Digital, print, virtual and telephysiotherapy

Many physiotherapists want to share their services and knowledge with a wider audience. Using digital technology and telemedicine to deliver services and publishing material in print or digital media have specific insurance issues you must consider.

Websites

Physiotherapists who use a website as a platform for their services tend to offer one of two types of service:

Where their website provides advice and information

Where their website acts as a gateway for patients to access a secure site to enter into a one-to-one online 'virtual' professional relationship.

Advice provided over open-access non-secure websites may be general advice on physiotherapy topics only. It must not be tailored to the individual requirements of an enquirer nor be specific advice designed to address the concerns of individual patients or clients.

Any general advice must be reviewed on a regular basis to ensure that it is accurate and up to date and all such communications should carry a message clearly stating that the advice is general in nature. Patients requiring individual advice should consult their own therapist. In these circumstances of providing general advice, no duty of care would be established and it is most unlikely that the provision of such a general service could give rise to a claim in negligence law. If the advice is too specific, anyone using the information on the website who subsequently suffered harm might try to argue that you owed them a duty of care and therefore that you could have been negligent.

There are examples of web-based services that offer personalised advice and management to patients via a secure fee-paying log-in for services. However, you must remember that if you start entering into personalised assessment of a person's injury needs, or provide tailored intervention, you create a duty of care to that person. You must only offer any intervention based on appropriate assessment; and you will need to consider whether you can give such advice purely online or whether at some point you will need to see the person for an in-person face-to-face consultation. This would be particularly pertinent if you are offering diagnosis and prognosis - giving a diagnosis is personalised care, so you can only do this after proper consultation and assessment. Disclaimers are not acceptable due to the legal duty of care.

You must consider where your website is based and hosted, and there should be a statement explaining the legal status of your terms and conditions for the use of your information. Your CSP PLI does not provide cover for claims brought in the jurisdictions of the USA and Canada, and consequently CSP members should be advised not to provide specific advice services to individuals in North America.

The CSP scheme only covers individual members and does not include cover for any claim brought against a website or organisation owned by a CSP member, or any other organisation for whom, or on whose behalf, the member is acting.

Telemedicine and other virtual technologies

The CSP PLI scheme has restrictions on the extent of indemnity provided to members for telemedicine and other virtual technologies provided to people outside the United Kingdom.

If you are in the UK

Services provided from the UKby members who are ordinarily resident and based in the UK, to people who are also physically based in the UK at the time they receive the consultation, are covered by the PLI scheme subject to policy terms and conditions. A member based in the UK may also continue the care of their patient while that patient is temporarily outside the UK (for example, on holiday), or permanently resident overseas, worldwide but NOT in the USA, Australia and Canada, NOR any country where telemedicine is subject to local regulation, subject to policy terms and conditions. Read HCPC guidance on providing remote treatment overseas.

If you are outside the UK

If you are a UK CSP-member currently overseas, you will need to seek local advice and read the full PLI policy document.

For overseas nationals wishing to provide remote services into the UK, the HCPC states: 'Unless someone is intending to practise in the UK, they do not need to be registered with us. Any non-UK registered health and care professional providing telehealthcare from outside the UK must make clear to their UK clients based in the UK that they are not registered with the HCPC. They should also ensure that they are meeting any regulatory requirements of the country/state in which they are working.'

Some overseas countries require specific legal registration in order to deliver any healthcare by telemedicine or other online platform. We know it can be difficult to find details of overseas regulatory requirements, but it is your responsibility to make your own enquiries in the relevant country and to register if required. If you do not comply with any legal or regulatory obligations in territories that require it, you may be uninsured.

You have a duty of care to your patient when providing individual advice and/or intervention to patients over the telephone, internet or by any other digital means. The standard of care you must provide is the same as that for face-to-face interactions with patients, and no lesser standard of care is permitted.

Telephone and online consultations may be open to exploitation as part of alleged attempted insurance fraud activity. It is important that you undertake an appropriate assessment of the patient, obtain consent for treatment and document your intervention in the same way as for a face-to-face appointment, including keeping proper appointment records.

Writing for publication

As background a physiotherapist must always distinguish between their role in providing advice for:

a) topics in general. This would be general physiotherapy advice that is not tailored to the individual needs of the audience/enquirer and could be found from other sources by the audience/enquirer e.g. another book, leaflet, DVD etc.

and

b) a specific named patient/person in relation to a specifically assessed and identified injury/issue. This would be physiotherapy advice and/or intervention that is given as a result of a full and appropriate assessment and identification of individual and tailored needs, that is provided by a registered physiotherapist.

Both activities are regarded as being within the scope of physiotherapy practice and are therefore included within the CSP PLI scheme.

When writing or creating for publication in books, DVDs or media broadcasts aimed at patients or the general public, or producing DVDs, the fundamental assumption must be that your audience – or potential audience – could be unknown to you, and is unassessed and undiagnosed and may not be suitable to follow your programme or advice.

There must be regular caveats:

that the advice is of a generalist nature and could not take into account the particular physical or medical condition of individual audience members.
that information is meant to be practical and informative but is not intended to be a substitute for professional advice.
that the information available is not meant to replace any relationship that exists between an audience member and their GP, hospital specialist or other healthcare professional.

Any advice given in such publications must be reviewed on a regular basis to ensure that it is accurate and up to date and all such communications should carry a message clearly stating that the advice is general in nature and patients/persons requiring individual advice should consult their own therapist. In these circumstances, no duty of care would be established.

Where you choose to provide a book/publication or DVD made by you to one of your patients for whom you do have a duty of care, your duty extends to ensuring that the contents of the book/publication or DVD are suitable for your patient’s needs, and the patient should be explicitly advised as to whether any parts of the book/publication or DVD are not suitable to their condition. In this circumstance, the provision of a book/publication or DVD to the patient which resulted in the patient suffering harm could give rise to a claim of negligence against you.