Private Practice and Coronavirus
We’ve gathered all of the current advice we could find as of 15th March about best-practice during the pandemic, so that you can access it in one easy place.
As well as general advice, we’ve collated information about preparing to work online with clients, from training you can take to choosing video, email and messaging applications, and the privacy implications of this way of working.
As you know, this is a period of rapid change, and the sources cited throughout this article may be updated frequently to reflect the latest information – please check the links provided to make sure the details are still relevant. At the very least, we encourage you to keep up to date with the latest from the Government, NHS and Public Health England sites, as these will be informing most other reputable sources.
We hope you find this useful during this period of change! If you would like us to include any additional information, please let us know.
In this article:
- Working with clients during the pandemic
- Face to face sessions
- Providing online, telephone and text-based nutritional therapy
- Preparing to work with clients online
- Software applications for online therapists
- Privacy and data protection
- Financial support for small businesses
- Looking after yourself during the pandemic
- Relevant reading
Working with clients during the pandemic
Several professional bodies have recently posted member updates about working safely during the pandemic:
- The Complementary and Natural Healthcare Council (CNHC) have issued a statement offering guidance and practical, safe-working tips for therapists in private practice during the pandemic. In this statement, they stress the importance of hygiene advice and refer practitioners on Accredited Registers who regularly come into contact with the public to the UK Government guidelines.
“As holders of accredited registers, our key purpose is to protect the public. We also support registrants in the safety of, and the continuity of, their practice. We hold the registers of over 80,000 health and care practitioners in the UK. We want our registrants to maintain services to patients, clients and service users, keeping safe and healthy as you do so.”
“For those practitioners on Accredited Registers that frequently come into contact with members of the public, the UK Government has produced extensive guidance for healthcare professionals.”
- FHT has issued a similar statement which details practical ideas on how to adjust your practice and continue to offer nutritional therapy, alongside maintaining your own health and wellbeing.
- Association for Nutrition (AfN) has provided information for trainees and practising therapists who may be attending courses or universities on their site and have issued a statement on changes to working with the professional body whilst the pandemic continues.
For the sake of brevity, we’ve only listed two professional bodies here; generally speaking, the advice appears to be fairly consistent, but you may wish to check your own professional body’s site for specific details if it’s not listed here.
Some key things to consider are:
- What steps can you take to minimise risk for your clients – and yourself? These may be as simple as increasing hygiene measures, to suspending face-to-face contact temporarily.
- Are you capable of providing nutritional therapy remotely – e.g. online or via telephone – during the pandemic? Would these methods be suitable for your clients?
- How will you communicate any updates to your clients – for instance, if you become unwell and are unable to take sessions?
- Do you have a process in place for clients to let you know if they are unwell, or have been in contact with a confirmed case of COVID-19 – and has this been communicated to them? Do you need to review your cancellation procedures in light of recent news?
- If you contract COVID-19, do you need to let your clients know that you may be asked to provide their details to the relevant authorities for contact tracing, and is this covered by your contracts and insurance?
- How might your fees be affected? For instance, if you normally charge a cancellation fee, will this still be the case in light of the pandemic? Might this cause a client to feel compelled to break self-isolation to come to a session?
- How will you take care of your own health during this time?
Face to face sessions
There are many simple steps you can take based on existing advice, such as:
- Practise social distancing. Keep at least one metre away from clients (ideally two metres for extended periods, i.e. over 10 minutes). Avoid hand-shaking or other physical contact.
- Wash your hands thoroughly before and after each client.
- Regularly disinfect door handles, hand-rests of chairs, computers, laptops, phones, writing implements etc between clients.
- Make sure tissues are available to clients (if they weren’t already) so they can practice the mantra “catch it, bin it, kill it”. Pre-divide tissues into batches so that you can provide clients with their own portion – don’t have one central box of tissues that could become contaminated.
- If you provide a bin for tissues, make sure it is emptied between clients and use appropriate measures to prevent yourself from coming in contact with the contents – or ask clients to take their tissues home and dispose of them themselves.
- Air out the consulting room where possible by opening windows etc.
- Use your judgement: if you have any doubts about your own health or that of your client, take the appropriate steps. This may include self-isolation, sign-posting clients to resources such as NHS 111 or PHE, and notifying other individuals who you may have been in contact with (or who may be affected).
These are just a few ideas that could make a difference; think about the way your practice currently operates, and what changes you could put in place that will have the greatest impact for you and your clients. You could even discuss ideas in our Member Notice Board, or in other online therapist groups that you’re a part of.
Providing online nutritional therapy
For ease, we will refer to all of these methods as “online nutritional therapy” throughout this article unless otherwise specified.
Online nutritional therapy may provide an excellent alternative to face to face sessions during the pandemic, and may enable you to keep working with clients who might be otherwise unable to attend.
Online nutritional therapy is currently unregulated, and there are no specific qualifications required to conduct sessions online instead of face to face; however, you should be mindful of your professional body’s code of ethics and any specific competency frameworks in place.
Regardless of the method in which you deliver nutritional therapy, you will naturally still be expected to adhere to your professional body’s code of ethics, and to only offer therapeutic services that you’re competent to deliver.
If you currently offer online or telephone nutritional therapy, ensure that your Nutritionist Resource profile has been updated to reflect this. You can specify your methods of delivering therapy here.
You may also want to update your main profile text to refer specifically to Online or Telephone nutritional therapy sessions and how these are conducted, as we anticipate that this option will be of particular interest to visitors over the coming months – and it’s likely to be an approach that many aren’t familiar with.
Preparing to work with clients online
For those new to providing online nutritional therapy, you may need to adjust the way you’re used to working. You will also need to be able to competently assess your own ability to deliver nutritional therapy effectively online, and the client’s receptiveness to this approach.
To ensure you are prepared to offer online nutritional therapy, consider reaching out to the professional body you are a member of or training organisation to ensure you are fully equipped to offer this type of therapy and continue to adhere to their code of ethics:
- Association for Nutrition: Standards of Ethics, Conduct and Performance
- BANT: Professional practice Handbook
- Hcpc: Standards of Conduct, Performance and Ethics
- CNHC: Code of Conduct, Ethics and Performance
- FHT: Code of Conduct and Professional Practice
Some practicalities to consider include:
Check that your insurance (and that of your employer, if applicable) covers you for online and other forms of remote nutritional therapy – you may need to amend your policy to make sure you’re covered when working in this way.
- Client contracts
- Client payments
You may need to investigate electronic means of being paid, such as bank transfer, Paypal or other online invoicing. Many of these options are quick and easy to set up.
Working remotely has the potential to be a challenging transition when you’re used to seeing human beings in person day to day, and it’s important to recognise that you may need to spend a bit more time looking after yourself while you’re at home. We’ll talk more about looking after yourself later in this article.
Software applications for online therapists
Communicating with clients over the internet requires a platform that you can both use to speak to each other – and, often, see each other too.
It’s natural to feel a degree of trepidation when transitioning from the familiar world of face to face work to your first online client, particularly if you don’t consider yourself to be technically astute.
The good news is that, as far as the technical aspects go, connecting with a client online is actually relatively straightforward, and opening communications can be as easy as sending a video link to them prior to their next session!
Video-calling and Instant Messaging
Here is a list of three popular video-calling and messaging services used by therapists: use the links to see which one fits the bill for your practice.
Trusted by household names such as Sonos, Delta Airlines and 21st Century Fox, Zoom offers a free Basic package with no limit on 1 to 1 meetings (meetings with 3+ participants have a 40-minute cut off).
VSee is the platform of choice for 1000+ telemedical companies, as well as NASA for the Space Station. It offers HIPAA-approved secure video communications, and their Free packages offer up to 25 video calls per month plus unlimited secure messaging.
Signal provides end-to-end encryption on calls and messages and is available in desktop and mobile app form. As an open-source project, it is free to use.
While a popular option, some therapeutic organisations have expressed concerns about the security and overall suitability of Skype as a platform for therapy. Because it is an application most likely to already be used by many members of the public – and therefore adds a certain degree of familiarity and ease of use during periods of distress – you should assess the pros and cons of this platform yourself, and check that your client has familiarised themselves with the terms of this product. You may find ACTO’s guidance notes on Skype an interesting read.
The following platforms offer enhanced privacy and may be of interest if you’re planning to conduct sessions in this way:
Designed for the healthcare industry, Hushmail provides encrypted email and secure webforms for clients to contact you. Fees start at $5.99 per month per user (a small business will typically only require 1 email address), and a 1-off setup fee of $9.99. It has a 60-day cooling-off period, during which you can get a full refund.
Switzerland-based Proton offers end-to-end email encryption, and is open-source – meaning it’s free to use.
Privacy and data protection
Your obligations to protect the data you process don’t change materially when you work online with clients; however, you will need to apply the same kinds of security measures while working in this way that you would have to normally. For instance:
- Who has access to your computer / applications that you’re using to work online?
- If you’re using third-party applications to process your clients’ data, what are their security policies? How will they protect this data?
- If you’re using applications based outside of the EEA, will you need to update your privacy notice or client contracts?
For general advice on Privacy and your obligation to protect the data you process, The Information Commissioner’s Office (ICO) Guide to Data Protection is the place to go. If you still have questions after reviewing the information available, you can contact the ICO directly for clarification.
In it, they confirm that communicating updates to your clients about public health – e.g. if you keep them informed about measures your practice is taking – are not direct marketing, and so are not restricted by data protection laws. Ensure you have a way to communicate with your clients quickly and easily so that you can keep them informed of any factors that affect them.
In addition, public bodies may require “additional collection and sharing of personal data to protect against serious threats to public health”: as outlined above, you should keep clients informed about the possible implications contract tracing may have on your confidentiality clauses. You may be asked to provide information about individuals’ health to the authorities, though it is unlikely.
ICO have stated that they “recognise the unprecedented challenges we are all facing during the Coronavirus (COVID-19) pandemic”, and are happy to answer questions. You can contact them on 0303 123 1113.
Financial support for small businesses
The Government has issued information about financial support for employees, benefit claimants and businesses following the 2020 Budget, including measures to protect small businesses and self-employed people during the pandemic.
This includes a dedicated helpline for businesses and self-employed individuals in financial difficulty, and how to access support.
If you have income protection included on your insurance policy, you may wish to familiarise yourself with any updates your insurer has provided in light of the pandemic.
Looking after yourself during the pandemic
Last – but by no means least – we want to take a moment to talk about you. You. The human being who bridges the gap between individuals needing help and support and their own rich personal life (and that of their family) which may be being affected by the current state of play.
First and foremost, we can’t stress enough that following official guidance on social distancing and hygiene is paramount to safeguarding your physical health. It goes without saying that you can’t realistically look after others without looking after yourself first.
When it comes to seeing clients, your own judgement is key, and this is apparent in professional body codes of conduct. In their Code of Conduct, Ethics and Performance under Your own health and wellbeing, CNHC write that their members should:
“…get and follow professional advice about whether or how you should modify your own practice when clients may be at risk because of your own mental or physical health. You must notify CNHC at the earliest opportunity if you have a health issue that could affect your ability to practise.
“You are encouraged to monitor your own health and wellbeing to reduce the risks to clients. If possible, you should use your professional insight to identify when your ill health may put clients at risk. It is recommended that you get the help, support and advice of an appropriate health professional in this.”
FHT has issued a statement detailing how to take care of yourself and your clients at this time, highlighting, “First and foremost, take good care of your own health and wellbeing at this challenging time, including your emotional and mental wellbeing. Find some time each day – even if it’s just 10 minutes – to practice mindfulness, yoga, or a short breathing exercise. Or simply do something you enjoy, whether it’s baking, taking a long warm bath, exercising or reading a book.”
In short, you will need to weigh up the two sides of the scale:
- Your ethical duty to protect the welfare of clients
- Being responsible for your own health and wellbeing.
Measures such as working online / via telephone or text-messaging with clients may strike an excellent balance between the two, and offer you a way to continue nutritional therapy while balancing risk – provided you are both mentally and physically (and ethically!) capable to do so.
If you find yourself unable to commit to sessions for the immediate future, the key thing is to make sure that your clients are informed, and to make provisions for their ongoing support in your absence. If you need help doing this, your professional body or supervisor will be able to signpost you to the relevant sources.
If you’re used to working from a building with other people, you may find the switch to home working takes some adjustment. You may even find that missing out on the change of environment that comes with travelling to a consulting room has an unexpected impact on you. The Guardian has prepared a list of helpful tips for home-workers which you may find useful, even if some of the information may not be directly relevant to the way you work.
Finally we wanted to take a moment to share some of the self-help literature that we’ve produced for the public in the last few days. As you know, this is something that we truly believe in at Nutritionist Resource and Happiful, and sometimes the little things really do have a big impact.
- Coronavirus: 8 Ways to help yourself and others
- Worried About Coronavirus? Here’s What You Need to Know
- Working From Home – 7 Steps For a Better Work Day
- Happiful: Managing Coronavirus: A Psychotherapist’s Perspective
- BANT: Wellbeing guidelines
- GOV.UK: Coronavirus (COVID-19) guidance for employees, employers and businesses
Please note: Nutritionist Resource and Happiful are not affiliated with any of the organisations referenced in this article, and this article has not been sponsored by any third parties. We strongly recommend that you carry out your own research to make sure that you can make an informed choice that best suits your business. While we hope that this information is useful, we cannot be held responsible for any business decisions you make based on this article, or for the information published on third party sites.
All information correct as of 15/03/2020.