COVID-19: UPDATE FROM CHAIRMAN

Following updated guidance from Her Majesty’s Government on Sunday 10th May 2020, it is time to attend to the gradual re-opening of your clinical practice. Crucially above all else, this ought to be done carefully so as to protect your health and well-being plus that of your household. 

Guidelines:

• If you or anyone in your household is displaying COVID-19 symptoms (fever and a new continuous cough) OR has had a confirmed case of COVID-19, no service should be provided for a minimum of 14 days.

• If your patient or anyone in their household is displaying COVID-19 symptoms (fever and a new continuous cough) OR has had a confirmed case of COVID-19, no service should be provided for a minimum of 14 days.

- If you are in a particularly vulnerable group or have been contacted by the Government as one of those that must continue to self-isolate for a minimum period of 12 weeks, then we strongly urge to refrain from providing any physical treatments.

 - If you provide services to a residential home, you MUST liaise with the home to ensure you can work within their plans and policies that protect the residents.

• You are insured to treat patients in all other circumstances, but MUST exercise careful clinical judgement before deciding to provide treatment.

The sufficiently reduced spread of the pandemic in the community allows for the easing of the most stringent social distancing measures. So the potential risk to your customers is rather lower although issues that could become apparent with their feet may rather rise. Accordingly, clinical judgements on whom to treat and when, ought still to be made based upon:

• How failure to provide treatment will likely stretch precious NHS resource further and unnecessarily.

• Balancing the risk to the patient's health and wellbeing of no treatment against the potential of contracting COVID19.

At this time, we urge planning to return to more clinical practice. Over the next couple of months, the NHS are seeking to get many of their services back up to normal and have indicated planning to deliver service; based on urgency of care needed – not just emergency. Hence, planning to tend to the needs of the most urgent and pressing cases first and gradually working towards those less urgent, would be appropriate. This is paramount now since the Prime Minister indicated that stricter social distancing measures could be re-introduced on the re-proliferation of the virus.  

The patient's needs ought to be established via telephone consultation first; running through screening questions related to their general health, potential infection/symptoms of COVID-19 and any current foot problems.

The other main consideration necessary at this time relates to safe working practices; including both the working environment and personal protective equipment (PPE). Accordingly, we are issuing the following advice in conjunction with advice from Public Health England (PPE and Work Safely) 

Summary:

Pre-screening of all patients over the phone to ascertain whether attending to them is safe, required and possible (i.e. a problem likely to be out of scope should be arranged remotely to minimise the number of people necessary to sort out their problem).

• Reducing the amount of patient caseloads seen in a day – establishing there are sufficient gaps between patient caseloads to allow for PPE items disposal and decontamination of patient-to-patient accessories.

• Minimising time spent with patients WITHOUT affecting quality of care provided. This might include completing the patient's record card after leaving their company. Prolonged individual exposure increases risk of disease transmission. 

• Providing treatments in an outdoor environment where possible, practical, appropriate and agreeable. 

• Employing the strictest infection control practices and adequate PPE.

• Taking payment over the phone or via card transaction.
  

PPE Guidelines:

• Use of surgical gloves that are disposed of after every treatment and/or when damaged or visibly soiled with bodily fluids (as is usual practice).

• Thorough and rigorous hand-washing before and immediately after removing PPE.

• NOT touching the face at any point whilst wearing PPE or once removed until after hands have been thoroughly washed.

• While FFP2 or FFP3 masks are optimal, surgical face masks are sufficient when treating a patient with low suspicion of COVD-19. Surgical face mask disposal is after every appointment. FFP2 or FFP3 masks may be reused up to 3 times if not damaged or soiled AND/OR there has been no close contact with the face or upper-respiratory tract of someone with suspected (or confirmed) COVID-19.

• Offering and encouraging patients to wear a surgical face mask for the duration of their appointment and disposing of them after their appointment.

• Wearing a face shield/visor at all times during the consultation (these can be thoroughly disinfected between patients).

• Full-length sleeved gowns may be worn but regular aprons suffice.

While not possible to fully socially distance during treatment, we are fortunate to work at the distal end of the patient's body and are typically over a metre away from their upper body. Thus, risk of transmission is relatively low in comparison to other health and care profession contexts. Outside of the treatment moments, a distance of over two metres should be maintained between everyone from different households.

All listed PPE items are available through Podiacare®. Please note that due to current supply chain issues it may not be possible for Podiacare® to immediately supply all the listed items but are working very hard to ensure their availability. Please remain in touch with Podiacare® for your supplies.

If you have any queries, please do not hesitate to contact me and please do continue to keep safe and well.

Kindest regards,

Deborah Mercer
Chairman BCPA/BAFHP