Clinical wills are an important part of running a private practice. They are also a requirement of several membership bodies, including the BACP and NCPS. Documenting a clinical will is fundamental to running an ethical private practice, and shows that you have actively considered continuity of care for your clients in all circumstances.
What are clinical wills?
A clinical will is a document that you, as a Private Practice Therapist, create. They outline exactly how your practice should be managed should a set of circumstances arise in which you are unable to continue working with your clients and are not able to make alternative arrangements for your clients yourself.
A well-written clinical will should feel like a handover document, ensuring that the clinical will executor acts in the best interests of your clients, has all the information they need, and ensures minimal impact on the care of your clients as possible.
It is also important that your clinical will grows with your practice, ensuring that it remains up-to-date and relevant to your current ways of working and caseload. For example, a clinical will written when you first start in private practice may no longer be relevant 10 years later.
Why are clinical wills important?
Clinical wills are crucial to ensuring continuity of care for your clients should a situation arise in which you are unable to continue working with them, and unable to make alternative arrangements for them yourself.
That being said, they are equally important for your family and colleagues too, since they remove guesswork and provide a well-documented set of instructions and your wishes for your practice and clients should the will need to be initiated.
Clinical wills are also especially important if you use digital practice management systems over paper-based notes and diaries. They can be used to instruct your clinical will executors on how to access the information you store within your digital systems.
What does my clinical will need to include?
To write a well-structured clinical will, there are some key sections you must cover. These should make it clear who is the initiator of the will, as well as any executors. It is important to remember that, should your clinical will be initiated, you will not be around to clarify any ambiguity. With that in mind, you should ensure that your instructions are concise and don’t assume that the executor will understand any references you may make.
Practitioner Details
The first section of your clinical will should simply provide your personal information, including:
- Your full name, and practice name (if applicable)
- Your home address
- Your practice address (if it is different from your home address)
- Your email address (which you use for your practice, not a personal email address)
- Your practice phone number
It is important to remember that your clinical will represents you as a practitioner and, as such, should contain your work contact information rather than anything that is explicitly personal. This is why it’s considered best practice to keep a separate email address and phone number for your practice, if you don’t already.
Side Note: Keeping a separate email address and phone number for your practice also helps to enforce professional boundaries when compared to using your main mobile number and personal email address. It also offers a cleaner separation of concerns in that you can ensure no-one else has access to your practice email address, without having to discern between work and personal emails on a personal inbox.
Clinical Will Initiator
You must include the name and contact information of the person who will be responsible for initiating your clinical will should something happen to you. This will often be a partner, or a family member.
Your written clinical will should clearly state that this person is responsible for initiating your clinical will, without any ambiguity. Their responsibility is to make your primary clinical will executor aware of the circumstances, and that they are initiating your clinical will.
Your clinical will initiator should also be made aware that you intend to appoint them as your clinical will initiator, and what the responsibility includes. They should also retain an up-to-date copy of your clinical will, so they can refer to it in the event they need to initiate it.
Clinical Will Executor
Your clinical will must include at least one clinical executor. Usually this would be another therapist, or your supervisor. You must ensure you document their information, including:
- Name of Executor
- Job Title
- Address (either home or work)
- Phone Number
- Email Address
Before the details of the clinical will executor, you should clearly state that you have appointed the individual as your clinical will executor. Remember to avoid ambiguity or inferring anything without explicit statements.
You should also make sure that your clinical will executor is aware that you intend to appoint them before formally appointing them. Asking them for permission is not only courtesy, but gives them the opportunity to let you know if they feel there is someone else who may be better suited to be appointed as your clinical will executor.
Secondary Clinical Will Executor
While it may not be strictly required (depending on your membership body), it is a good idea to appoint more than one clinical will executor. This way, if your primary clinical will executor isn’t immediately available to execute your clinical will, your clinical will initiator can contact your secondary clinical will executor, minimising delays and potential knock-on effects for your clients.
The appointment of a secondary clinical will executor is much the same as the appointment of your primary clinical will executor. That being said you need to be clear, in unambiguous terms, which executor you would prefer to be contacted as your primary executor should something happen to you. You must include:
- Secondary executor’s name
- Job Title
- Address (either home or work)
- Phone Number
- Email Address
Should you wish, you can appoint more than one secondary executor. Though, if you would rather one take precedence, you should discern between your secondary and tertiary executors.
Clinical will executor responsibilities and authority
Immediately following your clinical will executor declarations, you must make a clear statement of the actions you give them authority to perform. This should be a clear and concise list of actions that you are happy for them to perform. Using a bullet-point list can be a good idea, but you must include sufficient detail to avoid ambiguity.
The declaration of authority must be made up of statements, such as:
- I authorise the named clinical executors to act on my behalf in making decisions about storing, releasing and/or disposing of my professional records, consistent with regulatory requirements and professional obligations.
- I authorise the named clinical executors to delegate and authorise third parties, at their own discretion, to act on my behalf in executing this clinical will
- I authorise the named clinical executors to act on my behalf in making decisions about the care of my clients, and ensuring continuity of care with suitable professionals.
It is important that the declaration of authority is made up of concise statements, avoiding use of open-ended language or phrasing that could be open to differing interpretations. This ensures that your clinical will is executed exactly as intended.
List of relevant information and contacts
It is key that this section is reviewed as your practice grows, and your ways of working change. Ensuring this information is up to date is crucial to ensuring that your clinical will remains actionable.
This section should explain where your clinical executors can find records, contact information, notes and any other relevant records relating to your clients and practice as a whole.
Client Notes & Records
This section should make it clear everywhere that you store client information and contact details, and how your clinical executors can access them.
You should make data retention requirements clear, instructing your clinical executors to retain the client records in line with regulatory requirements and professional guidelines (typically requiring that client records are retained for 7 years following your final session with them).
You should also clearly specify any other actions you want your clinical executors to take, such as informing your clients of the situation, offering referrals to new therapists, etc.
Other Clinical Contacts
This section should detail any professional contacts, and actions you wish for your clinical executors to take. You should include:
- Your Supervisor: including their name, phone number and email address, as well as any specific instructions on what you want your clinical will executor to do.
- Any other professional contacts, such as managers at charities or other organisations that you provide services for.
Referring organisations
If you work with clients on behalf of other agencies, such as Employee Assistance Programmes (EAPs), insurance companies (such as Bupa or Allianz), or charities, you must list them in this section.
You should also include the details of your contact point at each organisation to ensure that your clinical will executor can keep them informed of your situation. You should also include specific instructions on how you want your clinical will executor to contact the organisation, any questions you want them to ask, or any records they should provide to the organisation.
Supervisors and Supervisees
If you are a supervisor, you should include a list of all your supervisees, including their names and contact information. This is to ensure that your clinical will executor can keep them informed of your situation (and subsequent closing of your practice, if applicable). You should also include any specific instructions on how you want your clinical will executor to contact them, or contextual information you think will be useful.
Subscriptions and professional memberships
This section should list any subscriptions of professional memberships that you pay for, which you would like your clinical will executor to be aware of. It is a good idea to list all directories and membership bodies that you are registered with here, to ensure that your clinical will executor is aware of them.
You should also include instructions on how to access the accounts that are associated with them, as well as when and how you would like your clinical will executor to go about cancelling them and closing the accounts.
For example, you may wish to keep some of your directory listings active for a specified period of time but have your clinical executor update them to reflect your current situation; having them direct prospective clients to another resource, directory, or therapist.
If you want your clinical will executor to cancel any subscriptions, or delete any accounts, you should add an explicit instruction telling them to do so. You must also be sure to provide them with the necessary information to do so (such as usernames, passwords, etc.).
If you want your clinical will executor to leave any subscriptions active for a specific period of time before cancelling them, remember to make this clear in your instructions.
Devices, Accounts, Websites and Social Media
Your devices section should clearly list any devices that you use for the running of your practice, the purpose that they serve, and when your clinical will executor will need to use them. For example, you could note that they will need to use your personal mobile to retrieve a two-factor authentication code when they try to access your practice email account.
It is also useful to make it clear which devices you use for each aspect of your practice, such as:
- “Windows laptop is used for session notes”
- “Macbook is used for scheduling, video sessions, and has access to my iCloud account, which is used for notes storage”
- “The iPhone in the blue case is used for WhatsApp sessions, and for general client communication”
- “My personal mobile, in the yellow case, is used for two-factor authentication codes for all of my accounts”
If you use a web-developer, or web-design agency, you should include contact information for them and what you want your clinical will executor to do - such as requesting your website to be taken down, or a landing page explaining that your practice is closed (temporarily or permanently).
You must ensure that your instructions are explicit and state the exact actions you want your clinical will executor to take. For example, if you want your subscriptions to be cancelled you must make it explicitly clear, as well as providing the required information on how to do so.
Accountants and Business Banking
This section should go into detail on the financial side of your practice, including where your earnings from sessions go, how you keep track of payments, bank details, etc.
If you use an accountant, you should include their name and contact information, as well as any specific instructions for your clinical will executor. For example, you may instruct them to contact your accountant to discuss any outstanding tax returns, or whether there are any documents your accountant needs to file a final return.
You should also instruct them on how to gain access to your practice bank account if necessary. For example, if you have clients who pay for blocks of sessions in advance, you may need to provide instructions to your clinical will executor on how to access your practice bank account to refund any overpayments made by your clients.
General instructions and other contacts
The General Instructions section of your clinical will is a good place to list final instructions for your clinical will executor and anything that may not relate directly to your practice. For example, you may provide the name and contact information for the executor of your personal will, and ask that your clinical will executor contacts them to make them aware of your current situation.
You may find that this is one of the shorter sections of your clinical will, and that is perfectly acceptable. The other sections of your clinical will are likely to cover the most important aspects of your practice. It’s possible you won’t need to include the general instructions section at all, if all your instructions fit well with other sections.
Signature & Witness
Your clinical will should end with a declaration and signature, as well as being signed by a witness if applicable. This is important since it confirms that you have written and reviewed the clinical will, and are signing to confirm that it is an accurate representation of your wishes for your practice should you be rendered unable to continue working with your clients.
Conclusion
Clinical wills are one of the more difficult parts of private practice admin to get right. Deciding what to include is a challenge, and it isn’t pleasant to sit down and actively consider what your practice looks like without you in the picture. That being said, getting it right is crucial. Not only because membership bodies require a clinical will, but because your clients deserve continuity. Having a clinical will in place also gives you peace of mind knowing that you have fulfilled your duty of care to your clients and ensured that they will continue to receive a good standard of care should anything happen to you.
Clinical Wills with Counselling Buddy
If you use Counselling Buddy to run your practice, you can appoint clinical executors via your account settings. This will allow your clinical will executors delegated access to the information your store within Counselling Buddy should a situation arise where you are incapacitated.
Once you have appointed your clinical executors within your Counselling Buddy account settings, they can request access at any time, by following the instructions provided in the email they receive. (When you appoint an executor, they are sent an email with instructions on how to access the information you store within Counselling Buddy).
Once a clinical executor requests access to the information you store within Counselling Buddy, we start a 7-day countdown, during which time we will contact you daily. You will have the option to perform a one-click override of their access request. If you do not override the request within 7 days, your clinical executor will be granted access to the information you assigned to them.
FAQs
What if I can’t think of anyone to appoint as a clinical will executor?
If you are part of a membership body such as the BACP, you should already have a supervisor as part of your professional obligations. Asking your supervisor whether they would be willing to be appointed as a clinical will executor can be a good place to start, or you can ask them to recommend someone else if they aren’t happy to be appointed.
Do I need to include all of the listed sections in my clinical will?
No. Whilst the sections listed each serve a purpose, every practice is different - so they may not fit yours. That being said, it is a good idea to ensure you keep your clinical will structured and concise, with each instruction sitting under a relevant section. This helps to make things easier for your clinical will executor than if instructions were scattered.
Do I need a clinical will?
If you are a private practice therapist, you should have a clinical will. If you are registered with a membership body, such as the BACP or NCPS, you are required to have a clinical will as part of your professional guidelines. Whilst there isn’t a legal requirement to have a clinical will, not having one would leave your clients with no continuation of care should anything happen to you. As such, it could be considered unethical practice to actively decide against writing a clinical will.
Questions or Suggestions?
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Cover image courtesy of Gabrielle Henderson on Unsplash, with thanks.
