FHT Member Guidelines – preparing to return to therapy practice

First published: 6 May 2020

Previously updated: 13 April 2021

Last updated: 4 May 2021

Any significant amends/additions made since the previous version (20 April) are highlighted in yellow.

Please note that this guidance was originally published in May 2020, to help our members prepare for returning to work after the first lockdown. At the time, government guidelines for close contact services were yet to be published for all four UK nations. While we still think FHT’s guidelines provide useful/additional guidance for our members, please note that guidance from the government and other authorities takes precedence over FHT guidance.

Introduction

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.

Below are some guidelines that we believe will help to minimise the risk of contracting and spreading COVID-19, 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.

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. As government guidelines for close contact services are regularly updated, it is important to revisit these on a periodic basis for new information.

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 We are also in a situation that is ever evolving and guidance that may be relevant one day may be superseded the next, as new evidence-based information about the virus becomes available and infection rates potentially rise and fall.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 and FAQs (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 (including the vaccination), we would recommend looking at the NHS, government (EnglandScotlandWales 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 country’s 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 clinically extremely vulnerable and considered at high risk if they are exposed to the virus;
  • 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 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 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. (Please note that the government guidelines for close contact services in England indicate that from Step 3 of the roadmap [no sooner than 17 May 2021], you can"provide reading materials such as newspapers and magazines in client waiting areas. You should replace them frequently and ask clients to use hand sanitiser before and after handling them".)

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. (Please refer to your country’s government guidelines for more guidance on providing mobile close contact services safely - links can be found in Section 1.)

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. (The Welsh government guidance for Acupuncture, clinical and sports therapy services - aimed at complementary and alternative practitioners, including sports massage and sports therapists - even suggests “undertaking consultations virtually either by phone or video call” in order to reduce the amount of time spent with the client, but we appreciate this might not always be possible or practical, in which case maintaining physical distancing as much as possible throughout the appointment is key, along with other safety measures in place to reduce the risk of transmission.)

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 members returning to full practice in England, the government’s Working safely during coronavirus (COVID-19): close contact services, states: "Businesses should consider providing shorter, more basic treatments to keep the time to a minimum". In line with this guidance, we strongly recommend providing shorter treatments where possible and not to exceed an hour (total appointment time) until COVID-19 is no longer considered a threat to health. 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).

For members working in Wales, the government’s Acupuncture, clinical and sports therapy services: coronavirus workplace guidance (aimed at complementary practitioners, including sports massage therapists and sports therapists), “Most therapy treatments are conducted in small private rooms; the nature of the work is such that maintaining social distancing will not usually be possible when actively treating a client. In these circumstances, both employers, employees and the self-employed should do everything they reasonably can to reduce risk. This must include enhanced ventilation, increased cleaning protocols, reduced treatment times and appropriate gaps between clients.” For those therapists following the Hair, beauty, holistic, tattoo and body piercing services: coronavirus workplace guidance, the Welsh government advises that measures to reduce the risk of transmission include “keeping the activity time involved as short as possible”. As such, we would advise following the recommendation for members in England, outlined above. In addition, please note that both sets of guidance in Wales outline that the amount of time spent working in the high risk zone (directly in front of the client’s face) should be restricted to as short a time as possible.

For members working in Scotland, the government’s Coronavirus (COVID-19): retail sector guidance – close contact services (due to be updated before 26 April) currently states: “Good practice involves the practitioner continually moving from side to side or from the back avoiding the high-risk zone, inactive periods, and keeping the activity time involved as short as possible.” Please refer to the recommendations for members in England, outlined above.

For members working in Northern Ireland, the current guidance on Keeping workers and clients safe during COVID-19 in close contact services states that in order to protect the health and safety of staff and workers, mitigating steps include “Keeping the activity time involved as short as possible”, therefore please refer to the recommendations for members in England, outlined 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 or website, 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 fht.org.uk/your-return-to-work-pack 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, as well as government guidance for close contact services (see Section 1 for links).

  • Hard, non-porous surfaces should be washed down with warm soapy water first, to remove dirt, and then wiped down with disinfectant or other suitable cleaning product. 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. (Welsh government guidelines for therapists recommend washing any textiles that have come into contact with the client 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 use. Ensure all of your equipment and products are appropriately washed down and disinfected between clients.
  • 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/washed 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 other people 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. For more guidance on ventilation, please refer to government guidance for close contact services and visit the HSE website.
  • Use an automatic or 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. Otherwise, ensure that your therapy clothing is washed at the end of each day.

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.

Otherwise, please see the government guidance for close contact services in the county where you work for more information, in order to ensure you are adhering to the latest requirements (for links, please see Section 1).

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

  • Medisave sell a range of face masks, face shields, 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 shields, gloves and hygiene products (members receive a 10% discount)

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 and in government guidance for close contact services.

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 (or equivalent in your country) 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/support bubble, has symptoms of COVID-19, you must self-isolate and arrange to have a test. 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 test positive for COVID-19, do not resume work until it is safe to do so (a minimum of 10 days after you first developed symptoms) and you feel completely well again.

In the interests of self-care, if you have received medical treatment (eg. been hospitalised) due to COVID-19, seek advice from your doctor or other medical health professional responsible for your care about returning to work.

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, arrange a PCR test as soon as possible and defer seeing clients until you know it is safe to do so.

Screening your clients for COVID-19

Contact your client before each treatment to screen them for COVID-19. (We recommend contacting them 24 hours before treatment, but if your country’s government guidance for close contact services indicates a different timeframe – such as Wales, which recommends 48 hours - please follow government guidance instead, links to which can be found in Section 1.) 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 on the NHS website. If the client indicates 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 booked a test, advise them to do so.

Q. Have you had COVID-19 or tested positive for COVID-19?
If a client indicates they have had COVID-19, ask them if they received medical treatment (eg. were hospitalised). If the client answers ‘yes’, ask them to seek permission from their GP before having 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 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 outside of your household/bubble in the past 10 days who has symptoms of COVID-19?
If the answer is ‘yes’, defer seeing your client until it is safe to do so, unless they have been wearing medical grade PPE (eg. NHS staff or other healthcare professionals).

Q. Have you been contacted by the NHS Test and Trace service (or equivalent in your country) and told to self-isolate? 
If the answer is ‘yes’, 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 clinically extremely 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 extremely vulnerable?
While anyone can get seriously ill from COVID-19, the government has identified certain people as being at a higher risk than the rest of the population. These people are classed as ‘clinically extremely vulnerable’ – click here to see if your client falls into the clinically extremely vulnerable category. If your client is clinically extremely vulnerable, providing they are not shielding, please see Section 9 for guidance on assessing their suitability for treatment.

You can download some COVID-19 pre-treatment questions from FHT's Your Return to Work Pack for members, 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 from FHT's Your Return to Work Pack).

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 a child or a vulnerable adult, then they can be accompanied by a chaperone, but please ensure social distancing is maintained between you and the chaperone and a face covering is worn by the chaperone. Also check that the chaperone does not have symptoms of COVID-19, and has not been in contact or lives with anyone who has COVID-19, and make a note of this on your client's records.)

If the client is coming to see you, ask them to bring their own bottle of water (to minimise you handling any refreshments) and explain any new procedures you are putting in place at this time, for example, using hand sanitiser on arrival and how to enter the premises and make their way to the treatment room without coming into close contact with you or others. If you have also moved to cash-free payments, make them aware of this before the appointment.

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, and that the room requires ventilation before and during treatment, etc.

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 extremely vulnerable

While anyone can get seriously ill from COVID-19, there are 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’ and should have received a letter from the NHS – click here to see if your client falls into the clinically extremely vulnerable category.

Please note that at this time, we are strongly advising members not to treat anyone who is shielding, as and when shielding is a government requirement.

With clients who are clinically extremely vulnerable, 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 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 the government is clearly concerned about the impact COVID-19 may have on people considered clinically extremely vulnerable, 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 advise against treatment at this time.

Keep treatments to a minimum
In line with available government guidance, we think it is prudent at this time for ALL therapists to provide shorter treatments where possible, and particularly for clients who are considered clinically extremely vulnerable. As such, we would recommend not to exceed an hour (total appointment time) at this time. 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 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 and FAQs.

There are sector-specific guidelines in place for EnglandWales (Complementary/Sports and Beauty/Hair/Spa), ScotlandNorthern Ireland and Jersey that are relevant to therapists.

Please note 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 book a test.

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 and link this to your clients’ records, 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 government, NHS 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.

You can access a template COVID-19 policy in FHT's Your Return to Work Pack

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. Please note that doing this on or very near the date the government has indicated you can return to practice could result in delays, due to the high volume of applications and queries FHT typically receives around this time.

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, to any new procedures you have in place at this time. See FHT's Your Return to Work Pack 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 regional/national 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.

If you have health issues or are 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