FHT Member Guidelines – preparing to return to therapy practice

Pictured: link to COVID-19 resources

Published: 6 May 2020, 14.45

Previously updated: 14 August 2020, 11.30

Last updated: 27 August 2020, 13.00

Please revisit this webpage on a regular basis, as the content will be updated as the situation and government guidelines evolve. Any amends made on 27 August are highlighted in yellow.

At FHT, we fully appreciate how much COVID-19 has impacted our members and that many of you are eager to return to full practice in order to support your clients’ health and wellbeing and generate much-needed income.

With different countries now starting to ease their way out of lockdown, lots of our members are asking us how they can return to full practice safely, when their country’s government indicates it is safe to do so.

Below are some guidelines that we believe will help to minimise the risk of contracting and spreading COVID-19, if/when your country’s government has indicated that it is safe for you to return to full practice, bearing in mind that each country in the UK is working to a slightly different road map and timescale.

Please note that these guidelines should be read in conjunction with any guidelines produced by the government or local authorities in the country where you live and practice. Where these differ, guidance issued by your government and local authorities take precedence over the FHT’s guidelines. In England, please see Close contact services: Guidance for keeping workers and clients safe in close contact services. In Scotland, please see Coronavirus (COVID-19): retail sector guidance – close contact services. In Wales, please see Close contact serivces businesses: coronavirus workplace guidance. In Jersey, please see their advice for wellbeing, cosmetic and beauty service providers

We would like to stress that these FHT guidelines are not exhaustive and the FHT are not experts in COVID-19. We are also in a situation that is ever evolving and guidance that may be relevant one day may be superseded the next, as new evidence-based information about the virus becomes available and infection rates potentially rise and fall. This is why we urge members to closely follow the latest updates and guidelines issued by their country’s government and other authorities, which take precedence over the FHT’s guidelines.

Please note that while many of the recommendations in this document ‘apply to all’, we are very mindful of the fact that our members work in a variety of contexts, offer a broad range of treatments and support clients who are all unique individuals. With so many potential variables, there will be times when you will need to make your own business decisions, based on your risk assessment, advice from the government and other authorities, and in line with principles of best practice, regulatory requirements and the law.

Similarly, if you are an employee or volunteer, you may need to adhere to protocols and procedures put in place by the person or organisation you work for, which may go above and beyond those set out in FHT’s guidelines. This might be particularly relevant if you are working in a statutory regulated healthcare setting, such as a hospital, hospice or care home. And, of course, you may wish to adopt additional measures that are not outlined in FHT’s guidelines. Providing these are lawful and justified, that is a matter of professional judgement and personal choice.

Throughout these guidelines, we have signposted you to websites where you can find relevant and up-to-date information. This is to avoid giving detailed information regarding certain aspects of COVID-19, which may change as the situation evolves.

We will, of course, continue to update these guidelines and our coronavirus statement (available at www.fht.org.uk/coronavirus) on a regular basis and support our members with information and guidance wherever possible, so please keep checking this webpage, as well as your regular newsletters.

1. Consider your resources carefully

With so much conjecture and false information circulating about COVID-19, it is important to stick to trusted sources of information.

For information about COVID-19, and any measures in place to try and tackle the virus, we would recommend looking at the NHS, government (England, Scotland, Wales and Northern Ireland), and World Health Organization (WHO) websites. You can also access a useful Coronavirus Patient Leaflet on the BMJ (British Medical Journal) Best Practice website, which is regularly updated.

For up-to-the-minute reporting, we would suggest the BBC and The Guardian, which both offer daily round-up emails that you can sign up for.

2. Understand COVID-19

Before re-evaluating your work practices and returning to work (when your government indicates it is safe to do so), it is extremely important that you are aware of the latest information regarding:

  • how COVID-19 spreads, so that you can minimise the risk of becoming infected or spreading the virus;
  • which individuals are extremely vulnerable or at high risk if they are exposed to COVID-19;
  • the signs and symptoms of COVID-19, so that you can identify if you or a client may have the virus;
  • how long people affected by COVID-19 should self-isolate and what is meant by self-isolation;
  • how long COVID-19 survives on different surfaces; and
  • how to prevent the spread of COVID through enhanced hygiene measures, including cleaning and disinfecting potentially affected surfaces.

All of the above information can be found on the World Health Organization (WHO), NHS and government websites (see Section 1 for relevant links).

3. Carry out a fresh risk assessment

Before you return to work, you must re-evaluate all of your work practices and carry out a fresh risk assessment, which addresses the risks of COVID-19. For information about risk assessments, see the FHT Code of Conduct and Professional Practice for some basic guidance, and the HSE website for more detailed advice and a risk assessment template).

This will help you to decide whether you need to adapt any of your work practices or put extra measures in place until COVID-19 is no longer considered a threat to health. This includes (but is not limited to):

  • business premises and treatment areas
  • hygiene protocols
  • the consultation and treatment
  • client aftercare advice
  • business policies
  • insurance requirements.

Unless you employ five or more people, you are not required to keep a written record of your risk assessment. However, we would highly recommend that you document your findings and any measures you put in place in order to minimise the risk of you, your clients and your staff from contracting COVID-19 through your business activities.

Please note that you may need to update your risk assessment as the situation evolves, for example, if the your country's government or another authority issues new information or guidance relevant to your business practices, or updates any guidance already published.  

4. Assessing your business premises and treatments

To get your fresh risk assessment underway, one of the first things you might like to do is walk through your business premises and consider every item and surface your client is likely to come into contact with when they visit you for a treatment.

Remove any items you identify that are non-essential and particularly those that cannot be washed and disinfected between clients in order to kill the virus. This might include, for example, magazines, cushions, electric blankets, throws, rugs and other soft furnishings. If you ordinarily provide samples or test products that can be used by multiple clients, these also need to be removed.

If you are a mobile therapist, think through how you can minimise your risk of contracting or spreading coronavirus in the different types of premises you work in, as you will obviously have less control over the hygiene levels in these environments. For example, if you visit clients in their own home, you might want to ensure you have a bottle of hand sanitiser that you can carry in your tunic pocket and easily access and use after touching any surfaces.

Another important part of your risk assessment is to consider the different types of therapies/services you offer, and what measures you might need to take in order to minimise the risk of cross-infection for that particular type of therapy/service.

5. Maintaining social distancing measures and length of treatment

When returning to full practice and providing treatments that involve close contact with the client, it is accepted that maintaining physical distancing measures will not be possible during the treatment itself. 

However, you can ensure that physical distancing, in line with current government guidelines, is maintained at all other times, for example, when the client or you are arriving or waiting for a treatment and during the consultation process.

Certain treatments will carry less risk because they don’t require close contact with the client (for example, mindfulness, nutritional therapy, counselling and personal training), can be carried out through clothing or other textiles, so don’t involve skin contact (for example, acupressure, the HEARTS Process and reiki), or can be done without facing the client (for example, back massage or seated acupressure).

It is also important to bear in mind that the shorter the treatments you provide, the less close contact you have with your client, and therefore the lower the transmission risk between you both.

For therapists returning to full practice in England, the government’s Close contact services: Guidance for keeping workers and clients safe in close contact services, says: "Businesses should consider providing shorter, more basic treatments to keep the time to a minimum" and “Where extended treatments are undertaken, such as […] massages, consider how the length of the appointment could be minimised.”  In line with this guidance, please look to provide shorter treatments where possible and not to exceed an hour (total appointment time) at the early stages of returning to work. Similarly, we would advise against multiple treatments for the same client that, combined, last longer than an hour (for example, a body massage followed by a manicure or pedicure). If we receive any clarification from the government on this point, we will provide members with an update.

For therapists working in Scotland, the government’s Checklist that should be considered by close contact business owners states: “Good practice involves the practitioner continually moving from side to side or from the back avoiding the high-risk zone [in front of the face], inactive periods, and keeping the activity time involved as short as possible.” Again, please see our recommendations in the paragraph above.

6. Enhanced hygiene measures

FHT members already adhere to high standards of hygienic practice, as outlined in the FHT Code of Conduct and Professional Practice, which includes cleaning the hands and treatment area appropriately between clients. The NHS also provides detailed guidance on appropriate hand washing and some basic guidance on how to avoid spreading COVID-19.

However, in light of COVID-19, it is important that members review and potentially enhance the current hygiene measures they already have in place when returning to full practice. The FHT recommends the following:

Creating a checklist of things to clean

While each therapy business is unique, on top of the usual therapy items and equipment that require cleaning or disinfecting in between clients (such as couches, towels and therapy tools/equipment), you will also need to take into account other items that clients are likely to come into contact with, which may include:

  • a front doorbell or knocker
  • handles, handrails and bannisters
  • lift buttons and light switches
  • toilet and sink area
  • chairs in a waiting area
  • pens or mobile device screens
  • payment terminal.

If you are a mobile therapist and therefore not in a position to clean and disinfect some of these surfaces yourself, ensure that you thoroughly wash your hands DIRECTLY before and after treating the client, and before entering and on exiting the premises. If this is not possible, use an appropriate hand sanitiser instead (with an alcohol content of 60% or above).

Consider creating and referring to a checklist of everything you need to clean and disinfect between each client, so that you don’t overlook anything. You may also want to mention or share your checklist with clients in advance of their treatment, or display a copy on your treatment room wall, to give them confidence in your hygiene and health and safety protocols. Alternatively, you can display or share a special poster with your clients, produced by the FHT, that outlines the key measures you are taking to help protect them (available at www.fht.org.uk/coronavirus with other useful resources).  

Cleaning surfaces and textiles

There are various guidelines available for both healthcare and non-healthcare settings. On the basis that members working in a hospital (or other statutory regulated health or care setting) will be following the protocol and procedures of that particular context/establishment, the following information is based on government and World Health Organization guidelines for cleaning in a non-healthcare setting,and is based on the assumption that any client may be pre-symptomatic or asymptomatic. Please refer to both of these links for further guidance.

Wear disposable gloves when cleaning between each client and dispose of these appropriately after use.

Hard, non-porous surfaces should be washed down with warm soapy water first, to remove dirt, and then wiped down with disinfectant. In a community/ private setting, it is likely that sodium hypochlorite (bleach/chlorine) at the appropriate dilution will be sufficient.

Ensure that any fabric items that are needed for the treatment that cannot be disinfected or washed between each client – such as bolsters – are covered in a non-porous material that can be washed down and disinfected and then covered with something soft and replaceable/ washable between clients. (It is important to note that porous materials, such as pillowcases, sheets and couch roll – even if replaced between clients – may not prevent COVID-19 from reaching the underlying objects they are intended to ‘protect’, such as couches, couch covers and towels.) However, please think carefully about whether these items are essential, or if something that can be replaced/washed between clients can be used as an alternative at this time, such as a rolled-up towel in place of a bolster.

Towels or textiles used to cover the couch or protect the client’s modesty should be changed between each client. These should be stored in a plastic, resealable bag, that can be disposed of after use, or a plastic/wipeable wash bin, with a lid, that can be disinfected after use. Towels and other textiles that have come into contact with the client should be washed at the warmest water setting possible (refer to the manufacturer’s instructions), or if you would prefer to follow the guidance used in relation to healthcare settings, wash at 60˚C. Try to minimise handling and 'shaking out' dirty laundry.

Tunics and workwear should also be washed at the warmest water temperature possible, according to the manufacturer’s instructions.

If possible, avoid travelling to work on public transport. If you are travelling to work on public transport, take your therapy workwear with you, so that you can change into this on arrival, and change out of it on departure. Ensure you do not place your therapy workwear on potentially contaminated surfaces when changing.

If you are a mobile therapist, carry your products and any other items needed in a bag that can be safely disposed of or disinfected/washed after each use. Ensure all of your equipment and products are appropriately washed down and disinfected between clients – this may mean returning home or to your business premises to ensure it is done properly.

If you are a mobile therapist, take your own towels or other textiles to be used during the treatment. Once the session has ended, place these in a bag that can be safely disposed of or disinfected after the items have been placed in the washing machine.

Single use and disposable items should only be used once and disposed of appropriately.

Other hygiene measures

Ask your clients to wash their hands or use hand sanitiser before and after treatment, to help protect you and any staff or family that may be using the premises.

Try to increase the flow of fresh air into the building as much as possible. For example, ventilate the treatment room by opening the window and/or door between clients, particularly if you work in a confined area.

Use a foot-operated pedal bin with a lid and plastic liner for rubbish. Seal and dispose of the bag appropriately at the end of the day.

Provide tissues that your client can easily access and ask them to use these if they need to sneeze or cough, and to then dispose of these in an appropriate bin after use.

If your tunic or therapy workwear comes into contact with the client, or they unexpectedly cough or sneeze during the course of the treatment, change into clean clothing before you see your next client. 

7. Use of personal protective equipment (PPE) and other protective measures

Where a therapy service you are providing would have ordinarily required the use of PPE, such as a face mask or gloves, continue to use these.

England, the government’s Guidance for keeping workers and clients safe in close contact services was updated on 14 August, and now requires those providing close contact services to wear a visor and Type II face mask:

"Clearly, when providing close contact services, it often may not be possible to maintain social distancing guidelines (2m, or 1m apart with risk mitigation, is acceptable). As a result, personal protective equipment in the form of a visor and a Type II face mask will be required to mitigate the risk, further details on which can be found in Section 6.” (Section 1.1)

Both disposable and re-usable visors are available. A re-usable visor must be cleaned and disinfected between each client using normal cleaning products. Type II face masks are medical face masks and available in two types: splash resistant (Type IIR, typically used in clinical settings) and non-splash resistant (Type II).

To mitigate the risk of infection, the guidelines for England also state, "Unless crucial for the treatment, avoid skin to skin contact and use gloves where possible". This guidance is open to interpretation and uses the phrases “unless crucial” and “where possible”. If you believe it is not possible to perform a particular treatment with gloves on, or that skin to skin contact is crucial for that treatment, then it is important that you highlight this within your risk assessment, along with what other measures you have put in place to mitigate the risk of cross-infection. For those who are wearing gloves, please be aware that latex or rubber gloves can degrade when working with oil (look for nitrile-based gloves instead, or others that will not degrade if using oil).

For therapists working in Scotland, the government’s Checklist that should be considered by close contact business owners states: “Staff should wear a visor in addition to a face covering. Visors are recommended but face masks are mandatory. Customers are also required to wear a face covering.”

Coronavirus (COVID-19): retail sector guidance – close contact services states: “Gloves provide a barrier where there is anticipated contact with blood or body fluids and should continue to be used for any treatments where this is a risk. However, over-use of gloves leads to contamination of both the users gloves and the surrounding environment. Frequent hand decontamination is very important. Alcohol-based hand rub should be used regularly where hand washing cannot occur".

In Wales, the government’s guidance indicates that PPE requirements vary according to the type of close contact services/treatments being given and the business's risk assessment, but as a minimum, therapists would need to wear a Type II face mask and visor. For more information, please see Close contact services businesses: coronavirus workplace guidance.

For guidelines from the Jersey government, please refer to their Advice for businesses during Level 2 (Wellbeing, cosmetic and beauty services).

If PPE is a government requirement or you would simply feel more comfortable wearing PPE when returning to full practice, the FHT has identified two reputable suppliers:

  • Medisave sell a range of face masks, face visors, gloves and other PPE (enter the code CODE5OFF for best possible prices)
  • Physique Management, a Partner Brand of the FHT, also sell a range of face masks, face visors, gloves and hygiene products (members receive a 10% discount)

The FHT has been assured by both suppliers that ordering their products will not impact the supply chain to health professionals, including NHS workers.

If your government requires you to wear, or you choose to wear, any form of PPE, ensure this is removed and disposed of safely - guidance on how to do this can be found on the government website.

8. Pre-treatment checks and when not to treat

While it is possible that you or one of your clients may be pre-symptomatic (have the virus but are yet to display symptoms) or asymptomatic (carrying COVID-19 but without any obvious symptoms) you can help to reduce the risk of exposing yourself or your clients to the virus with some simple pre-treatment checks.

Screening yourself for COVID-19

If the NHS Test and Trace service contacts you to say you have been in close contact with someone who has COVID-19, you must follow NHS guidance and defer seeing clients until it is safe to do so.

If you (or a member of your household or support bubble) has symptoms of COVID-19, you must self-isolate and use the NHS 111 online coronavirus service, which will tell you what to do and help you get a test if you need one. Defer seeing clients until it is safe to do so.

If you provide a therapy service in your home and another member of your household or support bubble has symptoms of COVID-19 or has tested positive, even if you are well, you must self-isolate and defer seeing clients in your home until it is safe to do so.

If you have tested positive for COVID-19, or you test positive for COVID-19 in the future, seek advice from the NHS or your doctor about when it is safe to return to practice.

Even if you are feeling well, as an extra precaution, check your temperature at the beginning of each workday and if you have a high temperature, use the NHS 111 online coronavirus service and defer seeing clients until you know it is safe to do so.

Screening your clients for COVID-19

Contact your client 24 hours before each treatment to screen them for COVID-19. Prepare some COVID-19 pre-treatment questions to use in addition to their standard consultation form, and record and date the answers to their questions. We would suggest including the following, as a minimum:

Q. Do you currently have COVID-19 or any symptoms of COVID-19?
Run through the main symptoms of COVID-19 listed by the NHS at that point in time. If they indicate they have any of these symptoms, are waiting for a COVID-19 test result or have tested positive for COVID-19, defer seeing them until it is safe to do so. If they currently have symptoms of COVID-19 but have not yet used the NHS 111 online coronavirus service, advise them to do so. (Please also refer to Section 10 regarding less common symptoms.)

Q. Have you had COVID-19?
If a client indicates they have had COVID-19 but are now well and no longer need to self-isolate, ask them to seek permission from their GP before they have a treatment. As COVID-19 is a novel virus and there is still much to learn about its short and long-term effects, where possible, we feel it is best to get input from someone medically qualified and responsible for the client’s health before going ahead with a treatment.

If you or the client have tried to obtain consent from their GP but have been unsuccessful, providing the GP has not expressed concern about the client having treatment, ultimately it is for you to decide whether it is safe to proceed, based on your risk assessment of that individual client and your professional judgement.

Before reaching your decision, you might like to ask the client additional questions to determine: how long ago they had COVID-19; how severe their symptoms were; how their health has been since they had COVID-19; and if they have experienced any long-term symptoms or unusual health issues since they had COVID-19 (you may like to run through the list of symptoms for COVID-19 with the client).

Once you have weighed up all of the facts, if you decide that the benefits of treatment outweigh the potential risk, and you have discussed the matter with your client and they are also happy to go ahead with treatment, a note of this should be made on their records, which they must sign (physically or digitally).

Q. Does anyone in your household or support bubble have COVID-19 or symptoms of COVID-19?
If the answer is ‘yes’, defer seeing your client until it is safe to do so.  

Q. Have you been in close contact with anyone else in the past 14 days who has symptoms of COVID-19 or been contacted by the NHS Test and Trace service and told to self-isolate?
If the answer is ‘yes’ to either question, defer seeing your client until it is safe to do so.

Q. Are you currently shielding?
If your client is shielding, we strongly recommend deferring treatments until they are no longer shielding, after which we strongly advise members to follow the guidance offered in Section 9 of these guidelines, regarding treating vulnerable clients. (If you are working in a statutory regulated health or care setting, rather than in the community/private practice, adhere to relevant protocols and procedures in place in that work environment, as well as guidance from the medical professional responsible for the patient’s/resident’s care with regarding safe treatment.)

Q. Are you classed as clinically vulnerable (moderate risk) or clinically extremely vulnerable (high risk)?
While anyone can get seriously ill from COVID-19, there are groups of people that the government has identified as being at a higher risk than the rest of the population. These people are classed as ‘clinically extremely vulnerable’ (high risk) or ‘clinically vulnerable’ (moderate risk) – click here to see if your client falls into one or more of these categories. If your client falls into either of these categories, providing they are not shielding, please see Section 9 for guidance on assessing and their suitability for treatment.

To download these COVID-19 pre-treatment questions, visit fht.org.uk/coronavirus, however please also refer to Section 10 regarding less common symptoms.

Other things to ask or highlight to your client before their appointment

Explain to your client what measures you are putting in place to help reduce the risk of spreading COVID-19. If you like, you can email them a poster, which can also be used as an information leaflet or checklist, produced by the FHT, that outlines the key measures you will be taking (available at www.fht.org.uk/coronavirus).

Ask your client to check their temperature on the morning that they are due to come to you for a treatment. If this is higher than usual, or they have any other symptoms, ask them to call you to defer their treatment.

Advise your client that you are currently in good health but if you develop symptoms before their appointment, you will call to defer treatment.

Ask your client if they can attend the appointment on their own, where possible.

If the client is coming to see you, ask them to bring their own bottle of water (so that you don't have to handle any refreshments) and explain any new procedures you are putting in place at this time, for example, how to enter the premises and make their way to the treatment room without coming into close contact with you or others, or how to make a non-cash payment.

If you are visiting the client in their home, highlight any special requirements you may have at this time. For example, arrange how and where you will be working in their home, and explain the need for physical distancing to be maintained before and after the treatment. Ask them where you can wash your hands during your visit (but take your own hand sanitiser, in case this is not possible).

If you are visiting a client at their work premises, for example, an office, ask them if there are any special procedures in place that you need to be aware of and adhere to when visiting.

9. Treating clients who are clinically vulnerable (moderate risk) or clinically extremely vulnerable (high risk)

While anyone can get seriously ill from COVID-19, there are groups of people that the government has identified as being at a higher risk than the rest of the population. These people are classed as ‘clinically extremely vulnerable’ (high risk) or ‘clinically vulnerable’ (moderate risk) – click here to see if your client falls into one or more of these categories.

At this time, we are strongly advising members not to treat anyone who is shielding.

In the first instance, and if your therapy toolkit allows, it may be worth considering whether a hands-off treatment such as reiki, meditation, mindfulness, yoga, nutritional therapy or hypnotherapy, would be of benefit to the client, as it would allow you to maintain social distancing.

However, if their preference is to have a close contact/ hands-on treatment, then we would strongly advise the following before going ahead with treatment.

Risk assess the individual client
As well as completing a full risk assessment of your business, we advise carrying out a short risk assessment for that individual client, taking into account factors such as the type of treatment they are requesting, where the treatment will take place, the seriousness of their condition, and their overall state of health. Make a note of your findings on their client record.

Screen for COVID-19
Before the treatment, screen the client and yourself for COVID-19 (see section 8 of these guidelines).

Check for other contraindications and red flags
As you would for any client, carry out a consultation before each treatment, to establish whether there are any other contraindications or red flags that indicate treatment is not appropriate at this time.

Seek consent from the client’s health professional
Having done all of the above, if you are happy to go ahead with treatment, ask the client to seek consent from their GP/midwife/consultant. As COVID-19 is a novel virus and the government is clearly concerned about the impact it may have on people placed in the clinically vulnerable and clinically extremely vulnerable categories, we feel that it is best practice to seek consent from the medical professional responsible for their health, in case they wish to express any concern about the treatment going ahead.

Remember, written or verbal consent can be obtained by either you, the therapist (with the client’s permission) or the client themselves. If consent is obtained verbally by your client, the client must sign and date a statement on their record, confirming that they have obtained verbal consent from their GP/consultant/midwife. If you are no longer using paper records that can be physically signed by the client, the client can confirm they have obtained verbal consent in an email or via another digital means. The key thing is that it is clearly recorded that the client has obtained consent, and that they confirm this, so that you can keep this information on file.

What to do if consent has been sought but not obtained
If you or the client have tried to obtain consent but have been unsuccessful, if the client is clinically extremely vulnerable, we would strongly advise against treatment at this time.

If the client is clinically vulnerable, then providing their GP/consultant/midwife hasn’t expressed concern about them having treatment, ultimately it is for you to decide whether or not it is safe to proceed, based on your risk assessment of that individual client and your professional judgement.

Having weighed everything up, if you decide that the benefits of treatment outweigh any potential risks, and you have discussed the matter fully with the client and you both feel comfortable to go ahead with the treatment, a note of this should be made on their records, which they must sign (physically or digitally). Needless to say, it is vital that you follow your country’s government guidelines for close contact services, including enhanced health and safety measures and PPE requirements.

If you do not hold insurance with the FHT, make sure you check with your provider that they would be happy to provide cover under the above circumstances.

Keep treatments to a minimum
In line with government guidance produced for England and Wales, we think it is prudent at this time for ALL therapists to provide shorter treatments where possible, and particularly for clients who fall into the clinically vulnerable and clinically extremely vulnerable categories. As such, we would recommend not to exceed an hour (total appointment time) at the early stages of returning to work. Similarly, we would advise against multiple treatments for the same client that, combined, last longer than an hour - for example, a body massage followed by a manicure or pedicure.

Be comfortable with your decision
If you do not feel comfortable treating clients who are clinically vulnerable or clinically extremely vulnerable at this time, that is of course your choice, and you shouldn’t feel pressured into giving a treatment.

Ultimately, you need to be confident that you are doing all you can to protect the client’s health and safety and minimise the risk of infection.

10. Treatments that may be restricted when returning to practice

As this is an ever-evolving situation, please follow your country's government guidelines regarding any services that may be restricted in your country when therapists are able to return to work. We will also be providing updates on our Coronavirus statement.

Currently there are sector-specific guidelines in place for England, Wales, Scotland and Jersey that are relevant to therapists.

Please not that if infection rates rise in a particular region, local restrictions on businesses may also apply. If/when this happens, please follow guidance issued by your government and the local authorities.

11. The consultation process and aftercare advice

Ensure that you run through your COVID-19 specific questions BEFORE the client comes to you for treatment (see Section 8 above for suggested questions).

When the client arrives for treatment, check that they are still feeling well and have no symptoms of COVID-19. If they do, cancel the appointment and ask them to return home and use the NHS 111 online coronavirus service.

As a professional therapist, it is important to carry out a consultation prior to ALL treatments, to ensure that the most appropriate treatment is being given to the client and that no new contraindications or contra-actions have occurred between treatments.

It is important to note that while the NHS website lists the main symptoms of coronavirus, there are some less common symptoms associated with COVID-19. These might include headaches, aches and pains, rashes, fatigue and a sore throat. Be aware of these symptoms, which are likely to be raised as part of your standard consultation process before each treatment (if not, consider including these in your COVID-19 pre-treatment questions). Advise the client to seek medical advice if you are concerned.

In light of COVID-19, you might like to consider switching to online consultation forms or client management software to remove the need for handling paperwork and pens. If this is not practical, then ensure that you and your client use separate pens and that these are cleaned and disinfected between clients.

Where possible, switch to contactless or online payment systems or use a payment terminal that can be easily wiped down and disinfected, so that you don’t have to handle cash. Discuss this with your client ahead of the treatment. If they can only pay by cash, then ensure they bring the exact amount and place it somewhere convenient at the end of the treatment. Always wash your hands after handling cash.

Before your client leaves (or you leave your client, if providing a mobile service), along with any usual aftercare advice you provide, encourage them to stay safe and to be vigilant in terms of any signs or symptoms that they or someone close to them may have COVID-19.

To offer further support, you could point your clients to trustworthy sources of information about COVID-19 and feel free to share with them links to the various self-care articles and videos we have published on the FHT blog (visit fht.org.uk/blog). If you feel your client’s mental health is suffering and this is outside your scope of practice, please consider referring them to an appropriate charity, such as Mind, or an Accredited Register that offers talking therapies, such as counselling or psychotherapy.

As always, make sure you document everything on your client’s record, including any pre-treatment and post-treatment advice you have given to minimise the risk of either party contracting COVID-19. If your client is completing any COVID-19 pre-treatment questions or standard consultation forms via email, as they are unable to provide a signature, ask them to acknowledge in their return email that they declare the information they have provided is correct and they consent to treatment, and store this information securely.

12. Creating a new COVID-19 specific policy

As your business practices are likely to change for some time due to COVID-19, we recommend that you create a COVID-19-specific policy, for the benefit of you and your existing and prospective clients (should they wish to see this). This does not need to be lengthy or complicated and you can copy, paste and adapt any of the information in this guidance. For example, it might include bullet points about:

  • how you will be monitoring the health of you, your staff and your clients, to reduce the risk of spreading COVID-19
  • that you will be deferring any treatments if you, your staff or the client has COVID-19, or is displaying any signs or symptoms of COVID-19
  • your terms of business, if a treatment is cancelled or deferred by either party as a result of COVID-19 (we would recommend not charging for treatments that are deferred or cancelled as a result of COVID-19)
  • that you will be adhering to guidelines produced by the NHS, government and the FHT regarding safe practice, hygienic practice and the use of any PPE
  • if you will be adapting or restricting your treatments in any way.

For a template policy, please visit www.fht.org.uk/coronavirus

13. Make sure you have active membership and insurance

As part of your planning to return to full practice, please ensure that your FHT membership and insurance is current and active.

14. Other things you might like to consider…

Clear communication
Make sure you communicate with your clients in a clear and timely fashion – from announcing when you will be resuming practice (once your country’s government has CONFIRMED a return to work date), to any new procedures you have in place at this time. See fht.org.uk/coronavirus for links to a range of downloadable resources, including an email template, social media graphic, COVID-19 policy template, pre-treatment questions and an information checklist/poster.

Give yourself plenty of time between treatments
Build extra time into your schedule to allow for: answering any questions your client may have; carrying out enhanced hygiene protocols between clients; and ensuring that clients aren’t leaving and arriving at the same time. If you have a waiting area, or share premises with other practitioners, you will need to ensure that clients are kept a safe distance apart.

Be flexible and prepared for change
It is possible that the government and other authorities may change their guidance on certain matters, from treatment restrictions, who should be wearing what sort of PPE and in what contexts, to re-introducing social distancing measures or 'revional lockdowns' if the number of people affected by COVID-19 rises again. Bear this in mind and be prepared to adapt your working practices accordingly.

You may struggle to get hold of products
As the demand for certain products are in high demand and many suppliers are being impacted by COVID-19, deliveries may take longer than usual or you may struggle to get hold of certain products and equipment at this time. Build in this extra time and start planning for your supply of these goods.

If you are a vulnerable person or uncomfortable about resuming work
If you are a self-employed therapist and the government indicates that it is safe for you to resume business but you are concerned for your own health and safety, or that of your family and clients, you are not obliged to return to work. What you would need to consider (and find out) is if this might impact your eligibility to continue receiving any financial support from the government that you were entitled to as a result of COIVD-19. If you are employed and your employer requests you to return to work, we would recommend you seek advice from Citizen’s Advice.

Closed business premises and Legionnaire’s disease
If your business premises have been closed or have had reduced occupancy during the COVID-19 outbreak, it is possible that stagnation may have occurred in the water system due to lack of use, increasing the risks of Legionnaire's disease. As part of your fresh risk assessment, you will need to consider and manage the legionella risks when you reinstate any water system or start using it again, and when restarting certain types of air conditioning units. For more information, see the Health and Safety Executive’s Legionella risks during the coronavirus outbreak guidance.

 

IMPORTANT: while we have tried to ensure that the information provided in this document is as accurate as possible, the FHT cannot be held liable for any errors or omissions. The information contained is for guidance only and as the COVID-19 situation is constantly evolving, FHT members must satisfy themselves that they are following and adhering to the latest guidance offered by the government and other authorities in the country where they practice, which takes precedence over any recommendations made by the FHT. © FHT 2020