatment?

Please check below guidance for what to do in case of infection.  Explain to your client the protocol that will be taken in this case.

If anything changes between now and your appointment time, do you promise to inform your therapist before your appointment date?

Do not depend on your client to update you 🙂 Inform them that you will call/text/email them the day of their appointment to check that nothing has changed.

 

The last 2 replies are very important to communicate as they may contradict your current GDPR rules.  You should also inform client that track and tracing apps could pose a client confidentiality and GDPR risk.

It is important that talking is kept to a minimum during treatments. So, to reduce talking and to maximise the effective use of your face-to-face time together, we recommend that consultations are done virtually before the live appointment session.

For Established clients:

  • Sessions must be held over a video conferencing application such as skype or zoom (or a similar application) where you both can see and hear each other.
  • The same levels of privacy and client confidentiality must be respected as if you were in clinic.  (i.e., sessions are not to be held in the same room as your partner, children, etc)
  • You must have a way to contact the client should you become disconnected through Zoom, such as a telephone, etc.  You do not want to leave them abandoned in the middle of a session.
  • Both yourself and the client must be confident that they understand the self-care techniques you have provided them and are able to practice them safely once the session has closed.
 

For New Clients:

  • All of the above, plus an additional thorough online client consultation.
  • With clients that you have never worked with face-to-face, common sense should be used and only the lowest of risk techniques should be used with them.
 

The above is basic advice, but we advise you to contact your insurance company to discuss your personal circumstance before engaging in virtual consultations and offering self-care advise.

 

Where your therapy requires posture assessment, you might want to additionally consider applications such as posturescreen mobile to assisst you. 

Clients should also be advised beforehand of the new protocols by email or text, such as:

  • Additional measures you are taking for their safety
  • If they usually wait in your waiting room, then advise that the waiting room will be closed
  • Online payments
  • New GDPR considerations, including the potential use of track and trace applications and the contact that will be required if your clinic should face a contamination.

Last Updated 09 July, 2020

  • While social distancing is still in place, we advise treating those who are deemed clinically vulnerable only in an urgent-need basis where not having treatment would cause detrimental deterioration to their condition. (i.e. vulnerable person in therapy for stroke rehab)
  • After social distancing is lifted, as well as in the case for before, we advise using visor, face coverings and gloves when working with this particular group.

We also advise to schedule vulnerable people at the beginning of your working day, whenever possible.

Who is classified as a vulnerable person?

Expert doctors in England have identified specific medical conditions that, based on what we know about the virus so far, place some people at greatest risk of severe illness from coronavirus. Disease severity, history or treatment levels will also affect who is in this group.
Clinically extremely vulnerable people may include:

  • Solid organ transplant recipients.
  • People with specific cancers:
    • people with cancer who are undergoing active chemotherapy
    • people with lung cancer who are undergoing radical radiotherapy
    • people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
    • people having immunotherapy or other continuing antibody treatments for cancer
    • people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
    • people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
  • People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD).
  • People with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell).
  • People on immunosuppression therapies sufficient to significantly increase risk of infection.
  • Women who are pregnant with significant heart disease, congenital or acquired.
  • Other people have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs.

GPs and hospital clinicians have been provided with guidance to support these decisions.

More information about who has been classed as clinically extremely vulnerable is available on the NHS Digital website.

If you’re still concerned, you should discuss your concerns with your GP or hospital clinician.

For more info:
https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

Updated 09 July, 2020

First and foremost:

We deem this environment to be the highest risk for therapist.  While Social Distancing is still in place, we advise limiting mobile treatments only to urgent-care need clients.

No work should be carried out in a household which is isolating because one or more family members has symptoms.

When working in a household where somebody is clinically vulnerable, but has not been asked to shield, for example, the home of someone over 70, prior arrangements should be made with vulnerable people to avoid any face-to-face contact, for example, when answering the door. You should be particularly strict about handwashing, coughing and sneezing hygiene, such as covering your nose and mouth and disposing of single-use tissues.

We advise to Communicate with households prior to arrival, and on arrival, to ensure the household understands the social distancing and hygiene measures that should be followed once work has commenced to minimise risk for all parties.

In this instance, we advise the use of a visor, face covering and gloves  by the therapist.  Government Guidelines for using the bathroom of another household still varies across regions, so to avoid confusion, in this time we advise the stringent use of hand sanitisor.  You are advised not to sit in furniture and to consider a change of clothes between clients.  Remember, hands should be thoroughly sanitised after removing gloves, and before and after removing your face covering.  

Linens must stored in a sealed bag or container until they are washed.

Full sanitation of all items brought into the home of the client needs to be considered.

PLEASE CHECK WITH YOUR INSURANCE BEFORE ENGAGING IN MOBILE TREATMENTS.

For further information, you can view the government’s guidance on working in other people’s homes

Updated 9 July, 2020

First and foremost:

We deem this environment to be very high risk for both client and therapist. If the government allows the CAM industry back to work while social distancing is in place, we advise limiting in-home clinic treatments only to high-level need clients who are not in shielding or deemed clinically vulnerable and only if your own household does not contain someone who is vulnerable or shielding.

At this time, to maintain cohesive recommendations across regions, you must limit to a maximum of 2 clients per day, and you are not to mix any other households in your home in that same day.

Hand sanitisor should be provided for the client, and until all devolved government guidance allows for the use of using the bathroom in the home of another, we are advising against the client’s use of your bathroom within your home. If there is a sink within your treatment room, then this is fine for use. 

No work should be carried out in a household which is isolating because one or more family members has symptoms.

When working in your home with somebody who is clinically vulnerable, but has not been asked to shield, for example, someone over 70, prior arrangements should be made with vulnerable people to avoid any face-to-face contact, for example, when answering the door. You should be particularly strict about handwashing, coughing and sneezing hygiene, such as covering your nose and mouth and disposing of single-use tissues.

We advise to Communicate with clients prior to arrival, and on arrival, to ensure the client understands the social distancing and hygiene measures that should be followed once work has commenced to minimise risk for all parties.

In this instance, we advise the use of a face covering and visor  by the therapist.  It is advised that clients do not to sit in furniture and to also change clothes between clients.  Remember, hands should be sanitised, and preferably washed before and after removing your face covering

PLEASE CHECK WITH YOUR INSURANCE BEFORE ENGAGING IN TREATMENTs FROM YOUR HOME

For further information, you can view the government’s guidance on working in other people’s homes

Last Updated: 09 July, 2020

This guidance is covering a  range of modalities and some will pose much less risk than others, so we are going to try and help you to risk assess the nature of the therapy you practice.  Your individual circumstance may vary, and this assessment is under the pretense that you are treating a non-vulnerable client in a controlled environment (i.e. in a clinic, not mobile), so please just use this assessment as a simple guidance to help you consider the risks you should be looking to consider in your own work.

Government Guidance for Close Contact Indicate that the first line fo defense for protection is Ventilation and Reduced Treatment Time in enclosed spaces.  Further PPE is indicative of your risk assessment and circumstances

Please read this section of guidance along with other sections as it does not give a complete picture.

  • Therapeutic, Remedial, and Sports Massage – Low-Risk
    • Virtual Consult, virtual payments, virtual rebooking.
    • Clinic time reduced to maximum 45 minutes in enclosed environment (treatment outside where possible, such as onsite sports massage, can exceed 45 mins)
    • Therapist should familiarise themselves with the post covid skin rashes for those who developed respiratory symptoms.
    • Evidence has suggested that blood clots could be a post-covid symptom.  So if client previously had covid, then very light pressure should be used.
    • Skin-to-skin contact reduced. (i.e. consider and try to reduce techniques that exceed hands [such as forearm] wherever possible)
    • AVOID touching or treating around the face – no neck treatments supine.
    • Hands should be treated last.
  • Pregnancy Massage – low-risk
    • According to the Royal College of Obstetricians and Gynecology, all evidence suggests that pregnant women are at no greater risk of becoming seriously unwell that other healthy adults if they develop coronavirus. 
    • Virtual Consult, virtual payments, virtual rebooking.
    • Clinic time reduced to maximum 45 minutes
    • Skin-to-skin contact reduced. (i.e. consider and try to reduce techniques that exceed hands [such as forearm] wherever possible)
    • As treatment is side-lying, ensure all cushions have washable removable covers.
    • AVOID touching or treating around the face – no neck treatments supine.
    • Hands should be treated last.
  • Reflexology – Low-Risk
    • Virtual Consult, virtual payments, virtual rebooking.
    • Clinic time reduced to maximum 45 minutes in enclosed environment
    • AVOID touching or treating around the face.
    • Therapist should familiarise themselves with the rashes such as ‘covid toe’ which have been reported to those who have had covid with respiratory symptoms
    • Hands should be treated last.
  • Bowen Technique – Low-Risk
    • Virtual Consult, virtual payments, virtual rebooking.
    • Clinic time reduced to maximum 45 minutes in enclosed environment
    • Therapist should familiarise themselves with the post covid skin rashes for those who developed respiratory symptoms.
    • Skin-to-skin contact reduced. Clothed if possible. 
    • AVOID touching or treating around the face – no neck treatments supine.
    • Hands should be treated last.
    • As Bowen Therapists leave the room, provisions for hand sanitising before and after touching the door handle need to be considered both when exiting and entering.
  • Myofascial Release – Low-Risk
    • Virtual Consult, virtual payments, virtual rebooking.
    • Clinic time reduced to maximum 45 minutes in enclosed environment
    • Therapist should familiarise themselves with the post covid skin rashes for those who developed respiratory symptoms.
    • Skin-to-skin contact reduced. (i.e. consider and try to reduce techniques that exceed hands [such as forearm] wherever possible)
    • AVOID touching or treating around the face – no neck treatments supine.
    • Hands should be treated last.
  • Yogatherapy (1 to 1) – Low Risk
    • Virtual Consult, virtual payments, virtual booking.
    • Maintain a social distance during session
    • Because of nature of breathing for this therapy, while social distancing is in place, we recommend a face covering worn by the therapist and by the client at their own discretion.
  • Seated Acupressure – Low Risk
    • Virtual Consult, Virtual payment, virtual rebooking
    • Disposable chair covering where possible
    • Plastic disposable facecover where possible

PPE & Precautionary Recommendations

The use of PPE will be dependent on your personal circumstance and risk assessment (which is in the above section)

WHO official guidance says people need only to wear PPE if they have Covid-19 symptoms are are caring for someone who does. With that said, we are advising therapists to avoid treating those with suspected Covid-19 and to keep medical grade PPE use to a minimum.

The below PPE recommendations are based on the current risk level of the UK and under the pretense that we may begin practice before social distancing is lifted.  In the case that our return to work is postponed until after social distancing measures are lifted, then we will likely see recommendations further reduced.  

Each region’s government is likely to have different start dates, in different phases, and with different stringency of PPE use.  So, to keep our guidance cohesive to cover all regions, we will be offering guidance on the side of caution.  Where relevant, we will inform the different guidance in each section as it becomes available.

Additonally, check with your local public health authority for what they specifically advise.

Last Updated 3 July, 2020

This area of guidance will be updated as threat level in the UK reduces

The UK government is currently advising against the use of medical grade facemasks in low-risk settings working 1-to-1 with member’s of the public who have been screened and do not show signs or symptoms of CoVid-19, but instead recommend the use of ‘face coverings’ due to the current shortage of facemasks.  The setting that our industry is advised to work in is considered very low-risk, Therefore we are advising against the use of medical grade face masks.

Some of the authorities we have spoken with have offered contradictory advise as to the use of face coverings.  We must express that some authorities have informed us that they are concerned that a face covering may give a false sense of security and may encourage touching of the face and spread of contamination in our particular industry.

Other authorities feel that the close nature of our industry and the time spent together, it would be advisable to wear a face covering.

In this moment, at the current risk level in the UK, the amount of time therapists will be in close proximity with their clients, and under the presumption that we may return to work before social distancing has been lifted, we are recommending therapists to wear washable and re-usable face coverings that are to be changed in-between clients in the following instances:

  • Poorly ventilated rooms
  • Treatments exceeding 1 hour
  • Working extended period around the face with client supine
  • When working with particularly chatty clients. 

Scotland’s Guidance requires Therapist to wear a Face Covering in all situations.

We are advising that the client’s use of a facemask or face covering will be at their own personal choice and discretion.

Where client’s are considered vulnerable, a face covering is recommended to be worn by both parties, but is still down to client discretion.

Wearing a facemask alone will not protect you or your clients from CoVid-19, and it is paramount that you stay on-top of your hand sanitation and, ventilation of the room, and reduced treatment time where possible. You will be required to wash your hands before and after putting on and taking off your face covering, and if you accidentally touch your mask in the middle of a treatment, you must wash or sanitise your hands immediately.

Click below to open a new window with government guidance which will teach you:

Last Updated 3 July, 2020

The government guidance for close-contact services indicates  a requirement for use of visors when treating around the face.  Because of the nature of most manual therapies, where treatment may move from lowerbody to upper in one session, we are advising the use of a visor as mandatory.  

Even therapies such as reflexology where the therapist is ata  distance from client’s face, we will recommend a visor as this will protect you if the client sneezes, for example. 

Additionally, it is thought that it will reduce the liklihood of therapist touching their face

Due to PPE Shortage, we are recommending those who choose to wear visors consider re-usable visors that they decontaminate. 

Last Updated 9 July, 2020

Based on the liaisons we have had with several bodies, we are not advising the use gloves for most therapists, but instead are advising increased hand hygiene.  If a therapist prefers to use gloves, then this is not discouraged.

There are instances where gloves are deemed as mandatory,  Such as:

Working mobile due to less hand sanitising opportunities, but please first review the risk assessment section for working mobile.

Working with Clients deemed as Clinically Vulnerable

But besides vulnerable groups:

The NHS says that items like face masks and gloves play a “very important role” in a clinical setting but there is “little widespread evidence” that they are useful for members of the public.

Public Health England (PHE) and the World Health Organisation has also not recommended people wear gloves or face masks to protect themselves.

A spokesperson for PHE has told several agencies: “PHE is not recommending the use of gloves as a protective measure against COVID-19 for the general public.
“People concerned about the transmission of infectious diseases should prioritise good personal, respiratory and hand hygiene.”

Public Health England says: “The best way to protect yourself and others is: wash your hands with soap and water, or use a sanitiser gel, regularly throughout the day. Catch your cough or sneeze in a tissue, bin it, and wash your hands.

WHO says the best way to prevent spread is to wash your hands frequently with alcohol gel or soap and water.

We advise washing your hands frequently including but not limited to:

  • Before interaction with client
  • immediately after treatment
  • After client leaves
  • After sanitation of treatment area
  • Before next client interaction

If it is not possible to wash your hands after treatment without causing contamination throughout your setting, then hand sanitisor should be used before going to wash your hands. 

Hand Washing should extend to the forearm

Hand Washing Specification:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/878195/Hand_Wash_Specification.pdf

Laste Updated 11 June, 2020

Due to the low-risk environment that therapists will be working in, we recommend that the use of aprons should only be considered when working with clients considered vulnerable.

This is a fully discretionary option.

Therapists should already be used to a high-level of sanitation within their treatment premise, but in this instance we are advising to make a few extra considerations.

  • Minimise ‘nick-knacks’ and items that clients may touch or pick up such as samples.
  • If offering drinks or water, use disposable cups or bottles that the client can take with them.
  • Minimise use of excess linens such as towels
  • Reduce the opportunity for clients to touch door handles
  • Encourage the use of hand-sanitising alcohol immediately upon client arrival and on exit.
  • Linen and Garbage should be kept in sealed containers
  • Contact your local public health authority to see if they advise you of special disposal of PPE items.
  • Linens should only be exposed when entering washing machine and should be washed at a minimum of 60 degrees Celsius
  • Because of the risk of saliva getting onto face rests, we recommend face rests have disposable plastic covers in addition to linen covers that are both changed between clients.
  • Therapists should allow a minimum of 30 minutes between clients to allow the room to fully ventilate.

In the case of working Mobile, FULL sanitation of all items brought into the home of client need to be considered.

Further government sanitation advise:

Click Here for Government Guidance on Routine Decontamination

Last Updated 9 July, 2020

The Govt Guidance for Close Contact Services is working from the basis that there is substantial evidence that shows an increase chance of infection the longer a person spends in a closed space.  Therefore, a spokesperson from PHE has recommended that sessions are kept to a maximum of 45 minutes. 

Reduced treatment times is considered one of your first lines of defense in protection of yourself and clients.

It is also worth considering that track and tracing apps will be very focused on areas with traffic where individuals are spending a significant amount of time.

Consultations and assessments should be done prior to client arrival, and we highly recommend that talking during treatment is kept to a very bear minimum. especially in the case where the client is not wearing a face covering. There is more than enough substantial evidence showing that talking in enclosed spaces over long-periods drastically increases the risk of spread.  Even more so when in combination with deep breathing inhalations.

While social distancing is in place, where possible, we also recommend leaving at least 1 day between working days.  The reason for this is that if you or one of your clients were to become infected, this minimises the spread and allows for any symptoms to show.

Last Updated 3 July, 2020

The govt Guidance for Close Contact Servies is working from the basis that there is substantial evidence that shows that ventilation reduces the risk of infection in an enclosed space. 

Ventilation is considered one of your first lines of defense to protect both you and your clients and is the first element that an HSE officer would look for when visiting your premises.

  • Natural ventilation will be your best option, and where possible an air purifier. 
  • Air conditioner that supplies air
    from directly outside
    *Air conditioners that supply entire buildings should be avoided
  • In the case windows and external
    unit is not possible, there should be
    a fan at the door circulating fresh air
    into the room; even if air is from from
    a hallway.

Studies have shown that the best ventilation would be hybrid (mixed-mode) ventilation but generally this is not an option for most people.  

30 minutes should be allowed between each client to allow the room itself to ventilate as much as possible.

reference: https://www.ncbi.nlm.nih.gov/books/NBK143278/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7180358/

We highly recommend that you are making a daily checklist of the precautions, considerations, as well as concerns for insurance purposes.  In the case that yourself or a client were to become contaminated and was seeking liability, you will have proof to show that you have taken every measure possible to look after client safety.  This will also be the case should track and tracing show a ‘hot spot’ over your clinic.

Where possible:

  • We highly recommend that both payments and notes are moved digitally to reduce all possibilities of cross-contamination and to reduce time and movement within treatment space.
  • We advise digital note keeping to minimise movement within clinic.
  • We advise using a program designed for holding notes as to maintain GDPR standards – Acuity is a very popular choice amongst therapists, but there are several choices.
  • Therapist and client need to be made aware of the use of track and tracing apps and the effect that this will have on GDPR and client confidentiality. 

In Case of Infection

While Covid-19 is present in the UK the risk of infection for you and your clients is going to be possible even with the highest preventative measures in place.  If our industry is allowed to go back to work before social-distancing levels have been lifted, then there will be an increased risk of infection.  With that said, it is paramount that you have a plan and protocol in place should you or one of your clients become infected.

This section of guidance should be used in the case that:

  • Therapist becomes infected or shows symptoms
  • Someone within the household of therapist becomes infected or shows symptoms
  • Client becomes infected or shows symptoms
  • Someone within the household of client becomes infected or shows symptoms
  • Someone within clinic becomes infected or shows symptoms

Should any of the above show signs or symptoms, then anyone you have treated within the 7 days either side of symptoms should be contacted to inform them and to find out if they have had any symptoms and to contact you immediately if they do. 

If it is a client who has contacted you, then you need to inform them that you will have to report their symptoms to the government’s health protection team

If You or someone within your household is the one who is showing symptoms, you are to immediately close your clinic and self-isolate for 2 weeks. Entire clinic should be decontaminated by a professional cleaning company.

If one of your clients or someone within their household become infected or shows symptoms then you should consider isolating for 7 days in case you or an additional client begin to show symptoms. Entire clinic should be decontaminated by a professional cleaning company.

If someone within your clinic or the client of someone else within your clinic is showing symptoms but you nor any of your clients are showing symptoms, then that person should refrain from returning into clinic for 2 at least 2 weeks, and entire clinic should be decontaminated by a professional cleaning company.  

In all instances, those showing symptoms of being infected should report their symptoms to the UK’s Health Protection Team

If the person showing symptoms is yourself or one of your clients, then you should additionally explain the professional circumstance to the Health Protection Team.

Frequently Asked Questions

This is by far the most common question being asked in forums.  Please understand that we are updated on this answer in the same way that you are; by government updates.  Some regions are not announcing dates for their phasing of easing out of lockdown.

Back to Practice dates for Maunal Therapies by region:

England:  13 July, 2020

Northern Ireland: 06 July, 2020

Scotland: Unknown

Wales: Unknown

 

A common question and frustration we have seen is that Therapists do not understand why Physios, Chiros, and Osteos are deemed as essential and able to practice when our industry is not, even though the close nature of the work is the same in terms of risk.  

The reason these professions  come under different government regulations is because they are degree level qualifications and Protected Titles that are statutorily regulated under their respective bodies and councils.

There is no modality in the  CAM Industry that this guidance is aimed at that holds a Protected Title of Statutory Regulation.  This includes members of the CNHC.

There is a possibility that Hairdressers will be allowed to go back to work before our particular industry, and before social distancing is lifted.  This is the roadmap that several other EU countries have taken also.  We realise your frustration in that, for health purposes, this makes so logical sense, and the answer will be even more frustrating; They are simply seen as more essential of a service in the wider public domain.  

If you practice a therapy that allows you to provide self-care to your clients, then by all means you are able to practice online. 

For Established clients:

  • Sessions must be held over zoom (or a similar application) where you both can see and hear each other.
  • The same levels of privacy must be respected as if you were in clinic.  (i.e., sessions are not to be held in the same room as your partner, children, etc)
  • You must have a way to contact the client should you become disconnected through Zoom, such as a telephone, etc.  You do not want to leave them abandoned in the middle of a session.
  • Both yourself and the client must be confident that they understand the self-care techniques you have provided them and are able to practice them safely once the session has closed.

For New Clients:

  • All of the above, plus an additional thorough online client consultation.
  • With clients that you have never worked with face-to-face, common sense should be used and only the lowest of risk techniques should be used with them.

The above is basic advice, but we advise you to contact your insurance company to discuss your personal circumstance before beginning to online work.

If you want more support in taking your practice online, then we highly recommend a very thorough course from our affiliate school, Blend Therapy & Training’s  Take Your Practice Online.

We understand and appreciate your concerns, and support you being safe over sorry.  There is a possibility that our industry will not be allowed to practice until after social distancing measures have been lifted; which may not be until August or September.  With that said, the UK government is offering income support extended into September. 

More information for fincial support for small businesses by region can be found at:

https://www.gov.uk/coronavirus/business-support

https://findbusinesssupport.gov.scot/coronavirus-advice

https://dbei.gov.ie/en/What-We-Do/Supports-for-SMEs/COVID-19-supports/Government-supports-to-COVID-19-impacted-businesses.html

https://www.nidirect.gov.uk/articles/coronavirus-covid-19-businesses-and-employers

https://businesswales.gov.wales/coronavirus-advice/support/financial-support-and-grants/covid-19-grant

CAM in the UK is not regulated and unfortunately all of the Professional Bodies work on an individual basis.  Although we come together in some cases under the GCMT and the Integrated Healthcare Collaborative, in this particular instance, APNT was not in agreement with the way that our group and umbrella representations were sourcing information and/or putting together their guidance, so we decided to use our own government relationships to create our own guidance.  

We will note once again that None of the PA’s are providing you with regulatory rules, including us.  It is merely guidance to help you gain clarity and confidence to go back t practice, but it does not override the advise of your Local Public Health Authority.

We realise that for those of you who work in a purely remedial way that this is a very frustrating time.  You know that your clients depend on you, and in some cases it could lead to a detriment to the quality of life for some of your clients.  Unfortunately, though, because CAM is not regulated to a national standard, there is no way for the government to deem a particular sector of CAM as essential. 

This will be a very frustrating answer, but unfortunately, those of you who are trained to Level 5 and above are in the same category as a weekend beauty therapist in the governments eyes in terms of being essential and where to categorise you.  

If you have a client who’s physical health would deteriorate to a detrimental state without regular treatments (i.e stroke rehabilitation) and you can prove through a GP referral that all avenues have been exhausted and your treatment is deemed essential, then it is possible (although not guaranteed) that you can contact your Local Public Health Authority to be granted the ability to treat that particular client on an individual basis.  You must have written proof of this permission, otherwise you will not be covered on your insurance and may face government penalties.

To find your local Pubic Health Authority, Click on the relevant region: England, Scotland, Wales, N. Ireland, S. Ireland

No, this guidance is not mandatory regulation nor is any guidance from ANY Professional Association.  Why? because our industry is not regulated and there is not a single governing body.  After speaking with several government bodies and insurance companies, your most authoritative guidance will come from your LOCAL Public Health Authority. 

To find your Local Public Health Authority, click on your region for a new window to open and select your local area to find your Local Public Health Authority:  England, Scotland, Wales, N. Ireland, S. Ireland

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