A different type of insurance - Clinical Wills with Anna Bunch

Welcome to the Business of Psychology podcast. I am thrilled to be here today with my friend and colleague, Anna Bunch, from Psych VA. You might remember Anna, she's been on the podcast before talking to us about the systems and processes that we need to have in place for our independent practices. But for this season, which is all about resilience and adaptability, I just had to get Anna back on to talk about something which I know that she's really passionate about, but to be honest, wasn't at the top of my list when I started in an independent practice. And that is this concept of a clinical will, which is not the right term for it, and we're going to talk about why, but that plan that needs to be in place for if you are incapacitated and can't run your practice anymore. It's a really important area, it's one that I've avoided for the eight years I've been in independent practice, and I'm sure that many of you will also have avoided, but Anna has absolutely convinced me that it's important and something that we all need to address.

Full show notes and a transcript of this episode are available at The Business of Psychology

Links:

Links for Anna:

Website: psych-va.co.uk

Clinical Continuity Plans: psych-va.co.uk/clinical-continuity-plans

Links for Rosie:

Substack: substack.com/@drrosie

Rosie on Instagram:

@rosiegilderthorp

@thepregnancypsychologist

The highlights

• Anna talks us about her business, Psych VA, and how it came about 01:23
• Anna tells us what a clinical will, or rather, a clinical continuity plan is, and why it’s important 04:28
• I ask Anna about the process of putting clinical continuity plan in place 17:10
• Anna talks us through the two packages she offers 18:23
• Anna tells us what sets Psych VA apart in offering this service 20:20

SPEAKERS

Rosie Gilderthorp, Anna Bunch

Hello and welcome to the Business of Psychology podcast. I am thrilled to be here today with my friend and colleague, Anna Bunch, from Psych VA. Now, you might remember Anna, she's a friend of the podcast, she's been on before talking to us about systems and processes that we need to have in place for our independent practices. But for this season, which is all about resilience and adaptability, I just had to get Anna back on to talk about something which I know that she's really passionate about, but to be honest, wasn't at the top of my list when I started in an independent practice. And that is this concept of a clinical will, which is not the right term for it, and we're going to talk about why, but that plan that needs to be in place for if you are incapacitated basically, and can't run your practice anymore. It's a really important area, it's one that I've avoided for the eight years I've been in independent practice, and I'm sure that many of you will also have avoided, but Anna has absolutely convinced me that it's important and something that we all need to address. So I'm really excited to have her here talking about that today. So welcome to the podcast, Anna.

Hello. Thank you for having me back.

Well, can you start by telling us a little bit about your business, Psych VA, and kind of how it came about?

Sure. So Psych VA is in its seventh year, can you believe it?

No, I can't!

I know. It was actually my business birthday in February. It completely passed me by. So yeah, so we are a virtual assistant agency, I don't like using the word agency, it sounds too big and corporate. So yeah, our business, we look after psychologists, therapists of all kinds. A bit of a one-stop shop. So helping people who are fresh into going into private practice, you know, after leaving the NHS perhaps, and helping people navigate the admin side of their business. So, yeah, people usually meet with me and we consult on what systems to use, you know, how it's actually gonna work from an admin perspective. And then we've got a wonderful team of 15 virtual assistants who are on the team now, all from private, healthcare background, all use the same systems, know all of our clients' pain points and yeah, basically take away the overwhelm and help people on with their admin tasks. And I think we've got about 50 clinics at the moment that we regularly, that we are doing ongoing business support for. So yeah, it's gone really well. We're very niche and yeah, we understand the sector so seven years and still going strong and growing day by day.

That's amazing. And I think it's such an important area because a lot of people that I meet in coaching or students on my programs, they have amazing ideas, but they lose their confidence because they think they're not good at the admin side. And so maybe that stops them from being paid properly because they're not chasing up invoices. Or maybe it means that they don't have enough time in their week because they're constantly buried under a pile of, you know, admin tasks that they're procrastinating or like me doing badly and then having to redo. And that can really undermine your confidence in your ideas. And so often, I think if you sort out those systems and processes and bring somebody into your team who's really good at that stuff, it frees up your creativity and it allows you to really flourish at the stuff that we did train to do, which was not admin.

Absolutely. And you know, I get such, I'm so passionate about helping people and the amount of people just from doing little changes and taking that off them are so grateful. Giving people back their evenings and just yeah, some head space, you know, enough time to see another client, perhaps a week, you know, where they're not chasing insurance companies or yeah, doing the admin stuff. So yeah, it's, outsourcing's a way forward.

Yeah. I had never heard of what we're going to talk about today until, I think it was about two years ago, you put it on my radar as something that I should look at and think about. And then we were calling it a clinical will, but actually we learned that wasn't the right thing, and now we talk about a clinical continuity plan. So can you tell me, you know, what is one and why is it important?

Sure. So back in, I think it was September 23, a lot of the professional bodies like BCP, BACP, UKCP and all the other ones, said that, you know, therapists need to have a clinical will in place, some kind of clinical continuity plan. So if, you know, unfortunate, you know, if you had an accident or you know, if you were incapacitated in any way, or in worst case scenario, you know, if you, if you died, you know, what happens to your practice? What happens to your clients? So yeah, they've mandated that you must have some kind of clinical will in place. So it was actually some of my clients who were coming to me saying, Anna, you need to offer this service. I know some people have been going to their supervisors or family perhaps, or you know, another therapist to try and help them with this. And it's been a really gray area and believe me, since I've been starting this service, because I've been, it's been going about a year and a half, I've gone down so many rabbit holes with it. I've been working closely with Clare Veal, Aubergine Legal, and she's been helping me navigate it from the legal perspective and GDPR and yeah, just trying to find a way that meets the standards, which, you know, the legal and the ethical ones, because they put, they put out that you need these, there's something in place, but they don't tell you how. And I have contacted all of them for further clarification and throughout this process, and I've been met with either no reply or it's up to you, you know how we just say it needs to be done, but how you do it, it's nothing we can really comment on. And there's other services out there doing it as well, but it's a very gray area and from what I've found out from going down this hole, you know, it's actually, it's not right. It shouldn't be called a clinical will to start off, we ended up consulting with quite a few probate lawyers because they were saying you can't use the word term clinical will because it's, it's misleading. You know, it's not a traditional will and we need to take will out of that.

It got really confusing, didn't it? At one point, you know, it was thinking, oh, this is somehow attached to your personal estate and would have to go through the, I dunno what the right terminology is, but the person that takes control of the rest of your stuff after you die and, and that just seemed wrong. It didn't seem to make sense.

So, and I questioned it and poor Clare, I was like a dog with a bone on this one, because you know, when you get an answer that you don't like and you're like, can we just ask some more people about this, some different probate lawyers till someone tells me, you know, the answer that we want kind of thing. And that answer never came. And, you know, we did consult and with a lot of, you know, different probate lawyers, and we kept on getting the same answers. And this is where, yeah, this is why people should have a traditional will, and this will, which we're going to call a letter of wishes, it does need to sit with your solicitor, you know, it does actually have to be addressed to them, but it's allocating, well, appointing a professional trustee, which is, is going to be me, Psych VA, and you, Rosie, because you are involved in this too, I've dragged you into it.

Indeed.

So yes, we have to move away from using executives and trustees. And yeah, you should have a proper will in place. And I know there's lots of people out there from setting up the service and coming back and saying, well, I don't have one. So it's something you should definitely consider. But you know, I was thinking surely if we just going to contact people's clients and tell them that they're not gonna be able to attend their appointments, you know, why does that need to go through this? But what we've managed to ascertain, to keep everything legal and compliant, as I say, it's from the data aspect, you know, that's the biggie, that as long as if you don't have a will, then your estate is in what's known as in intestacy, I think I pronounced that right, and it means that then it would go to your next of kin. So for in, if we get permission, we are in the position to notify your current clients because if something happens, if you get run over by a bus, sorry, I know it's not the nicest thought, but you know, in reality, and you've got clients coming to your clinic the next day, who's going to notify them? You know, is it your next of kin? Are they really going to be in a position to then want to pick up the phone and just try and work out who your clients are, you know, having access to your diary because really they shouldn't have access to this kind of information. You know, and if you've appointed a supervisor or what have you, you know, do they, you know, they're going to be upset. Are they in a position to do this? And also busy with their own business. So, yeah, it's not a nice conversation, but it's an important one and something that from a legal and ethical point of view, you need to have something in place. Just to digress slightly on this point, you know, what happens to the clients when they turn up and no one's there? I mean, I had a client, through doing some of my client's work, and they'd, they'd got the wrong day for their appointment and turned up at the clinic. But then I saw the, you know, the what, this person was so anxious and thought that they'd done something wrong, that their clinician wasn't, their therapist wasn't there. Why weren't they there to see them? And as it happens in this instance, it was, you know, an accident, they'd got the wrong day. But, you know, to see the turmoil and the anxiety that was coming through, because they didn't know what was going on.

Yeah, and that's such an important point because I think we all know from clinical experience that when, there are some clients who are more vulnerable to that than others, and there are some clients that when you have to change an appointment, if they're expecting it at a certain day, on a certain time, will find that incredibly difficult. And most clients, myself, and I've been in personal therapy, when I've shown up and there's been an emergency and my therapist wasn't there, I was really upset. I partly worry for them, but also partly kind of that paranoia does start to creep in about, you know, oh, do they not want to see me? And it, you know, maybe some people listening to this won't be able to relate to that, but I think most people that have been in therapy, because of the nature of the relationship with your therapist, it does feel very difficult and it will be a real loss. You know, if you’re, you know, even if it's not the worst case scenario, even if you're not dead, but if you for some reason, suddenly can't be their therapist anymore, and you and I know that that has happened to me, in my practice, before where I've had to very suddenly stop seeing clients, particularly when I became very sick with HG, that has a huge awful impact on those people. And because I was still alive, I could see that. And so it does make me think, you know, how would somebody manage that? How would they find that resilience to manage such a difficult loss when they're already potentially at quite a low ebb? And so it is, I think, really important and one of the reasons I did want to be involved as the like clinical person in this, is that you have to think really carefully about each person and what's the right thing for that person, and you know, whether they should be passed to somebody, like a supervisor that knows this person already, probably in some capacity. Whether it's safe to pass them on to somebody with similar qualifications, whether they need an immediate appointment actually, because this news is going to be so difficult for them, that we need to do a risk assessment straight away. That kind of clinical decision making, I don't think you want that falling on your friend's doorstep when they've just heard that something terrible has happened to you. It certainly can't be done by a partner or your next of kin unless they also happened to be HCPC registered, or whatever your governing body is. And so I feel more comfortable knowing that I have paid for that to be done by somebody that will be clearheaded and shares the same ethical considerations that I do. So I think it's a really important service and as somebody that might have a little bit of an OCD tendency, I don't find it easy at all to think about this stuff, and you've had to remind me over and over again, and I've been a really bad client, because of that. But I do believe it's really important and I'm glad that we're finally talking about it. Because you've mentioned a few things here about the continuity of care being really important, the legal and ethical concerns, looking after your clients, their wellbeing, and the peace of mind that it gives you. But it also is professional responsibility, isn't it?

It is. Absolutely. and then even past the immediate of letting the clients know and then sign posting them onto the therapist, what happens to the rest of your practice? You know, who's going to do all the other stuff? So, informing landlords, your social media, that might, you might want in your wishes for your Facebook page to be memorialized or taken down, putting an out of office on your emails, going into your website and putting a note on there, you know that you're currently unavailable, or depending on the situation, it'll be handled appropriately. Closing down subscriptions, notifying your accountant. Your client records, what happens to them? So as part of our service for the full practice close down, we will hold your client records and destroy them at the relevant retention guidelines, because yeah, what happens to them? I mean, if you, if you've got paper notes, are they going to sit in a filing cabinet in an office, you know who's gonna deal with that? Whereas, you know, as a part of our service, if you do have paper records, obviously, I don't have access to them, but within your, within your plan, there can be instructions to someone, maybe your supervisor or if someone's nearby who knows where they are, lets them know what to do with them, so they can be dealt with appropriately. Again, it's all these things that you don't want to think about, but it's, they are going to need to be dealt with, and they do need to be, that is classed as winding up your estate. Now, this is one of the points that I was very, it can't be part of winding up your estate, you know, it's nothing to do with this. We're not dealing with finances here, we're not touching bank accounts, anything like that. It's basically letting key people know and closing them down, but yeah, it was the lawyers that have been, we've been questioning this repeatedly, may I add, they've said that, yeah it is classed as winding up your estate, hence why you need, it needs to say that who is going to be doing this when the situation, if the situation did arise, you know, I'd be working with the solicitors and, you know, it would be a joint, you know, a conversation and making sure that we are doing things in the best legal way.

Yeah, and it is important to remember that your business is an asset that you own, so I guess that's why it does form part of your estate, because if this kind of process was mishandled, then potentially any money that was left in your business or anything that could go to your, you know, allocated people that you've dedicated it to in your will, you know, they could lose out because the money in the business would have to be spent on paying off debts or paying fines for things that haven't been handled properly. You know, just thinking about things like if nobody notifies Company's House that I've closed down, or HMRC that I've closed down, they're gonna be expecting things like corporation tax and you know, my accountant needs to know to handle that for me. You know, otherwise you can rack up massive fines very quickly, and if nobody's reading the post, then who's going to find out about any of that? So, yeah, I can see why it got into those tangled legal waters. And I think we're, we're both lucky, aren't we, that we have Claire Veal from Aubergine Legal to help us steer that, and even, you know, find the right probate lawyers to talk to and, and all of that. Because yeah, it's intimidating. And I, you know, I'm grateful that you persisted with it because I would've been scared off probably.

Well, yes, no, I was, I was quite persistent.

Let's talk a bit about the actual process. So say somebody decides, okay, I want to get a clinical continuity plan in place. How do they go about doing that?

Okay, so it can start with a conversation with me. You can book in for a discovery call, we can talk through it. Or on the website there's a link to, there's like an information booklet which gives you a bit more information. And then, so once you express an interest, there's a very short eligibility form, just so I can just gauge whether, first of all, I'll be able to help you, what software you are using and the size of your business, you know, how many clients you've got. And then I will respond with a quote. So it's between 12 and 15 pounds a month plus VAT. I've tried to keep it in the price point of maybe the customer therapy session a year. So just a small amount. And then what will happen is we will, there'll be a service agreement signed and then you'll be sent to your blank clinical continuity plan to complete.

So I understand that there's two packages that people can choose between depending on the size of their practice, and you'll help them think about which one is right for them. Tell me what happens if I go for the core package?

So for the core package, you will, you will have your dedicated clinical continuity agents, which are me and you, and that will allow us to, if the process ever needed to be implemented, we would contact your clients and let them know the situation in an appropriate manner, and then if necessary, and they wanted sign posting onto another therapist, we would work together and make sure that all your clients are looked after.

There's also the full close down package, which is the most popular, which covers everything. So basically we do the same as in the core package, notify your clients, but as we mentioned before, closing down those subscriptions, your social media, letting your solicitors know, accountants, landlords, it goes on. So what you would need to do, is there would be a form to complete for either of those, which would give us the data that we need, which is stored in a very secure folder. That will be reviewed every year, or if you have any changes or want anything adding, you can do it any time. And your client records with the practice close down, they will be held and destroyed as appropriate for the correct data retention lengths. So yeah, I'd say having the full package, that is the one that gives you complete peace of mind. So like I say, you don't have next of kin, obviously at a difficult time, having to work out who they need to notify, cancel, et cetera.

Brilliant. I mean, it sounds like such a comprehensive service and I know you always get uncomfortable talking about, you know, why people should choose you, but you know, what is it that makes this different? Because I have seen other services popping up, talking about it. Interestingly, many of them talking about clinical will, which made me a bit concerned they might not have done their homework, but what, yeah, what sets you apart, do you think, in offering this service?

So, yeah, we are well known within the sector, we know our clients and our clients' clients and we deal with everything, you know, with compassion and empathy. We realise that this is a very sensitive subject. We've done our homework. All the legal stuff's in place. And then we've got you, Dr Rosie Gilderthorp, as our clinical piece of the puzzle, so to help obviously dealing with the clinical side. And yeah, we can handle, we've got access to, a lot of our current clients, we've already got access to everyone's information. Everything's all stored very safely, all GDPR compliant. And there's no need to upload client lists. I know there's a lot of, a few other people doing the similar thing, and they're asking for clinicians to upload their client list each month, which we've got ways of that not having to take place. So basically once it's up and running, you know, you don't need to do anything else. You can just relax and just know that everything's in hand.

I think that's so important. I remember when you were designing the service, that was the bit that we were talking about, like how do we make this accessible? Because I think it's unrealistic to think that you are going to update your client list every month. You know, maybe some people are organized enough to do that, but not me. And therefore I think maybe not many other people. So I think I really like the system that you've put in place, and although that initial document takes some time to fill out, it’s a really worthwhile investment I think. So, you know, I was thinking about, you know, what are the reasons that people would not do this and, you know, I think a lot of them are to do with your mindset, aren't they? And maybe partially that avoidance?

Yeah, it's one of those things, I think it's on people's to-do list. We've always got that one task that just gets transferred over to the next to-do list. And that's just human nature, isn't it?

We don't wanna think about, you know, what's gonna happen in the future or what might, you know, may happen. It's, I think there's a bit of, yeah, definitely avoidance there. And I think people maybe just haven't been sure of how to go about it. I mean, have you read and read all the standards from the different professional bodies, and it is, it's so wooly and it's not, it's like how do you go about implementing that yourself and knowing that you're meeting all, you know, the legal guidelines of it, you know? So I think it's overwhelming. Everyone's busy. It's, as I say, just one of those tasks that gets pushed aside and maybe from, you know a cost aspect, you know, but you know, as I've said, for the cost of one therapy session a year, perhaps it's, you know, it's not, it's, it's worth the investment just for the peace of mind, I think.

Yeah. It's another type of insurance I think, you know, of course it's not an insurance product, but it's acting in that way, in that, you know, you hope you'll never need it, but it's there for the worst case scenario. And I think often what might hold people back is this kind of small practice mindset. Like, oh, I only see a few people and you know, it's just me, so I don't really need something as complicated as this. But actually the more you've encouraged me to think about it, because I might have been a bit prone to that before, the more it's occurred to me that actually the fact it's only a few clients and it's just me, doesn't make it any easier for my next of kin to manage. It would still be completely overwhelming and impossible for them. So that doesn't really matter. You know, of course it's super critical if you've got 50 associates and a really high volume of clients, but the emotional cost for your clients is just as important, even if it's just four of them, and the emotional cost for your next of kin is just as important, even if it's just you. So, yeah, to me it feels like size doesn't really matter.

Absolutely. And we can tailor it too. You know, some people might think, oh, well I don't need all of that, I just need this. But that's why I want to make it a personalised service. You know, we can have a chat and say, you know, what is it that you want? Or what's gonna work for your practice? And we can adapt it to that. You know, there's no hard, fast rules with this. It's, you know, we're here to put your mind at rest and just make sure that we're meeting your client's needs and you know, your clinic needs.

Okay. So thank you so much for coming on to talk to us about this. I know that it's not the topic, which is probably top of everybody's list, but actually when we're thinking about resilience and how we build practices which will sustain into the future, getting these ducks in a row is really important. So this season of the podcast, I've been thinking a lot about things like insurance and processes, so I think this will be really helpful for a loss of people. Thank you so much, Anna.

You are welcome. Thank you.