The Last Word: Practising Post-COVID-19

By Dr Tahera Bhojani-Lynch / 11 Jun 2020

After reopening her practice in May, Dr Tahera Bhojani-Lynch reflects on her experiences of going back to work

Lockdown was something my clinic had planned for and we had anticipated some aspects of it from February. In the days running up to the closure, staff were given laptops and were allocated work to do from home when the time came. However, when it happened, it was sudden; we thought we would have two more days, and I had not then realised that staff on the furlough scheme would not be allowed to work at all! 

Luckily, the laptops came in useful for lots of online training, which was allowed, and we became experts in online shopping and communications. I discovered, with some embarrassment, that Zoom was not the multicoloured ice lolly of my childhood, but the go-to online webinar and video call software!

While my staff enjoyed two months of paid leave, spent quality time with their young children, ran errands for elderly relatives and relaxed in the garden through one of the warmest Aprils on record, I spent 10 to 12 hours every day in my home office, in online meetings and on webinars, working and planning our return to work. These are the realities of working for yourself.

Early lockdown

To begin with, the days and nights of lockdown rolled into one another. I lost track of time except when punctuated with daily briefings from 10 Downing Street. All my clinic and office staff were furloughed, including my bookkeeper, so suddenly I was managing my own payroll, familiarising myself with the website, the Public Health England guidelines, and learning all about HMRC’s job retention scheme, local government rate rebates, bounce back loans from the bank, and much more.

I learnt and I shared; by word of mouth, suddenly I had a small group of businesses (grocer, restaurant, optician, clothes shop) that I was helping to access financial help, teaching them how to run their own payroll and helping with online furlough claims. I prepared live international training webinars for Teoxane, Sinclair and the International Association for Prevention of Complications in Aesthetic Medicine (IAPCAM). I attended faculty meetings online, I volunteered for the Birmingham Nightingale Hospital, studied immunology and virology and felt like I became a COVID-19 expert (didn’t we all)! By the end of April we realised that the Nightingale was not going be needed, and the clinic became the priority again.

I knew when the time came we would need PPE, infection control measures, distancing and physical barriers in place before safe clinical work could be resumed, but in the early days of lockdown, PPE was almost impossible to obtain, even for essential services like care homes.

Consequently, I knew that it would be some time before we were able to put the logistics in place for a safe return to work.

Preparing to return

On April 8, the lockdown on China was lifted1 and the international supply chain of PPE reopened allowing us to purchase gloves, masks and aprons for ourselves and for donation to essential services. By doing this we were able to start planning a return to work in May. I had always believed that as a Care Quality Commission (CQC)-registered medical clinic, and that as a doctor registered with the General Medical Council, we did not fall under the bracket of businesses that required to close and therefore did not need permission to reopen. I firmly believed that if we assessed and mitigated the risks, we ought to be free to work; if shops selling DIY items were safe to open, how can a doctor treating migraine, acne, scarring, removing moles, offering laser hair removal for NHS patients undergoing gender reassignment, signposting to GPs and mental health counselling, as well as cosmetic procedures, be unsafe? I felt that we did enough non-cosmetic work to justify opening even for our cosmetic work. Upon contacting my insurance provider, they were supportive of me reopening.

Overheads needed to be as low as possible during the period of zero income, which was to be followed by low income due to restricted numbers of patients when we returned. I arranged for one member of staff to return each week, in staggered rotation, to make the most of the furlough scheme. Each member of staff was asked to come off furlough for one week of work, followed by three weeks back on furlough, and rotate this on a four-week cycle, planning it until the end of July.

By mid-May I had written my policies,2 filled a treatment room with PPE and disinfectants, and re-trained my staff.

It took a full four weeks to prepare properly, which included physical changes to the clinic, incorporating screens for the reception area to protect retail staff, and diary changes to keep appointments spaced. We had a staff practise day to train in the COVID-19 specific procedures, including how to don and doff PPE, having antibody tests, how to implement cleaning, infection control measures and social distancing for patients and colleagues alike. We mimicked patients coming in, measured 2m distances, worked out how we would take card payments with screens in place and decided how many staff we could have and keep a 2m distance between people.

The challenges of reopening clinic

The clinic reopened on Thursday May 14 with telephone consultations and we began seeing patients face-to-face from Monday May 18.

It was timely that the British College of Aesthetic Medicine (BCAM) issued its formal guidance and legal opinion on members returning, on the same day we reopened.3 I was pleased to see that the College had concluded, as I had, that we were not to align ourselves with beauty salons or hairdressers and that the question was not when we should return, but more importantly, how we should return (i.e. once measures were in place for patient and staff safety and well-being in line with government guidelines).

We had scarcely been seeing patients for a week when we had an unannounced visit from the local council environmental health officer. She arrived outside the clinic in response to a written complaint made by an ‘allied professional’ with ‘a genuine concern for public safety’. I suspect this complaint came from a nurse working out of a local beauty salon.

The officer insisted on speaking to me immediately, even though I was in the middle of a treatment. I had to step outside in full PPE while I was questioned rigorously on who had given me permission to open, what kind of patients I was seeing, whether they were cosmetic or medical, whether I had sufficient PPE onsite, how often I was changing PPE between patients (sessional use or single use) and what policies and risk assessments I had in place. 

I was very polite and very co-operative, and was able to say with confidence that I had all the relevant policies and procedure documentation, supported by a comprehensive risk assessment, ready for inspection if required.2 In addition, I had a guidance document from BCAM supporting my return.3 I was asked to submit my evidence to the council by email by the end of the day, but she agreed that I could continue to work until a decision had been made. I was grateful to be able to add BCAM’s legal opinion amongst the documents I submitted to the council for their perusal.

I was advised by phone the following morning that, having reviewed the documents, the council were happy that I was not in breach of Government guidelines and I was able to continue to work. They made specific reference to the comprehensive nature of the BCAM document and its legal position. At that moment, I was very grateful for my BCAM membership. Whilst not everybody agreed with the fact that the association had sought this legal opinion, I felt they had acted very much in the interests of their medical and dental members, and for me it had proved to be invaluable.

Since then, the daily challenges of the return to work have been tough. I can only see half as many patients a day as I used to; there is only one room in use instead of two to comply with distancing in the clinic, we don’t serve coffee and can’t allow patients to use the toilets.

With only one other member of support staff on site, we both clean constantly: rooms, surfaces, hands. We change our own PPE after each patient, we call patients to conduct consultations and to make payments; we document, we file, we and run errands.

Cash payments cannot be taken, and the mountains of clinical waste now generated take up space and cost more than ever to be collected. We supplement our traditional clinical income with COVID-19 antibody tests, which we have made compulsory for all patients on arrival. The Rapid tests take 10 minutes to show IgM and IgG status and patients are delighted and keen to find out if they might have had the virus, especially if they have had colds or coughs in the last few months.4 We charge patients £25 to come into clinic now to cover the cost of PPE and the antibody test, which patients have thought is very reasonable under the circumstances.

Looking to the future

In spite of the UK having one of the highest reported COVID-19 death rate per head of population anywhere in the world,5 the beautiful weather and current drop in the rate of transmission of the virus has made us hopeful for the future. As a business owner, I am grateful to have been able to reopen and be earning a living, but as a healthcare practitioner, I cannot help feeling some apprehension of the likely second wave as the summer ends.

But for now, we are making hay while the sun shines! We don’t know how long we have before we may need a second lockdown, so we are busy working and earning, sharing our knowledge and experiences with colleagues. I am happy to share my clinic’s written policies and procedures on request via email2 and have colleagues who can supply 3ply medical grade 1 masks and antibody tests etc via the website.6 As practitioners, we will definitely be more successful if we support each other; we really are better if we are all in this together.

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