COVID-19: Frequently Asked Questions

 

The FAQ’s below are in line with current Government advice, NHS guidance and in alignment with other professional bodies for healthcare professionals operating in private practice and is correct at the time of publication.

 

 

 

 

 

Your questions:

Infection Control and PPE
What adaptations do I need to have in place to operate as a result of the Coronavirus?
  • You must have undertaken a risk assessment of the working environment for which you are responsible, and demonstrated how you have mitigated these risks, and recorded these.
  • You must ensure effective infection prevention and control measures, including access to personal protective equipment (PPE).

To enable you to put these steps in place, please review the guidance available from COVID Hub Adapting Your Practice.

Reviewed: December 2021

 

Do patients have to wear a face-covering during osteopathic consultations/treatment?

Government guidance has indicated that health and care settings must maintain appropriate infection prevention and control processes as necessary in line with the guidance issued by the public health bodies of England and the home nations.

Patients should be encouraged to wear a face mask or face covering during the consultation unless they are unable to tolerate its use and are exempt. Exceptions for the use of face coverings by the public are listed here.

If patients do not wear a mask or face covering, then it is recommended that practitioners wear a visor/eye protection.

Updated: December 2021

 

What if a patient is unable or unwilling to wear a face-covering?

If patients do not wear a mask or face covering, then it is recommended that practitioners wear a visor/eye protection.

As private enterprises, osteopathic clinics may wish to apply a policy where if a patient is unable or unwilling to wear a face-covering, they may not be able to receive treatment due to the close contact required and the risk of transmission.

Should you wish to apply such a policy, we recommend:

  • This is clearly communicated and made widely available to all current and prospective patients before appointments are booked,
  • You published your policy on your website and other clinic information materials.

We would also suggest that if you choose to put such a policy in place, you should make every effort to support the patient to find appropriate care. This could be by:

  • Offering a telephone/virtual consultation,
  • Recommendation to an alternative practitioner or clinic that is able to provide treatment
  • Referral to their GP for access to NHS services.

In addition;

  • You may wish to advise at the time of booking that you require the use of a face-covering unless they state they are exempt.
    • Patients do not need to reveal the details of their exemption but they can in broad terms answer, for example, that they have a disability. (Many people now carry a card or lanyard explaining their reason for not wearing a mask).
  • You can explain that the policy is in place to protect staff, who themselves may fall into vulnerable categories, and that it is your responsibility to balance the risks posed to staff against the patient’s interest in receiving treatment.

There have been concerns expressed that refusal to treat a patient who does not wear a mask may run the risk of being seen as disability discrimination.

While there is currently no case law on this issue, in the event of a complaint, following the advice and providing alternatives as suggested would be evidence that you have tried to make reasonable adjustments and therefore not acted in a discriminatory manner but in the interests of the health and safety of your staff and other patients

Reviewed: December 2021

 

What is the guidance on the use of PPE in osteopathic practice?

Based on the latest guidance issued by PHE and applicable for health and community care settings,  the  PPE recommended for use by osteopaths where they are providing direct care within 2 meters of a patient is:

  • IIR Fluid Resistant Surgical Masks – Sessional use (up to four hours) or sooner if soiled or damaged.

On risk assessment basis on anticipated exposure of body fluids/blood

  • Gloves and aprons – Risk assessed for above or if in contact with a confirmed case of SARS-CoV-2.
  • Visors/eye protection - Risk assessed for above or if patients are unable to tolerate a face mask or covering

When using PPE as per the recommended guidance, practitioners will not be required to self-isolate should they be contacted by NHS  contact tracing agencies and informed that they have been in contact with an individual with a suspected or confirmed case of COVID 19 in their professional, clinical setting.

For full guidance on infection control and PPE in osteopathic practice, visit our COVID-19 guidance here.

Updated: December 2021

 

What type of surgical mask should I be using?
  • Fluid Resistant Surgical Masks (FRSM Type IIR) are the most appropriate option and provide the level of protection required in most osteopathic contexts - UKHSA advice. 

The following can be used if the above is not available, although these are more expensive. Please note that the below types of mask must be fit-checked (according to the manufacturer’s guidance) to ensure an adequate seal and fit has been achieved. More information can be found by clicking here.

  • In the absence of a supply of FRSM IIR, the next grade up can be used - a Filtering Face Piece respirator FFP2 (also referred to as N95)
  • From June 2020, the Health and Safety executive has removed KN95s from their list of appropriate PPE.
  • In the absence of a supply of FRSM (IIR) or FFP2, the next grade up can be used - FFP3 respirators - these are more expensive.
  • Respirators (FFP2 and 3) must be fit checked (according to the manufacturers’ guidance) to ensure an adequate seal has been achieved
  • Facial hair should not be allowed to interrupt the respirator’s seal (PHE advice)

IMPORTANT: Once your order has been received, please check that the box and/or masks are labelled as the correct grade i.e. IIR masks should be labelled as such.

Reviewed: December 2021

 

What do I need to know about using PPE correctly?

There is specific guidance on how to ‘don’ and ‘doff’ PPE. The following video (published 2 April) provides the most up-to-date advice on donning/doffing PPE, including the type of PPE osteopaths need in private practice. You can also refer to the iO’s infographic on the use of PPE in osteopathic practice on how to put on and take off standard PPE by clicking here.

Gloves and aprons should be changed after each patient and disposed of as per the guidance. According to the Government / UKHSA guidance, surgical masks can be used for session work rather than single patient contact. In NHS terms, ‘1 session’ is usually considered a half-day or up to 4 hours.

IMPORTANT: If the mask gets wet from breathing, is contaminated or damaged, you will need to take it off sooner.

Dispose of your PPE in ‘double-bagged’ plastic bags, and keep away from all other rubbish for at least 72 hours prior to collection by your local authority. Please check with your local authority for any specific guidance in your area.

Reviewed: December 2021

 

Is my insurance invalid if I do not use PPE?

We have been working with our insurance partners and in liaison with other insurers who provide Professional Liability Insurance to the osteopathic profession throughout this process, to enable you to adapt your operations with safe practice protocol in place.

They require osteopaths to abide by legal and regulatory requirements and make safe and appropriate clinical decisions about their work based on the best practice guidelines, including those for infection control in osteopathic practice.

They will expect practitioners to take all reasonable steps to follow best practice advice to reduce the risk of infection, and if you choose not to use PPE, you will need to justify and record your clinical reasoning for your decisions.

Reviewed: December 2021

Do I need to allow fallow time between patients?

It is no longer considered necessary for osteopaths to maintain a fallow period for aeration after each patient. However, it is still recommended that enough time is left between patients to allow for a thorough cleaning regime of the clinic room to be undertaken in line with the guidance previously published.

It is recommended that osteopaths perform an air exchange of the clinical environment at the end of a session of use (i.e. during breaks and at the end of the day) or while decontaminating the full environment which will common areas as well as treatment rooms.

Reviewed: December 2021

 

How has the iO guidance been developed?

All the iO guidance has been developed taking into consideration Government guidelines and legal frameworks required of regulated healthcare professionals in line with other healthcare professions operating in the private health sector, and in close dialogue with both the regulator and insurers, so as to outline best practice in osteopathic care.

Updated: 19 May 2020

Operating Your Practice
What is the current guidance on the pre-screening of patients?

The infection control guidance for healthcare settings states that ‘screening for early recognition of patient COVID-19 should be undertaken wherever possible prior to attendance’. We therefore would recommend that clinics continue to screen patients for symptoms of COVID, and/or contact with those confirmed with COVID. There is a useful screen tool with the questions to be asked available from here. This can be prior to arrival at the clinic, or as soon as possible on arrival.

Updated: 4th February 202

I’ve been contacted by test and trace and been listed as a contact. Should I be self-isolating?

If you are fully vaccinated, you are not legally required to self-isolate if you are notified by test and trace as a close contact with someone with COVID-19 from a social setting. If you are not vaccinated, you must self-isolate if NHS test and trace advises you to do so.

If the contact has occurred in the healthcare setting and you have been wearing the correct PPE in accordance with the UKHSA guidance, you will not be considered a contact for the purposes of contact tracing and isolation.  Should you need to evidence that you need to be managed as a healthcare professional with contact tracing, please use the Test and Trace template letter. This can also be used with your local Health Protection Team, or any other body as required.

As a healthcare worker, if you have been identified as a contact you should take a daily lateral flow device (LFD) test before starting work for the 10 days since you last saw the person who tested positive. If you live with the person who tested positive, the daily LFD tests start from the date of their first symptoms, or their positive test if they do not have symptoms.

If you have symptoms of COVID-19 you should isolate immediately, take a PCR test and follow government advice for those with symptoms.

This UKHSA guidance was updated on 15 December is applies to NHS Test and Trace in England.  Test and Protect in Scotland issued similar guidance on 15 December

Source references for more information:

Test and trace: what to do if you are contacted (England) (15 December)

 Management of staff in health and social care settings (15 December 2021)

Coronavirus: Test and Protect Scotland

Published: December 2021

A family member in my household has tested positive, do I still need to isolate?

Guidance for those in England states that if you are in the same household as someone with COVID-19, you are not legally required to self-isolate if you are fully vaccinated.  As a healthcare worker, you are recommended to take a lateral flow device (LFD) test for 10 days from the date of their first symptoms, or their positive test if they do not have symptoms.

Guidance in Scotland differs and recommends that the contact will need to isolate regardless of vaccination status.

Source references for more information: Guidance for households with possible or confirmed COVID-19 infection (England)

Coronavirus: Test and Protect Scotland

Can I ask if a patient has been vaccinated against COVID-19?

The short response is that it will be dependant on the intent and context of the question.

The COVID 19 vaccine’s primary purpose, and where it has been shown to be effective, is in reducing the risk of serious illness and subsequent hospital admission.  It is on this basis that the government has relaxed certain restrictions for those individuals who have been double vaccinated, as their risk of contracting serious illness has been significantly reduced.

Risk assessment and infection control measures in osteopathic practice focus on primarily the risk of transmission, for which the vaccine is not necessarily a determinant.  Mitigating risk of transmission is through the infection control measures and PPE that is required of a health setting, such as osteopathic practice.

Vaccination status is a determinant of risk to the patient of contracting COVID-19. If patients are at a higher risk of contracting serious illness from COVID 19 as a result of, for example, underlying health conditions, then it is justifiable to determine their vaccination status to establish the full risk of them undertaking close contact osteopathic treatment.

We are suggesting that practices screen patients to assess for risk of transmission and their vulnerability to serious disease. Example screening questions are available from here.

Reviewed: December 2021

Do practitioners have to advise patients of their vaccination status?

There is a suggestion circulating of the need to advise patients of the vaccination status of practitioners as means to mitigate potential complaints of the transmission of COVID during a visit. We have sought advice and consulted with other professional bodies and the consensus is that this is NOT the case.  

The most effective measure to reduce the risk of transmission is the application of infection control guidance, including the use of PPE. While there is not yet any legal precedent, the consensus is that appropriate application of the recommended infection controls measures would be considered the best evidence of mitigation of risk of transmission.

Reviewed: December 2021

What should I do if a patient reports symptoms of COVID-19 after visiting the clinic?

If someone who visited the clinic subsequently experiences symptoms within 2 days of their visit, we suggest the following:

For anyone that has been in direct contact with the patient i.e. within two metres for 15 minutes or more, or within one metre for any amount of time:

If you are wearing PPE in line with the current guidance, then you do not have to self-isolate.

If you subsequently experience symptoms of COVID-19 we recommend you seek testing:

  • If you test negative, you may return to work.
  • If you test positive, you will need to self-isolate and then follow government guidance on the return to work.

For anyone that has had indirect contact with the patient during their visit to the clinic:

This can include other practitioners, reception staff, or other patients in the clinic at that time; should be advised of the situation and you should suggest that they monitor for symptoms. They do not need to self-isolate.

For clinic staff who subsequently experience symptoms, they should self-isolate as per government guidance or seek testing. If tested, the result of their test will determine if they need to self-isolate or if they can return to workas per the guidance on return.

For patients that have been seen by the treating practitioner during the period between seeing the suspected case and it is reported to the clinic:

If the practitioner who has been in direct contact has been wearing PPE in line with the guidance, there is no requirement to inform patients that have been seen by the treating practitioner in the 2 days since seeing the initial patient.

You may, however, as a courtesy, wish to inform patients that you have seen someone who has subsequently experienced symptoms - even if the risk of infection is very small - as the vulnerability of the patient and their close relatives may be an important factor for the patient to consider.

Reviewed: December 2021

Will my insurance cover me if a patient alleges that they contracted COVID-19 in my setting?

We have posed this question to our insurers and their response is as follows:

Providing you are following best practice guidelines, all the advice and rules emanating from the Government, Regulators, Health Department and Professional Body (iO), then the policy will cover your legal liability to patients. If you do not follow the best practice protocols (without a recorded, justified clinical reason for doing so) or break the law, it may be difficult for insurers to support you.

Reviewed: December 2021

Should I get my patient to sign a consent form for visiting the clinic?

As part of your screening, you will need to discuss with your patient the risks of infection when visiting the clinic, osteopathic manual treatment, and what you have done to reduce these. Their consent for the visit and treatment based on this discussion should be recorded in your patient notes.

IMPORTANT: Your patient notes are considered a legal document and will be taken as a true reflection of the discussions. While some may prefer to utilise a separate consent form, this is not a requirement if you have full and contemporaneous patient notes.

Reviewed: December 2021

Can I get my patient to sign a disclaimer form?

It will always be the osteopath’s responsibility to take reasonable care of their patient based on their clinical judgement. It is therefore not appropriate to use patient disclaimers to devolve the responsibility of the osteopath by suggesting they undertake treatment ‘at their own risk’.

Reviewed: December 2021

What if I am symptomatic of COVID-19?

If you have symptoms of COVID-19 you should follow current government guidance on self-isolation and management. You do not need to contact 111 or be tested for Coronavirus initially – see the UKHSA guidance on self-isolation.

If you are not clinically better after seven days, you should use the NHS 111 services who will advise if you need to be tested for COVID-19 and give you further health advice.

Reviewed: December 2021

 

Am I insured to provide telephone and video consultations?

If you have the iO’s professional liability insurance, we can confirm that you will be insured for telephone and video consultations if you follow the guidance for recording patient interactions as outlined in our telephone and video consultation advice guide. This includes new patients for which you should undertake a full case history as you would do at an in-clinic session.

If you are insured with another provider, please contact your respective broker to confirm the level of cover.

Updated: 24 March 2020

 

My practice is mainly in paediatrics. Is the guidance the same?

There are no restrictions on what patient populations you can see and you can see paediatric patients in line with the guidance for the management of face-to-face consultations.

We accept that in paediatric practice there will be other considerations for infection control and recommend reviewing the infection control guidance which will be useful for you to consider.

Reviewed: December 2021

Can I provide face-to-face consultations to NHS workers, particularly to those working in direct contact with COVID-19 patients?

A person’s job role/profession should not exclude them from receiving face-to-face care. As per our guidance, if you have in place all relevant infection control measures, have undertaken pre-screening, and in your clinical judgement a face-to-face is required, then you should feel confident to treat. For NHS workers it may also be worth asking if and when they have been tested, as this could also be noted as part of determining the potential risk of transmission.

Reviewed: December 2021

 

Can I still operate my practice from home?

For osteopaths to operate their practices within their residential property, it is important that they still follow and apply the guidance on infection control, risk assessment and mitigation.

It is best practice, if practical, that you have in place additional measures to ensure that those entering the premises for business only have access to areas of the property that are vital to access the treatment area and that these areas undergo stringent cleaning regimes to reduce the risk of infection between patients, as well as residents.

On discussion with our insurers, they have confirmed that if osteopaths follow the iO best practice guidance for infection control, risk assessment and mitigation, there are no exclusions in respect of your iO Medical Malpractice Liability Insurance. Risk assessments and documentation, alongside hygiene and infection control, are vitally important and will reduce the likelihood of any incidents and in turn support the defence of any claims.

We also recommend a review of following Government guidance and legislation available on working safely during COVID-19.

Reviewed: December 2021

 

 Can we still use dry needling/acupuncture at this time?

There is no restriction on the use of dry needling in osteopathic practice at this time. You should continue to follow the specific hygiene guidance as normal for use of dry needles.

Reviewed: December 2021

If I am contacted by a Tracing Officer advising that I have been in contact with a confirmed case of COVID-19, and I am asked for details of all those that I have been in contact with, can I divulge patient details without their prior consent?

We have sought advice from a GDPR specialist and their advice is as follows:

The introduction of a contact tracing system by the Central Government is in the public interest to protect citizens of the UK from the transmission of COVID-19. Notwithstanding the need by osteopaths to seek explicit patient consent to share medical records with third parties to satisfy GDPR Article 9, some details can be shared where it involves public interest matters.

Article 6 provides a special provision where the processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller.

Clearly tracing those potentially infected with COVID-19 is in the public interest and the osteopath can share basic contact information such as the patient name, address, telephone number and email address with tracing agents. However, they are not permitted to share any medical information (beyond basic contact details) without the consent of the patient or a Court Order.

Despite the urgency of the situation, the osteopath should also satisfy themselves from an ID card, email confirmation or some other verifiable method offered by the Tracing Officer that the person investigating the matter is working on behalf of Public Health England or the appropriate body in Scotland or Wales. They could have an ID card from a variety of sister organisations because Public Health England has a variety of people supporting the initiative under the direction of a regional director. This includes public health staff, local authority environmental health officers, and even NHS sexual health staff with experience of contact tracing and knowledge of their communities.

If the Osteopath is concerned, details can also be verified by contacting the appropriate regional Public Health Office here.

Also, click here to read a letter from Public Health England (first published May 2020)  which provides some useful background information.

Reviewed: December 2021

 

 

IMPORTANT NOTE: The safety of the public and our members is of paramount importance. The iO is following the UK Government advice, NHS guidance, and guidance from other professional bodies for healthcare professionals operating in private practice. Any guidance provided on this page is current as of the date of publishing and such guidance may change quickly at short notice.

 

Have a question pertaining to COVID-19?

Send an email to enquiries@iOsteopathy.org and we’ll get back to you as soon as we reasonably can.

 

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