Coronavirus COVID-19 Update from Speed Medical
2nd June 2020 - Physiotherapy Update
We are committed to actively monitoring all relevant advice and guidance from the Government, HCPC and the CSP and any potential impact it could have on our working partnership.
As a result of this activity, earlier this week we provided a brief update on our Physio Portal indicating that the potential to utilise remote appointments was being reviewed and as such today’s letter is the confirmation of the findings that this consultation has delivered.
To ensure that we continue with our successful coordinated and client-centric approach, I’ve conducted a thorough review of the latest guidelines with our Clinical Advisory Board (CAB) member, Andrew Cuff, Consultant Physiotherapist, and can confirm that we have made the decision to shortly commence with instructions for ‘Remote Physiotherapy’ sessions.
To further assist you with the management and service of these remote instructions, we are currently in the process of redeveloping our dedicated Physio Portal, so that we can continue to provide you with a reliable and user-friendly real-time resource to manage documentation, performance and workload.
Below you will find a detailed Physiotherapy Review conducted by myself and Andrew Cuff, to provide a more clinical elaboration on the new process and our practical advice on conducting these sessions. It is, however, imperative that you currently refrain from the practice of ‘Remote Physiotherapy’ sessions for any Speed Medical instructions until a firm date is confirmed. I will be in contact with you in the next few days to confirm the specific date that remote will be an acceptable means of treatment delivery.
Face-to-face sessions – CSP Guidance
Chartered Society of Physiotherapy (CSP) guidance is very clear that remote consultations should be the default and any face-to-face sessions should be the exception, rather than the rule. Given the scope of practice of those on the expert panel to provide non-surgical, non-invasive (i.e. no injection therapy) treatments, it would be very rare that a consultation necessitates face-to-face treatment. Such circumstances would be limited to rapid, significant clinical deterioration with suspicion of underlying serious pathology, or those presenting with worsening, progressive neurological symptoms of spinal origin. In all other circumstances, remote consultations (telephone or video) should be utilised. It is likely that a remote consultation will be the initial point of contact and within that consultation, a robust triage decision can be made regarding whether a face-to-face assessment is necessary.
For some tips on how to utilise video consultations in your clinic and for guidance on best practice, see here: http://www.pulsetoday.co.uk/clinical/clinical-specialties/respiratory-/video-consultations-tips-for-primary-care-during-covid-19/20040448.article
Prior to considering whether to bring someone in for a face-to-face assessment, the following should be considered (CSP 2020):
- You must follow Public Health England (PHE) COVID-19 infection prevention and control (IPC) guidelines.
- You must provide and use appropriate personal protective equipment (PPE) and have systems and policies in place that govern its use.
- A ‘virtual first’ approach with remote consultations must remain standard practice during this period.
- You must undertake a risk assessment and make a clinically reasoned decision for offering either a face-to-face or remote consultation for each patient and for each of their planned contacts. You must document your rationale for these decisions.
- A full risk assessment of the working environment for which you are responsible must be undertaken and documented, and you must demonstrate that all measures designed to mitigate risk and fulfil legal and regulatory obligations are in place.
Such a risk assessment should be clearly documented within the clinical records and should be provided to Speed Medical for review and capacity to audit. In addition to clinical need for face-to-face appointment (as outlined above), this risk assessment should consider two further strands: the risk to the staff member and the risk to the individual.
Factors to consider include (Jankowski et al. 2020):
- BAME background.
- Pregnancy status.
- BMI > 30
- Age > 65-years.
- Known immunocompromise e.g. HIV, diabetes
- Vitamin C or D deficiency
- Smoking status
- Gender: males at increase risk of COVID complications.
- Underlying respiratory condition e.g. asthma, COPD
Once the risk assessment has been completed; it is important that the risk/benefits of a face-to-face assessment are discussed with the patient with a shared decision then made.
The CSP guidance (2020) goes on to say:
- You must engage your patients in discussions regarding the rationale for remote or face-to-face consultations. If both parties deem it necessary to proceed with face-to-face care, the patient should be made aware of all current risks associated with this approach. They must give their consent and you must document these discussions and the outcome.
The team at Speed Medical will obtain consent for remote treatment to be facilitated from both the client and solicitor prior to your instruction. The consent will be detailed within the instruction letter or on a case by case basis for work in progress. Upon receipt of our instructions, a screening call is expected to take place between yourself and the client allowing you to determine the most appropriate treatment type: either remote or face-to-face.
There has been no change in standards expected from clinical documentation during this COVID-19 pandemic. You should continue to follow the standards outlined by CSP and HCPC around documentation with the addition of documenting the method in which the consultation has taken place i.e. telephone, video or face-to-face.
In order to allow patients to receive high-quality, exercise-based rehabilitation programmes whilst undertaking remote consultations, use of an online exercise platform is recommended. Such platforms are integral to an effective remote consultation. There are many in existence that I am sure you have already explored and may have already started utilising. There is no gold standard, and each has its advantages and disadvantages. My advice would be to consider what platform integrates best with your clinical record system and provides you with the ability to add or amend to the stock exercise library to enhance its use within your clinic.
To maintain, monitor and refine the COVID-19 response, Speed Medical will continue to audit to identify any areas for development and improvement. These audits will focus on safety, patient experience, and patient outcomes. You will be asked to record your method of consultation (telephone, video, face-to-face) on the portal to facilitate this.
Your Collaborative Partner
We understand that there have been many challenges of late with transformation of services and clinical innovation moving at both pace and scale to allow clinical delivery to be maintained for patient safety and rehabilitation, as well as business continuity. We remain grateful for all that you are doing to help and support in such an effort to minimise the indirect effects of COVID-19 on the wider population and the patients that we serve.
I will be in touch with you shortly with a definitive date to commence with Remote Physiotherapy sessions and ask that you please adhere to the current guidance until this next communication has been received.
As ever, we will continue to remain vigilant and proactive in our approach and together with our Clinical Advisory Board (CAB) we will report any changes that may affect you, your business and your partnership with us. The safety of you and our clients remains at the heart of our business and we believe compliance with the guidelines above will deliver enhanced measures to safeguard all.
We are here to support you if you have any further questions or queries, please do not hesitate to get in touch by calling the clinics team.
31st March 2020
MedCo have issued a further statement confirming that they have reviewed their previous stance on remote examinations.
Following this advice, as part of our coordinated approach to these unfolding changes in policy, we’ve conducted a thorough review of the guidelines, in consultation with our Chief Medical Officer, Dr Dan Bunstone, so I urge you to please ensure you read the information contained in this email in its entirety.
Before I elaborate on the new processes, the link below will give you MedCo’s new guidance published 31 March 2020:
As the situation continues to evolve, our Covid-19 Management Taskforce, Chief Medical Officer and Clinical Advisory Board (CAB) are ready and available to continuously review the relevant advice from the Government, clinically validate and amend our processes accordingly and keep you updated via direct communication and our website. As such I would like to provide the following amendments and how we can work best collaboratively in these challenging circumstances:
- If you wish to provide Speed Medical with explicit consent for MedCo case medical appointment to be conducted via remote consultation, please submit your approval for this means of appointment to Caroline.Arrowsmith@speedmedical.com
- Our support team will then contact your client on your behalf to seek explicit informed consent to be examined by remote means by one of our medical experts.
- Once we have obtained explicit consent from both yourself and your client, we will coordinate the appointment with the medical expert.
To ensure the clinical validity of remote appointments we are also asking our experts to make a professional judgement that it is appropriate for a medical appointment to be carried out by video and they are subjected to stringent approval processes to review the technology solution that they intend to employ for this purpose. We have a dedicated expert team here to help and support them in the delivery of video appointments and we have clear guidance on the methods we have scoped and deem appropriate and acceptable.
We have also advised all medical experts undertaking MedCo medical assessments for us that it is absolutely vital that all reports conducted via video appointment contain the following:
- A statement that the examination was not a physical one and that it was conducted remotely;
- Whether or not the claimant had received legal advice prior to agreeing to a remote examination; and
- That the informed consent of the claimant was obtained prior to proceeding with the examination and evidence of such can be provided on request by the compensator or MedCo.
Please note, this guidance is for MedCo cases only and does not apply to any other case type. Of course, we remain committed to providing you with choice and rest assured that if you do not wish to participate in this amended approach to medical appointments we will make alternative arrangements for your clients.
We will continue to remain vigilant and proactive in our approach and together with our Clinical Advisory Board (CAB) we will provide you with commentary on any changes that may affect you and our valued partnership.
The safety and wellbeing of you, our clients and our nationwide Expert Panel remain at the absolute heart of our business and we believe compliance with this new advice will deliver enhanced measures to safeguard the vulnerable and at risk.
I hope this communication has been helpful and we await your instruction that you give consent for your MedCo case medical appointments to be conducted via remote methods in the above way.
We are here to support you if you have any further questions or queries, please do not hesitate to get in touch by calling your dedicated account manager.
19th March 2020
In light of the evolving situation surrounding the Coronavirus (COVID-19) outbreak, we would like to assure all of our customers that you are still our priority and we are still responding to instructions in the same way. Although we are experiencing very uncertain times, you can be certain that we are doing all we can to ensure we maintain our close partnerships with customers and are putting measures in place to safeguard your clients.
Our customers are at the heart of all we do. We understand that this is a difficult time for everyone, and we’d like to reassure you that we have a robust continuity plan to ensure you can continue delivering the highest standards to your clients.
With these measures in place, we will continue to provide our services to your firm successfully in the event of an office shutdown, or if members of the Speed Medical team are advised to self-isolate.
Our plan is outlined below:
- In line with the latest guidance for ‘vulnerable groups’, we have identified all clients over the age of 70 with medical appointments to ensure their safety and proactively ensured their appointments are rescheduled for a convenient time in the future.
- As we are also concerned about the safety of our staff, we have been able to ensure that almost all of our staff can work from home securely and have full telephony and IT support. This action was taken in immediate response to the change in the official Government guidance.
- To ensure all clients receive the most up-to-date information, all external communications to clients, including mymedical, text and letters, will provide advice in respect to attending appointments, safeguarding them and our supply chain.
- All external suppliers have been advised to refrain from attending the offices of Speed Medical.
- Restrictions have been placed on workplace travel and all external meetings are being undertaken by video or call conferencing.
- We have been actively communicating with our Expert Panel, ensuring we are updated on any significant disruptions that may occur and will advise our customers and clients accordingly.
As the situation continues to evolve on a day-to-day basis, we will continue to review the relevant advice from the Government, amend our processes accordingly and update you via our website. If there are changes to your clients’ appointments, we will inform you immediately.
Although we are experiencing some very difficult times here and across the world, we will continue to strive for excellence in all we do. Our customers and clients remain at the core of our service delivery and despite the changes to the way we work, we will continue to listen to your needs and do our utmost to deliver on them. The wellbeing of our clients and customers is our top priority and we will always act quickly if any concerns arise.
If you have any questions, please don’t hesitate to contact us.