On 23rd March 2020, the UK went into lockdown in response to the global coronavirus pandemic. Government advice was to ‘stay home, save lives’, those who were able to work from home should begin to do so immediately. So, what happened to the businesses that rely on face to face contact?
We caught up with Carys Roberts at Swan Physio to find out how their practice responded to the strict lockdown measures and how they have continued to successfully adapt as the situation continues to develop.
Carys is the clinical director and lead physiotherapist of Swan Physio, based in Keele, Staffordshire. Swan Physio is a successful, multidisciplinary practice. In addition to physiotherapy, the clinic also offers sports therapy, osteopathy, pilates, hypnotherapy and podiatry treatments.
Prior to lockdown, Swan Physio was a bustling hive of activity, not only busy with patients but also offering student placements and training internships. As well as spending three days a week practising at the clinic, Carys is also a Consultant Physiotherapist on the Lioness Pathway working with elite female footballers aged 14-17 to support them with bespoke plans and on residential camps.
After hearing Carys describe all of the different aspects of her practice, my mind started to spin just thinking about the logistics of how she would have even begun to navigate the extreme lockdown measures imposed in late March, but Carys was calm, collected and most importantly, prepared.
As a conscientious business owner, Carys was well aware of the ripples being caused by COVID-19 in advance of the strict lockdown measures which were imposed in late March.
By 16th March Swan Physio had begun to see a significant change in their schedules as patients opted to cancel or postpone non-essential treatments and many were unable to attend due to self-isolation. ‘The diary turned red’ remembers Carys, as they marked more and more appointments as DNA’s. At this point, the clinic had already taken the decision to move pilates classes online. Carys explained how she wanted to begin the transition to virtual classes before they were forced to, meaning that they had time to talk through the process with their clients, explain how things would work and make sure they would be comfortable with the changes as well as get the technology working!.
As things continued to progress, Carys says that she went into clinician mode; her first thoughts were on how they could continue to treat their patients, people were still having surgery, people were still in pain and she started to think about how Swan Physio could continue to support their patients through what was inevitably going to be a difficult time.
One thing which Carys continues to go back to throughout our chat is the importance of communication, especially in those early days where things were still uncertain. In the lead up to lockdown, Swan Physio started to send out regular communications to their clients to keep them informed on exactly what was happening, how the practice was reacting to the ever-evolving situation and what to expect from their treatments. Initially, the clinic sent out emails via PPS which contained information on the enhanced infection control measures put in place, how the team at Swan Physio had been kept up to date with the latest guidelines and details on how procedures could potentially alter in the coming weeks and months, including online and telephone treatments, home visits and special time slots for those identified as vulnerable who still needed to come to the clinic for face to face treatments.
Eventually, Swan Physio updated their website to include all of the information they had previously been sending via email with a ‘COVID-19’ dedicated space where their clients could easily find all of the relevant information and continued to email their database with links to the webpage as it was updated.
Faced with the possibility of extreme changes to practice guidelines, Carys began to analyse Swan Physio’s patient database. Using PPS reports, Carys was able to identify all clients that were within a certain age bracket and all clients that had certain medical conditions/history and found that just 25% of the clinic’s patient database fell within the vulnerable category. Knowing that 75% of their patients were outside of the ‘at risk’ groups gave the team the confidence to remain open and continue treating where possible.
On the evening of Monday 23rd March, the UK’s prime minister announced a nationwide lockdown, with strict restrictions effective immediately.
Carys recalls listening to the announcement on the radio whilst she was mid-treatment with a fellow clinician who was also anticipating the news. With the lockdown measures being imposed in the evening, it left little time to prepare and at this point there hadn’t been much guidance published.
Throughout lockdown, Swan Physio continued to provide treatment and support to their patients as they quickly adapted to the situation.
Swan Physio began to operate on reduced staff and opening hours. Pilates classes were pre-recorded and made available to those who had pre-paid with passwords to access the sessions sent out securely via PPS. Hypnotherapy sessions continued to be conducted virtually via PPS Video Consultations feature, too.
From 23rd March Carys was the only clinician to work at the practice and was in clinic on a Tuesday and Friday, using the PPS diary to re-jig availability to accommodate and support the new schedule. In response to the circumstances, they had also upped their cleaning procedures and the whole practice was cleaned professionally on Mondays and Wednesdays ensuring hygienic conditions for the days on which any face-to-face treatments were conducted.
Carys continued to provide face-to-face treatment to clients that met the criteria to enable her to do so. These clients were identified as meeting the guidelines provided by the HCPC, CSP and Physio First. For all other clients, treatment was offered online via PPS’ telehealth integration which Swan Physio continues to use now, or postponed accordingly.
When asked about providing treatments during lockdown, Carys talks confidently about the fact that herself and her colleagues are highly trained and autonomous clinicians who, to qualify, worked in hospitals, are familiar with infection control and contamination procedures having worked on ITU rotations and who are well versed in the avoidance of cross-contamination and procedures to protect both themselves and their patients.
As time went on and lockdown measures remained firmly in place, Carys talks about how she had to begin to consider how to manage patients who did not currently meet the criteria for face to face treatments who, if left without, would soon qualify. In a bid to keep their patients in good health, those who were new to the practice and had begun treatment in January 2020 were given regular courtesy calls, providing free remote support to those unable to attend the clinic.
All in all, Swan Physio have had almost 500 patient contacts since lockdown began, made up of both face-to-face and virtual appointments. This is both a commendable and inspiring number considering the circumstances and is a testament to the drive and determination that the team have to provide high-quality care to all of their clients, no matter the obstacles they may face.
Reading this, it may be easy to think that Swan Physio seems untouchable, but they have not come through this completely unscathed. Prior to the furlough scheme being introduced the difficult decision was made to significantly reduce both the clinical and admin teams and through the months since March, they have seen a 60% reduction in revenue compared to last year for the same quarter – with April understandably being one of the hardest-hit months showing an 85% decrease.
Where are they now; as lockdown measures continue to ease
In mid-May, new guidance was published which gave clinicians a little more scope to begin to see more patients in face-to-face appointments and Swan Physio saw the numbers increase in clinic around June, although they still continue to only see patients in clinic that they cannot treat remotely.
Over the past few months, Carys also mentions, they have gained some new patients who were looking for treatment from alternative clinics due to a lack of communication from their previous practitioners, highlighting the importance of maintaining relationships where possible.
Although some may feel like things have started to return to normal, there are still many regulations in place that Swan Physio are having to navigate as they continue to dynamically adapt.
As Carys begins to talk me through all of the changes the clinic has undertaken in order to continue to safely treat patients, she mentions how they are in the process of moving to PPS Online Appointment Booking to manage their virtual treatments. New and existing clients can book virtual treatments only via their website and payment for any treatment is now required upfront as their onsite card machine has been temporarily removed for hygiene and safety reasons. Not only has the clinic found this useful for COVID-19 related safety reasons, but they have also seen a drop in the number of DNA appointments and online booking has been a reliable support system whilst working with a reduced admin team.
Swan Physio have seen such positive results from virtual treatment that they plan to continue offering all initial assessments via video call only.
Carys talks about how learning to adapt to online treatment has improved her diagnostics, having to rethink her assessment processes without being able to rely on touch and muscle memory.
Swan Physio now has a dedicated space at the clinic set up for online treatments based in their fabulous Rehab Gym where they have space, equipment and can use multiple devices to demonstrate exercises and movement to their clients from different angles, ensuring that they are providing the highest quality care possible. The team have also had to rethink their exercise prescription, learning to adapt their treatment plans to suit the space and equipment available in their patients’ homes.
Other safety measures that the team have introduced include temperature checks on arrival at the clinic, wearing PPE, risk assessments for face to face treatments and screening forms sent out to patients for them to complete prior to attending.
The team has also introduced regular internal testing which takes place on a weekly basis, testing all staff members for antibodies and active infections to avoid asymptomatic transmission within the clinic. This doesn’t come cheap but is an expense that the practice deems necessary in order to continue to practice safely and to give their patients the confidence to continue face-to-face treatment as needed.
On that note, Carys begins to talk about the importance of patient feedback and the clinic’s understanding of their comfort levels when on site. To ensure the practice continues to provide a safe environment in which their patients do not feel vulnerable, Swan Physio have started to work with Insight6, a customer experience specialist team. Following treatment, patients now receive a questionnaire, the results of which have helped Carys and the team to understand things from their patients perspective and has given them the insight into the customer experience that they need in order to adapt, making small changes like being clear about where to sanitise hands and introducing a video which is sent to all patients prior to attending treatment on what to expect.
Although the clinic is successfully continuing to practice, Carys predicts it will be at least another 12 months until they are anywhere near being able to get back to full capacity. As of July the team is reduced to senior clinicians only, each member of the team will have a ‘virtual day’ per week and only 2 practitioners will be treating patients face to face in clinic at any one time. Swan Physio usually offer training internships for new graduates which have been temporarily suspended and placements for the students of Keele University and Birmingham University have also been put on hold, too as a result of the pandemic, although Carys is currently trying to develop a virtual student placement offering which she hopes can be of use from the next academic year.
Over the next year or so, Swan Physio will be doing everything they can to remain in practice and have already begun to see improvements and an increased demand following what were some very difficult months.
Not only are Swan Physio a brilliant example of a dynamic and adaptable team but the positivity with which Carys remembered even the hardest and most uncertain times can serve as inspiration for any practice, big or small that might be wondering what the future holds.
Find out more about Swan Physio on their website: https://swanphysio.co.uk/