Following guidance from Her Majesty’s Government on Sunday 10th May the time has come to start turning my attentions to the gradual resumption of my clinical practice. It is crucial that above all else this is done carefully so as to protect my health and wellbeing, the members of my household and my clients. I will contact you in the morning before your appointment but you may want to contact me to cancel asap if…

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

I have received instructions from the SMAE Institute (college and Insurers for Foot Practitioners) that I’m to adhere to but I also have training in infection control from my nursing background.
The college has stated..”
What we urge you all to do at this time is to start planning your return to more clinical practice. The NHS are seeking to get many of their services back up to normal running over the next couple of months and they have indicated that they will be planning to deliver service based on urgency of care needed – not just emergency. Therefore, it would be appropriate to plan to tend to the needs of your most urgent and pressing cases first and gradually work towards those in less urgent need of foot care”.

In essence the general advice is along the following lines:

• Make sure that all patients are pre-screened over the phone to ensure that attending to them is safe, required and possible (i.e. if their problem is likely to be out of your scope – please seek to arrange that remotely so that they minimise the amount of people they have to see to sort their problem out)
• You will need to reduce the amount of patient caseloads that you see in a day – ensure that you have sufficient gaps between patient caseloads so as to allow for disposal of PPE items and decontamination of any accessory items that you would use patient-to-patient
• You will need to seek to minimise the amount of time spent with patients WITHOUT reducing the quality of care that you provide. Prolonged exposure to individuals increases the risk of disease transmission. This might include completing the patient record card after you have left the company of your patient
• Where possible, practical, appropriate and agreeable with the patient, seek to provide treatments in an outdoor environment
• Ensure that you employ the strictest infection control practices and have adequate PPE
• Where possible seek to take payment over the phone or via card transaction

PPE Guidelines:

• You will be required to use surgical gloves that are disposed of after every treatment and/or after they have become damaged or visibly soiled with bodily fluids (as is usual practice)
• Hand-washing has to be thorough and rigorous before donning PPE and immediately after removing PPE
• DO NOT touch your face at any point whilst wearing PPE or once it is removed until you have thoroughly washed your hands
• FFP2 or FFP3 masks would be optimal BUT surgical face masks are appropriate where treating a patient where there is low suspicion of them having COVD-19. Surgical
face masks are to be disposed of after every appointment. FFP2 or FFP3 masks may be reused up to 3 times if they have not become damaged or soiled AND/OR where you have not been in close contact with the face or upper-respiratory tract of a person with suspected (or confirmed) COVID-19. • Patients should be offered and encouraged to wear a surgical face mask for the duration of their contact with you and they can dispose of them following their contact with you
• A face shield / visor is to be worn at all times during the consultation (these can be wiped clean thoroughly with a disinfectant between patients)
• Regular aprons will suffice but you may wish to wear full-length sleeved gowns.

Whilst it is not possible to fully socially distance whilst providing treatment to patients, we are fortunate that we are working at the distal end of their body and are typically >1m away from their face, mouth and nose. Thus, risk of transmission is relatively low compared to in other health and care profession contexts. Outside of the moments of treatment, you should seek to place a distance of >2m between you and the patient and you and anyone else in their households.

Are you vulnerable and in urgent need of treatment or not?