We’ll be updating this hub regularly with FAQs and other important information that can guide you through this difficult time. 

Latest news

    Frequently asked questions

     

    Support and resources



    COVID-19 and our operations

    MDA National is standing with doctors as they work tirelessly to respond to COVID-19. We have safeguarded the delivery of our Member service in the event of quarantine measures being imposed by the government while taking active steps to reduce the risks to staff who are supporting Members. You can still contact us for medico-legal advice on 1800 011 255 or complete our Contact Us Form.

    Please visit COVID-19 and our operations for more information.

    FAQs


    Refer back to this page to keep across all the latest updates and information, and get in touch with our Medico-legal Advisory Service if you have any concerns.

    A doctor is not required to administer the vaccine if they do not consider it to be in the patient’s interests/otherwise contraindicated. If a patient indicates that they are being coerced, the doctor can decline to provide treatment and refer for further opinion/treatment (e.g., to a vaccination centre).

    Doctors should adhere to the most up to date public health and ATAGI advice in relation to obtaining informed consent. We recommend the doctor note in the patient records or on the consent form the date of the ATAGI advice to make it clear that this was the advice available at the time of consenting the patient.

    Where a doctor has completed the information and consent process and is satisfied that the patient is giving informed consent we recommend use of the consent forms specifically written for this purpose from the Department of Health.

    Updated:27 Jan 2022

    The ATAGI recommendations for booster vaccines continue to be updated as the course of the COVID-19 pandemic evolves. Current recommendations are that “as soon as practicalities allow, providing boosters to all eligible adults from a minimum of 3 months following the primary course.”

    The Department of Health provides information on timing of booster eligibility however this may vary with availability in each State/Territory.

    ATAGI recommends that timely receipt of a booster dose is particularly important for:

    • people with risk factors for severe disease (including those aged ≥60 years, those with underlying medical conditions, those in aged/disability care and Aboriginal and Torres Strait Islander peoples); and
    • people with increased risk of exposure to COVID-19. This may include those in an outbreak area, or those with a high risk of occupational exposure

    Further information on clinical guidance for COVID-19 vaccine providers including vaccine preference recommendations, considerations for special populations and variation of vaccination schedules can be found here.

    Updated:27 Jan 2022

    Where a patient meets the relevant Commonwealth, State or Territory requirements, or the relevant clinical guidelines (ATAGI: Expanded guidance on temporary exemptions; ATAGI: Contraindications to vaccination; ATAGI: COVID vaccination clinical information), the practitioner can generally issue an exemption. The relevant form is the Australian Immunisation Register’s immunisation medical exemption form which can only be completed by specified practitioners. There may be specific State or Territory forms that need to be completed for exemptions to public health orders. Consider what objective information you might first require (prior patient records; evidence of PCR results; evidence of past clinical opinions).

    Practitioners should be aware of their professional obligations under section 10.9 of Good medical practice: a code of conduct for doctors in Australia regarding the completion of certificates.

    Care should be taken where a patient does not clearly meet clinically recognised exemptions, but continues to pressure for a certificate to be issued. There has been evidence of considerable pressure placed on practitioners by patients to issue an exemption (including threats of self-harm; or complaints). “I need to get some advice before I can progress your request” will buy you some time. A practitioner is not obliged to issue a certificate where they do not consider they have a reasonable basis to do so. Requests made on an unusual basis (e.g., participation in a vaccination trial) may be better addressed by obtaining advice from MDA National.

    When declining to assist, make it clear why you can’t provide the exemption certificate. If a patient becomes abusive or threatening, this breakdown in therapeutic rapport may be the basis for ending care.

    AHPRA and other health complaint entities are receiving complaints about practitioners issuing inappropriate COVID-19 vaccination exemption certificates, and significant regulatory action can be taken where there are high levels of concern (including suspension of registration). Complaints about a practitioner declining to issue a certificate are easier to address where there is evidence that insufficient objective information was provided to meet relevant guidelines.

    Updated:27 Jan 2022

    Where you are not aware of any dispute regarding treatment (e.g., one parent consents and there is no indication of refusal of consent by the other parent), immunisation can be given with the consent of one parent. The source of consent should be included in the records (e.g. “Presents with mother”). This advice arises out of the general principle that the consent of one parent (absent knowledge of disagreement by the other) is sufficient. There is no requirement for a doctor providing vaccination to make enquiries as to whether the other parent is in agreement.

    When there is a known family dispute, it is essential that the practitioner reviews any relevant court orders. MDA National article – Your guide to navigating family disputes is essential reading when managing children whose parents are in a family dispute.

    When there is a disagreement between parents about vaccination:
    • There may be relevant court or parenting orders regarding medical decision making, and if so, the doctor should review those and proceed in accordance with the orders. It is reasonable to delay vaccination while consent refusal is still an issue.
    • If there are either no court orders, or the court orders do not specify medical decision making, then the doctor could immunise if it is felt to be overall in the best interests of the child. However, the doctor should also consider the likely conflict that could develop between the parents and the damage that may cause to the child as a result when making this analysis of the best interests. Anticipate a complaint being made. To date we are not aware of a doctor who has decided to immunise in this circumstance and who has then faced a complaint to a health complaints entity with a serious outcome. In some circumstances, it may be appropriate for the parents to take the issue back to court for a decision.
    • The Family Court of Australia has already set up a COVID-19 list to prepare for hearing disputes about children being vaccinated against COVID-19. For more information see Family Law Practice Direction – National COVID-19 List | Federal Circuit and Family Court of Australia (fcfcoa.gov.au)
     
    When one or both parents don’t want their ‘mature minor’ child vaccinated

    Can a mature minor consent to being vaccinated?

    Some States have specific age-related requirements relating to COVID-19 vaccination, but others rely on the principles of Gillick competence.

    In general, if the child is approximately 14 or 15 years or older, they can consent to proposed treatment. To demonstrate Gillick competency, they must have decision making capacity, the legal competence, maturity, and intelligence to make the decision. The doctor must be satisfied that the child understands the necessity for the treatment, the reasons for it and the risks. They must also understand the intended benefits and outcomes of the proposed treatment and alternatives, including not having treatment.

    Updated:27 Jan 2022

    Ahpra and the 15 National Boards have published a joint statement to help registered health practitioners and students understand what’s expected of them.

    Yes. You are covered in a similar way to other vaccination programs, provided you hold a current MDA National Policy at the time you let us know of the circumstance or at the time the claim is made against you and notified to us. Coverage is subject to all of the terms of your policy including the conditions, exclusions and any endorsements.

    In some cases, we expect the vaccine manufacturer to cover claims where there is an adverse event and where there is no allegation of negligence against the practitioner. You may also may be covered under the Commonwealth government’s professional  indemnity scheme for COVID-19 vaccines which was announced on 28 June 2021. Please let us know of all circumstances that you consider may give rise to a claim in the future to ensure we can advise and support you appropriately.

    If you are in private practice and have a private practising category listed on your insurance certificate, then you don’t need to let us know. E.g. GPs who have a GP non-procedural or GP procedural category are in a private practice category.

    However, if you are employed in a public hospital (including students, interns and post graduate categories) and you plan to administer the vaccine outside of the public system, then you will need to let us know and arrange suitable cover.

    Similarly, if you work in the public system, other than as an employee, you may be indemnified through the hospital. Please check with your workplace’s administration to clarify your indemnity situation.

    A practitioner’s own MDA National Policy will cover a claim against the practice entity if the claim has arisen from healthcare services provided by that Member personally, and if the practice entity is controlled by the insured MDA National Member.
     
    If those criteria are not met in your circumstances, the practice may wish to consider obtaining a Practice Indemnity Policy to insure both the practice entity and practice staff and our Member Services team would be happy to discuss the practice’s requirements and provide a quote.
    Your MDA National Professional Indemnity Insurance Policy provides cover for your provision of healthcare services but not generally the provision of healthcare services by others.
     
    Ordinarily, a practice entity will hold its own insurance policy to cover its own liabilities including liabilities arising from its employees.
     
    If your practice does hold a Practice Indemnity Policy with MDA National, we would refer you to the ‘Practice related FAQs’ section below for further information on cover for staff administering the vaccine.
     
    If your practice does not hold its own indemnity insurance Policy and the relevant party at your practice entity would like to discuss the practice entity’s needs please contact our Member Services team for a quote.

    The Australia Government strongly recommends COVID-19 vaccination, however it is not mandatory and individuals can choose not to be vaccinated. In some cases it may be a requirement of employment, and in the future may become a requirement in other circumstances. 

    Most states have already enacted legislation which compels health care workers and health support worker to undergo mandatory COVID-19 vaccination.

    Residential aged care workers requirement for mandatory vaccination was covered under Commonwealth legislation in August 2021.

    Below are links to the relevant legislation (any any explanatory notes) for each State and Territory:

    • ACT - A worker for a health care facility must not work at the premises of a health care facility after 29 October without receiving one dose, or after the 1 December 2021, worker receiving 2 doses.

      The latest public health directions can be found here. Public Health (Health Care and Support Workers COVID-19 Vaccination) Emergency Direction 2021 found here. A worker for a health care facility must not work at the premises of a health care facility after 29 October without receiving one dose, or after the 1 December 2021, worker receiving 2 doses.

    • NSW - Public Health (COVID-19 Vaccination of Health Care Workers) Order (No 2) 2021 found here. Information that the vaccination order will be extended to primary care and private sector health service providers is here. Click here for further information about the Order. Click here for a copy of the medical contraindication form.

      Changes to the latest NSW Public Health Orders can be found here.

    • NT - Chief Health Officer directions can be found here. Consolidated version of COVID-19 Directions released on 10 November 2021 (No.55 2021: Directions for mandatory vaccination of workers found here.

      Original directions for mandatory vaccination of workers to attend workplace released on 13 October 2021 found here.

      Amendments can be found here.

      First dose must be received by 13 November 2021 and second does by 25 December 2021. Directions apply to workers who face patients in healthcare and ancillary health services and health care workers in hospitals and emergency departments.

    • Qld - A mandate is now in place via a Health Employment Directive. See FAQs “Is the vaccine mandatory if I want to keep my job” for further information and the latest Chief Health Office Pubic Health Directions can be found here.
    • SA - Mandatory COVID-19 vaccination for healthcare settings. Emergency Management (Healthcare Setting Workers Vaccination No 5) (COVID-19) Direction 2022) came into effect 29 January 2022.
    • Tas - Mandatory vaccination for all health care workers via a Public Health Order. Click here for a copy of the medical contraindication form.
    • Vic - Mandatory vaccination for all health care workers, allied health, administrative and ancillary workers via Directions from the Acting Chief Health Officer. Directions found here. And further information here.
    • WA - Health Worker (Restrictions on Access) Directions (No. 3). Click here for further information about the Direction and the link to the Booster Vaccination (Restrictions on Access). Directions is located here. Further guidance on exemptions are available on the WA Government website. If you would like more information about the types of exemption and information and evidence that may need to be provided, queries can be directed to COVIDVaccinationExemption@health.wa.gov.au.

     

    For further information on Coronavirus and Australian Workplaces Fair Work Ombudsman found here.

    A collaborative approach to staff vaccination in the workplace including discussing, planning and facilitating COVID-19 vaccinations for staff is important. This includes consideration of providing leave or paid time off to get vaccinated.

    In some situations, employers may be considering whether a workplace policy about coronavirus vaccinations is necessary and appropriate for their workplace.

    Before implementing a new workplace policy or changing an existing policy about vaccinations, employers should consider their workplace, employees’ circumstances and the obligation to provide a safe working environment. They should consider whether they need legal advice about their obligations.

    Employers can direct their employees to be vaccinated if the direction is lawful and reasonable. Whether a direction is lawful and reasonable will be fact dependent and needs to be assessed on a case-by-case basis, taking into account a range of factors.

    Further information can be found on the Fairwork website, as well as information regarding work health and safety obligations at Safe Work Australia.

    The OAIC has also released guidance on the obligations that organisations have to their workers if they want to inquire about workers’ COVID-19 vaccination status or keep records of their workers’ vaccinations.

     

    See also Mandatory vaccination for health workers.

    Many hospitals and child care require immunisation of staff, however we are unable to provide a response which takes into account every practice’s individual circumstances. Below are some of the issues to consider:

    Clinical considerations

    Employment considerations

    • The laws allowing for certain workplace direction (e.g. a requirement to be immunised) vary between different jurisdictions, awards and contracts.
    • The requirement, if not appropriately implemented, may be discriminatory or a breach of workplace law
    • Do you have an existing workplace policy employment requirement in relation to immunisation or are you bringing in a new policy or employment requirement It could be challenging to argue for compulsory COVID-19 vaccination if the requirement has not been in place for influenza
    • Assess role based level of staff risk. If staff have a medical exemption or contraindication to vaccination, consider whether role modification or re-deployment.
    • What steps will you take in the event of a breach, and are those actions lawful.

    Further information

    https://coronavirus.fairwork.gov.au/coronavirus-and-australian-workplace-laws/health-and-safety-in-the-workplace-during-coronavirus/covid-19-vaccinations-and-the-workplace

    See also Mandatory vaccinations for health workers.

    The Australia Government Department of Health website is being constantly updated with information, including Information for COVID-19 vaccination providers:

     

    The ATAGI website has a useful document for health providers about consent:

     

    For patients who are pregnant or breastfeeding, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists has some information:

     

    Information regarding vaccination for people with bleeding disorders:


    Updated 23 Sept 2021 

    In March 2021 new MBS items became available to enable GPs and suitably qualified health professionals to assess patients for their suitability to receive a COVID-19 vaccine, and administer the vaccine if appropriate. There are specific requirements – please see MBS factsheet.

    The vaccine suitability assessment service is free to patients, and the MBS items must be bulk billed.

    In some circumstances that is possible. The MBS factsheet has further guidance, including recommendations for documentation in this situation.

    The rules around billing have changed a number of times during the COVID-19 pandemic, so it is important for doctors and practice staff to be up to date with current guidelines.

    Examples of recent changes include the return of level C phone consults until 30 June 2022, and a pause on the 30/20 telehealth rule for consultant physicians and GPs.

    The links below provide information for billing of telehealth and COVID-19 vaccinations:

    Updated: 27 Jan 2022

    In respect of whether a doctor/practice can refuse to see unvaccinated patients, the answer is complex.

    In general, doctors are not required to treat any patient unless it is an emergency. Good medical practice: a code of conduct for doctors in Australia states that good practice involves keeping health practitioners and their staff safe when caring for patients - but it is expected that health practitioners will facilitate access to care in the current COVID-19 environments.

    Ahpra has recently released guidelines, Board Guidelines on treating unvaccinated patients, and there is some useful information here, regarding minimising the risk in a Primary Health Care setting, and the Australian Commission on Safety and Quality in Health Care has useful information COVID-19 infection prevention and control risk management.

    Practices have an obligation to provide a safe workplace and a risk based approach is required, taking into account risks at a practice level and the risks for an individual staff member.

    • Practice specific risks include patient cohort e.g., oncology practice, and respiratory practice- likely to be able to have more risk averse policies; or specialities requiring close contact with patients eg ophthalmology.
    • Staff risks – are all staff vaccinated against COVID-19? (some jurisdictions have public health orders requiring this) Some staff members have particular health issues placing them at increased risk.
    • Operational risks if there is a positive case and the practice has to close or operate with reduced staff levels.

    Practices can consider:

    • Telehealth consultations
    • Pre-consultation COVID-19 testing (if available)
    • Provide a dedicated examination room for unvaccinated patients who require a face-to-face consultation
    • Arrange a separate, dedicated time for appointments with unvaccinated patients
    • Provide referral to another medical practitioner who can offer face-to-face consultations, either at the same practice or elsewhere
    • Consulting with the patients with full PPE, N95 or P2 masks (this is being adopted by high risk specialties).

    Updated: 27 Jan 2022

    Advice regarding suspected cases and recommended management (e.g. self isolation; non-participation in health care) is rapidly evolving. You need to seek advice from the relevant public health advisory service (list provided by the Commonwealth Department of Health ACT NSW NT QLD SA TAS 
    VIC WA
    National Coronavirus Health Information Line on 1800 020 080).

    While it is not possible to pre-empt the specific advice, we are aware that there can be a number of outcomes advised, including temporary closure of the practice (to allow for testing, contact tracing and management plans) or the isolation (or removal from the provision of health care) of certain staff. If key staff are unable to work at the practice for a period, it may be that a pragmatic decision has to be made about the practice’s ability to remain operational during this period.

    The new telehealth item numbers will provide additional options for care.

    Updated: 21 July 2020

    This is a complex situation which may depend on contractual arrangements / staff awards etc. However, the general position is that a permanent/non-casual employee who has to take time off because of a health issue would be entitled to using their accrued sick leave (presuming the practice was still operating).

    If a health care provider falls under the recommendation to self-isolate and they are engaged under an independent contractor agreement, thus not an employee, there is no obligation on a practice to subsidise or compensate the individual for their financial loss of earnings.

    More information is available at:

    Fairwork Ombudsman Coronavirus and Australian workplace laws

    Updated:22 Sept 2021

    A practice may have to close because of a Department of Health directive, or there may be insufficient staff to safely operate. This situation is complex and the outcome may depend on contractual arrangements /staff awards etc. If the entire practice has to close there may be scope to declare a “stand down”. Employees may not need to be paid in such circumstance. FairWork discusses ‘stand down’ circumstances on this page.

    Where the practice management or owner make an elective decision to close the practice then the implications for staff wages may be different.

    The employer may allow employees to take accrued annual leave if they wish. The employer may decide to offer annual leave payments in advance however there is no current requirement to do so.

    More information is available at:

    Fairwork Ombudsman Coronavirus and Australian workplace laws

    Updated: 22 Sept 2021

    The Practice Indemnity Policy will cover both the practice entity itself and employed staff at the practice for their administering of the COVID-19 vaccine on the basis that:

    • staff administering the vaccine are employed by the practice
    • staff administering the vaccine are AHPRA-registered health professionals
    • the practice and staff adhere to all relevant regulatory and legislative requirements with respect to the COVID-19 vaccination roll out.

    Please note, the Practice Indemnity Policy does not cover medical practitioners, or staff such as contractors who are not directly employed by the practice, and medical practitioners and non-employed staff would be required to secure their own indemnity coverage.

    If your practice does not currently hold a Practice Indemnity Policy, please contact our Member Services team for a discussion of your needs and a quote.

    Am I obligated to still see them? What about other people entering the practice?

    This is a complex area that must be approached with care and on a case by case basis. There are different mask requirements and directions in each state and territory, and the situation is subject to change.

    Many practices have made mask wearing a condition of entry for patients, and other persons entering the practice. In many jurisdictions there is a public health directive for mask wearing for anyone without a valid exemption.

    Practices have an obligation under Good medical practice: a code of conduct for doctors in Australia and work, health and safety legislation to provide a work place that is safe for staff and other persons at the practice.

    However, your practice must also comply with discrimination laws, which are different in each state and territory. The requirement of the practice for patients to wear masks, and how the practice provides care to these patients that cannot, must be shown to be ‘reasonable’ in the circumstances. Relevant public health orders, the prevalence of COVID-19 in the community, the physical space, the length of stay required, the vulnerable nature of other people within general practices are all taken into account in this assessment of ‘reasonableness’.

    Practices have an obligation to ensure that patients who do not want to wear a mask or face covering or have an exemption are able to access medical services. Practically this could mean offering these patients a telehealth appointment, or treatment at the practice at a time when there are no other patients present, or referral to a local clinic or hospital.

    If a patient has a valid medical exemption from wearing a mask, then you can offer them alternative options for accessing medical care. If the patient refuses the alternative options for care and insists on a face-to-face consultation, then you may be required to allow them to enter the practice and receive treatment as though they were wearing a mask.

    If the patient is medically exempt from wearing a mask and is refused access, then they could claim you, or the practice has discriminated against them based on a disability. The law in this area is not settled and is different in each state and territory in Australia. Therefore, it is important to get specific advice with regards to your practice’s circumstances and your speciality.

    Abusive or threatening behaviour is never appropriate, and you may be required to end care in some circumstances.

    You can find out more about face masks and discrimination law here.

    Please check the face mask requirements for your jurisdiction:

    ACT:     Face mask requirements

    NSW:   Face mask rules

    NT:       Information about face masks

    QLD:    Mandatory face masks

    SA:       Face masks

    TAS:     Face masks

    VIC:      Face mask

    WA:      Face masks and FAQs

     

    Updated 27 Jan 2022

    Given the ever-diminishing time required for patients to remain in COVID-19 isolation (as close contacts, or post-COVID-19 infection) and the increasing need for critical workers to return to the workforce, patients may approach you with a requirement for a certificate to clear them from isolation, or to state that they are no longer infectious. Clinical opinion about how long patients remain infectious after COVID-19 infection is a complex area, and there are likely a number of contributing factors, which make dogmatic clinical declarations difficult to provide (e.g., whether ongoing positive PCRs indicate infectivity; immunisation status; which COVID-19 genomic variant is in circulation; underlying immune compromise / age / comorbidities). Rather than rely on subjective clinical judgements, it is better to base your opinion on your clinical objective findings, and relevant guidelines.

    You should first determine if the certificate refers to the guidelines under which the patient should be assessed. If there are none, there is information provided by the Commonwealth Department of Health from the Communicable Diseases Network Australia. Section 6 of the version 6.4 document released on 14 January 2022 refers to “Release from isolation”. This information includes nationally agreed definitions of when a patient (confirmed or probable case) is suitable to be released from isolation based on whether they are asymptomatic or not. For close contacts (again, a tightly defined term, where the definition has changed over time, and may vary between jurisdictions), relevant state or territory advice about how these cases are managed, should be sought.

    In your certificate, it is helpful to include a reference to the standards (and version) you have relied on in coming to your opinion e.g. “This certificate is based on CDNA Guidelines v6.4 Jan 14 2022”.

    Consider also what objective information you require to form an opinion. State any uncertainty e.g., “This opinion is based on the patient statement that they demonstrated a positive Rapid Antigen Test on 1 January 2022. I am not able to verify this result, and a later confirmed date of infection may change my opinion”. It may be that without objective information (e.g., evidence of a PCR test result) you are not able to issue the certificate.

    Updated:27 Jan 2022

    As COVID-19 spreads throughout the country and the number of positive cases is rising dramatically, private practitioners are being asked to participate in COVID-19 care at-home programs.

    If you are considering assisting the Health Department in your State, or you have patients who have asked you to be involved in their home care with COVID-19, there are some excellent resources available.

    RACGP has published Home-care guidelines for patients with COVID-19, and this guide may be useful for doctors who are treating COVID-19 patients.

    States dealing with large numbers of COVID-positive patients have moved to a model of shared care. It is important to be familiar with the requirements and recommendations of your State:-

    • NSW
    • QLD
    • SA
    • Victoria (which includes a link to clinical guidance and resources for managing patients)

    Other States and Territories are a work in progress with the bulk of care currently being provided through the State health system:-

    • ACT recommends that practitioners contact the Care@Home team on (02) 5124 3085 and refer to the National Taskforce resource
    • NT
    • Tasmania
    • WA

    It is challenging to agree to provide COVID-19 care at home yet there is a lot of information available to provide the support and guidance that can make it possible.

    Updated:27 Jan 2022

    All Members are covered in accordance with the terms and conditions of their MDA National Professional Indemnity Insurance Policy for advice given to patients regarding COVID-19 vaccination.

    This includes advice given in a face to face consultation, or a telehealth consultation, (providing the usual telehealth conditions are followed) or phone or email advice.

    Further information regarding the COVID-19 specific telehealth specialist items is located here.

    Face coverings have been compulsory at various times in specific areas according to State/Territory public health orders. A range of useful information about face masks, including when exceptions may apply, is available on the Victorian Health and Human Services website and the NSW Government website.

    If appropriate, doctors can supply a letter to their patient as below:
     
    Dear (patient) 
    I confirm that you have a diagnosis of [a medical condition].

     Dr X 


    The Medical Board’s Code of Conduct  (at 10.8) states doctors should only sign statements that they know, or reasonably believe, to be true.

    Updated: 02 July 2021

    The Deputy Chief Medical Officer has released a guide to help doctors talk with vulnerable patients about ways they can manage their increased risk. The guide contains up to date and accurate information on the situation in Australia.

    Updated: 20 July 2020

    When faced with such a request, the doctor should consider a range of factors including: the patient’s age, comorbidities, workplace, local community spread, public health advice and transmission risk. These factors should be discussed with the patient, including that our understanding of COVID-19 is still limited. 

    SafeWorkAustralia provides some useful guidance on risk assessments, as does the guide released by the Deputy Chief Medical officer

    If the doctor considers that the patient understands their particular risks,  the doctor can offer to provide a medical certificate (where objective standards are met) or a letter of support (where there is no objective basis for the request, or the doctor is not willing to certify the patient is fit to return but is happy to support that the patient’s request is considered). Relevant clinical information can be provided (with the patient’s consent).

    As always, doctors should be honest and not misleading when writing letters and certificates and only sign documents that they believe to be accurate. 

    See letter template (below) which you can adapt to suit your needs.

    Dear Mr Jones

    I write in support of your plan to return to your workplace, notwithstanding that you have a number of chronic health conditions. I can find no objective reason that would contraindicate your return to work, despite the risks discussed below.

    I can confirm that I have discussed with you the potential risks of acquiring COVID-19, and how to minimise your risk. 

    The Commonwealth Government also provides advice on how to protect yourself, including practising good hygiene, physical distancing, and following the rules for public gatherings, quarantine and isolation.

    I have also discussed with you that if you develop a COVID-19 infection, you are in a higher risk category where significantly more serious complications of infection, including death, may occur [or words which are appropriate for your patient].

    The Commonwealth Government notes that “People aged 70 years and over, people aged 65 years and over with chronic medical conditions, people with compromised immune systems, and Aboriginal and Torres Strait Islander people over the age of 50, are at greater risk of more serious illness if they are infected with coronavirus”.

    I understand that despite the above, you are keen to discuss your options with your employer, and what risk mitigation can occur at your workplace to reduce your risk of developing infection.

    Updated: 15 June 2020

    This is a situation where a letter of support may be more appropriate than a medical certificate.

    Medical certificates

    A doctor should only provide a medical certificate in a situation where they reasonably believe the patient has / had a certifiable health condition. Doctors may decide to take a patient at their word (e.g. ‘Doc I was up all night with gastro’) because there may be no objective findings on examination (perhaps the consultation is by phone or tele-link). See this Medical Council of NSW document for a detailed discussion about medical certificates.

    If a doctor is not satisfied the patient was ‘sick’ with a health condition, then they should not agree to provide a medical certificate. This is because a doctor has an obligation under the Medical Board Code of Conduct (at 10.9) to ensure a signed statement is reasonably true, not misleading, accurate, and they have not omitted relevant information deliberately.

    Letters of support

    A doctor may be sympathetic to a patient’s plight, but can’t certify that the patient is is unfit for work. In this case the doctor can offer to provide a letter of support, rather than a medical certificate. Relevant clinical information can be provided (with the patient’s consent) without certifying the patient unwell or unfit.

    Example 

    Dear Mr Jones

    I confirm I have been treating you for [list conditions] since [enter date]. You are currently on [list medications] to manage your chronic health conditions.

    You have indicated that you are concerned you will be at higher risk of serious infection if you contract COVID-19, due to your underlying health issues and/or age.

    I understand you are keen to discuss your options with your employer to limit your potential exposure to the virus. According to the Health Department website “those most at risk of serious infection are…people with chronic medical conditions” so any modifications you can agree with your employer in order to reduce your risk would be sensible.

    Updated:  15 April 2020

    Doctors are not obliged to treat patients unless it is an emergency, or a contractual requirement.

    Doctors may consider a range of issues when deciding who they treat, and this circumstance has been contemplated by the Medical Board of Australia in Good medical practice: A code of conduct for doctors in Australia:

    • 3.4.5 One of the considerations relates to your ability to keep …yourself and your staff safe when caring for patients. If a patient poses a risk to your health and safety or that of your staff, take action to protect against that risk. Such a patient should not be denied care, if reasonable steps can be taken to keep you and your staff safe.
    • 3.5 Treating patients in emergencies requires doctors to consider a range of issues, in addition to the patient’s best care. Good medical practice involves offering assistance in an emergency that takes account of your own safety, your skills, the availability of other options and the impact on any other patients under your care; and continuing to provide that assistance until your services are no longer required.

     

    If you feel you are not in a position to keep yourself, your staff, or your other patients safe in light of COVID-19, then you can decline to treat or suggest high risk patients postpone non-urgent appointments. This will be taken into account by Ahpra in the event of a complaint.

    If a patient cannot be seen at the practice, they should be directed to an appropriate alternative to access care, taking into account local resources. 

    Updated 23 Sept 2021

    Clearly document your assessment and advice to the patient including your concern of the risk to themselves and others.

    COVID-19 is now a reportable disease. If you have public safety concerns, you can notify your local public health unit who can assess the need to follow up with the patient.

    Updated: 16 March 2020

    Digital image prescriptions were introduced as an interim process to support COVID-19 telehealth consultations.


    The Department of Health announced these, which are temporary and cease on 31 March 2022. The steps for the doctor are:

    1.  Create a paper prescription on a standard PBS script pad, or an electronically generated script on PBS provided paper. The script will need to be signed as normal or using a valid digital signature.

    2.  Create a digital image of the prescription, such as a photo or pdf. The image must be clear enough to allow any barcode to be scanned.  

    3.  Send the image by email, text or fax to the patient’s pharmacy of choice. Record that a digital image of the original prescription has been transmitted.

    4.  Retain the paper prescription for 2 years.

     

    Schedule 8 and 4(D) medicines such as opioids and Fentanyl are not part of this interim arrangement. 

    If the patient prefers to receive the legal paper prescription, the script can be posted to the patient.

     

    Note that there are differences between states and territories - please refer to rules for prescriptions via telehealth in individual states and territories

     

    Electronic prescriptions are being rolled out across Australia and are currently available by providing a 'token' for patients to receive access to their electronic prescription.

     

    The basic steps are:

     

    1.  The doctor offers and the patient chooses to receive an electronic script rather than a paper one 

    2.  The doctor generates the script as a token (unique QR barcode) and sends it to the patient by SMS and/or email

    3.  The patient takes or sends the token to a pharmacy, where the token is scanned and the medication dispensed 

     

    To generate an electronic prescription, there are certain technical requirements:

    •  Doctor/practice: 

      - capable prescribing software

      - registration with the Healthcare Identifiers (HI) service, having the associated unique healthcare identifier for organisations (HPI-O) and professionals (HPI-I)

      - a National Authentication Service (NASH) Public Key Infrastructure (PKI) certificate to allow secure connection with the HI service 

      - connection to a Prescription Delivery Service through a Prescription Exchange Service (eRx or MediSecure)

    •  Patient: IHI (a unique 16-digit number assigned to all individuals enrolled in Medicare or the Department of Veteran Affairs, and already used for My Health Record)

    •  Pharmacist: capable software


    Further:

    •  A token can only hold the prescription for one medication – multiple medications require multiple tokens

    •  Once the token is scanned and used by a pharmacy to dispense the medicine, it is invalid and cannot be reused

    •  Repeats: At the time of dispensing, a token for the next repeat will be issued by the pharmacist, for use at any capable pharmacy

    •  Schedule 8 drugs and private scripts can be supplied this way

     
    Still in development, the Active Script List will be another way of electronic prescribing which will be more convenient for patients on multiple medicines.
     

    Updated: 21 Jan 2021

    Telehealth (healthcare services provided over the internet, video conference or phone) is covered under your indemnity policy, provided both you and the patient are located in Australia and the service is provided in accordance with the guidelines of the Medical Board, the relevant College and Medicare.

    Updated: 30 March 2020

    Please see our Telehealth Toolkit which you can access here.

    The Department of Health has a checklist to assist you to comply with your privacy obligations when delivering telehealth services here

    Updated: 11 May 2020

    MDA National does not recommend specific software. The Australian Digital Agency has a guide for healthcare organisations on using online conferencing technologies securely, which includes a comparison of some popular options. Other sources of information include your practice’s IT provider, your local Primary Health Network, ACRRM, the RACGP, and the University of Queensland’s Centre for Online Health

    The RACGP supports the use of free apps like Skype if doing telehealth on an ad hoc basis but for an ongoing telehealth service a professional platform will provide greater quality and sustainability.
    Medicare require practitioners to ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws.

    When evaluating a product from a privacy perspective you can look at the website and/or Terms & Conditions and look for:  

    •  a Privacy Policy which mentions the APPs

    •  servers in Australia; no data sent overseas

    •  security features like encryption and two-factor authentication

    •  no health information such as chat interactions, documents, images are retained by the commercial service provider


    Other considerations include:  

    •  technical support

    •  bandwidth requirements

    •  waiting room functionality

    •  browser compatibility

      

    Updated: 21 Jan 2021

    Documentation of telehealth consultations should contain the same level of detail as a face to face consultation, as well as the type of consultation and the patient’s location. The RACGP also recommends documenting information such as:

    (a) the rationale for a video consultation instead of a physical consultation

    (b) responsibility for any follow-up actions

    (c) the presence of other parties and the patient’s consent for those parties to be present

    (d) any technical malfunctions which may have compromised the consultation

     

    Consent to conduct a telehealth consultation can be verbal or written, and the patient should be informed that telehealth has some limitations, for instance:

     

    (a)  no physical examination

    (b)  possible technical issues, e.g. poor image resolution impeding diagnosis, Wi-Fi dropout etc

    (c)  security of the transmission may not be guaranteed (if using an app, is it encrypted?) and there is an extremely small risk it could be seen by a third party

     

    The default position is that telehealth consultations are not recorded (by audio or video), just as face to face consultations are not recorded. If any part of a video consultation is recorded, written consent is recommended. An example of a written consent form is available at ehealth.acrrm.org.au

    If patients send in photos, they should be told how secure the process is (e.g. unencrypted email) and whether the photos will be stored in the medical records or deleted.

    Updated: 19 March 2020

    Your gross annual billings are one of a number of factors used in calculating your medical indemnity premium. If your actual billings for the current financial year are significantly different to what you estimated them to be, you may be eligible to move you into a lower premium group, and receive a refund.

    Your level of billings is one of a number of factors used in calculating your medical indemnity premium.

    Recognising that every Members situation will be different, generally speaking if your estimated billings for the next financial year are significantly lower than this year it may result in a lower annual premium. We will be sending out our regular pre renewal communication to Members in the coming months, asking for confirmation of details for the year ahead.

    At this time, you will be able to advise us about your estimated gross annual billings, which will feed directly into the calculation of your medical indemnity insurance premium for 2022/2023.

    The definition of Gross Annual Billings can be found in the Risk Category Guide. In the meantime if you have any queries relating to your insurance or membership arrangements please call 1800 011 255 or email peaceofmind@mdanational.com.au.

    In response to the COVID-19 pandemic, the government announced  a partnership with the private health sector, to expand the availability of hospital beds and medical staff.

    Public patients being treated in a public hospital are usually indemnified by the relevant state government. It is not yet clear if state indemnity will extend to the treatment of public patients being treated in a private facility for COVID-19. Where and if state indemnity does not apply, when treating a public patient anywhere other than in a public hospital, MDA National will extend cover in accordance with the policies’ terms and conditions.

    Updated: 19 April 2020

    We anticipate that government indemnity will be extended to all medical students who are engaged /employed in public hospitals. We advise Members to ensure their engagement and contract terms clearly set out the terms of such indemnity prior to commencing any duties. Medical students also need to ensure that their Ahpra registration is appropriate to their circumstances.

    MDA National is pleased to advise that we will extend cover for student members under the Professional Indemnity Insurance Policy to provide an additional layer of support and protection.  
    Specifically for those MDA National student Members who are engaged to assist during the COVID-19 pandemic, we will extend indemnity  under the Policy to cover the costs of defending student Members against  hospital or professional body investigations or inquiries as well as employment issues in  accordance with the Policy terms and conditions.  

    This means that any student Member of MDA National who has a Professional Indemnity Insurance Policy issued by us should contact us for advice if they are required to respond to any inquiry or investigation. 
    This cover is provided at no cost to student Members.

    Not a MDA National student member? Join for free here 

    Updated: 3 April 2020

    MDA National will provide cover free of charge for those who elect to join the surge workforce in response to the COVID-19 pandemic.

    If you are a retired or non-practising Member of MDA National, it is very straightforward. Please contact us via email at peaceofmind@mdanational.com.au or on 1800 011 255 and we will issue you with a policy and confirmation of indemnity. 

    If you are not a retired MDA National member, you should in the first instance seek cover through your previous medical indemnity provider, as they will have all your details.
    Please also check that you are included on the Ahpra pandemic response sub-register of practitioners that fast tracks the return to practice of experienced and qualified health practitioners to assist with responding to the pandemic. 

    If you are currently indemnified under the Federal Government’s Run off Cover Scheme (ROCS), any employment as part of the COVID-19 pandemic response will not invalidate or impact your existing ROCS cover. 

    If you are not eligible for the ROCS and are currently covered under MDA National’s Run off cover category, we will simply amend that cover to reflect your COVID 19 work. 
    The cover we provide in this circumstance is only in relation to the work you are employed to do in response to the COVID-19 pandemic. This policy does not cover you for any work you undertake outside the scope of your employment or any work you undertake beyond the official pandemic period as set by the Australian Government. 

    Updated: 9 April 2020

    We are happy to confirm Members will be covered in the event of a claim or investigation arising as the result of (alleged) transmission of COVID-19.

    It is expected that Members will comply with all relevant Government, Hospital and Health Department directives in relation to COVID-19.

    Updated: 1 April 2020

    MDA National understands that you may be asked or required to provide care outside your usual specialty or area of expertise as part of the response to the COVID-19 crisis. Although there is a need for flexibility in the current circumstances, you should try to remain within what you consider to be your scope of practice and competence.

    The Medical Board and Ahpra recognise that the way you provide care may need to be adjusted:

    "As an overriding principle, the Boards are prepared to be flexible in their approach although safety remains our first priority for National Boards and Ahpra. In this context, we are considering how our regulatory requirements can adapt to emergency health service needs and support health service delivery while continuing to protect the public."

    "We encourage all registered health practitioners to work with colleagues and people using services, to use your professional judgement to assess risk, and to deliver safe care informed by any relevant guidance and the values and principles set out in professional standards and the codes of conduct for your profession."

    Ultimately whether you decide to provide care outside your usual specialty or area of expertise will be a personal decision. This decision may have medico-legal consequences and the following medico-legal framework may be of assistance:

    (a) Knowledge and skills in the area in which you are being asked to work
    All doctors have a duty to recognise and work within their competence. 
    Is there additional training you can do to improve your knowledge and skills in the area in which you are being asked to work?
    Who will provide you with advice and/or supervision when you are working?
    Do you know how and to whom you should escalate any questions or concerns?

    (b) Standard of care
    Our Members are asking us about what is a reasonable standard of care, given the rapidly changing health environment and health resource constraints. The ‘reasonableness’ of care provided by health practitioners (relevant to claims and complaints) is determined by the opinions and standards of practice of peer practitioners (e.g. Colleges and other professional bodies, Medical Board, hospital policy, evidence based practice guidelines, public health guidance), taking into account the circumstances at the time. We recognise that in such a rapidly changing environment, this may be challenging to determine.

    (c) Indemnity 

    •  If you are employer indemnified and have access to indemnity from the hospital  (e.g. a doctor in training), and you are asked to work in a different area to your usual area of expertise, then indemnity would generally continue to be provided by your employer/hospital. You should confirm this with your employer. As always, you can contact our Medico-legal Advisory team for advice (details below)

    •  If your practice is usually indemnified by your employer and you are undertaking any work during the pandemic in a private capacity that is not indemnified by your employer, please contact our Member Services team (details below) and we can help you move to the appropriate category if required.

    •  If you are in private practice and your indemnity is provided by MDA National and you are undertaking a practice or procedure not associated with your field of practice , please check our Risk Category Guide or contact our Member Services team. We are here to support you and ensure you are covered.
     
    (d) Employment considerations

    If you have questions or concerns about your employment, or you are involved in an employment dispute, please contact our Medico-legal Advisory team for advice.
     
    As always, you can contact our Medico-legal Advisory team for advice and support on 1800 011 255, complete our Contact Us Form or contact our Member Services team for membership and insurance information on 1800 011 255 or peaceofmind@mdanational.com.au.


    Updated: 30 March 2020

    MDA National recognises that some of our Members may face financial hardship following this health crisis.

    We have a process in place to assist our members. Please contact our membership team on 1800 011 255 or email peaceofmind@mdanational.com.au to discuss your options.

    Doctors health and wellbeing resources

    The COVID-19 pandemic is an unprecedented situation creating stress and anxiety for our Members and the wider medical community.

    During a period of increased uncertainty, it is more important than ever to look after your own health and wellbeing. Below are some health and wellbeing resources that you may find useful during this time:

    Health department advice

    MDA National is aware that the public health advice is changing daily and there are differences at the state level in the approach to management of this crisis.

    Doctors are encouraged to keep up to date with the health department advice in their state:

    National information

    COVID-19 blogs, webinars and podcasts

     

    All references to policy coverage, cover, indemnity, and insurance are subject to the terms and conditions of the current Professional Indemnity Insurance Policy and Practice Indemnity Policy.