A: You should only provide healthcare you are appropriately qualified and trained to do. Ahpra has provided the following information about medical practitioners being fast tracked into new roles in responding to the Covid-19 crisis.

We are being asked a range of questions about how the National Boards would respond to requests for changes to the way that we register individuals in the context of managing the health sector impacts of COVID-19.

As an overriding principle, the National Boards and Ahpra are prepared to be flexible in our approach although safety remains our first priority.

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.

Avant will continue to rely on and recognise the regulators’ assessments of appropriate qualification to act. To ensure you are covered you should only provide healthcare where you are qualified and maintain your insurance coverage.

You should maintain coverage with us that is appropriate for your practice and, if you are considering changing your area of practice, please check if you existing category or practice includes the new work you are undertaking.

If you are still unsure or need to change category, please contact us on 1800 128 268.

A: For patients treated in a public setting, your employer typically provides indemnity. We suggest you ensure that you are employer indemnified for any public work as this is not usually covered by your medical indemnity policy which is mainly for private practice. If you do not have cover from your employer for your public work, please contact us so that this cover can be arranged.

A: Medical indemnity insurance premiums are based on several factors. Your annualised billings is one of these factors. If these have changed significantly from what is noted in your current policy documents, we can amend them which could reduce your premium. Please call us on 1800 128 268 to discuss possible changes.

A: Yes. However, if you have stopped all practice of medicine, you may be eligible to change your category of practice to Absentee. This category continues to provide you with cover for claims against you that relate to your prior medical practice but does not provide cover for any current healthcare that you provide. The premium for Absentee cover is $200 for any period up to 12 months. You should only consider changing your policy to Absentee if you plan to stop all medical practice. You will need to notify us prior to returning to your practice to arrange appropriate cover.

A: Generally, the treatment of a public patient is state indemnified. Currently there is not a clear position on how the state insurer indemnity will operate for public patients in a private facility. Avant wants you to be able to practice with confidence and can confirm your current policy will cover you for healthcare provided to all patients in private hospitals where you are not indemnified by the state, the hospital or another insurer, provided you declare your private billings for this work.

Coverage is subject to the terms and conditions of the policy.

A: Avant is offering a range of options on indemnity policy premiums, to members whose incomes have been impacted due to COVID-19. Each member will have their own unique circumstances and we are offering solutions that best meet individual needs, which can include:

✓ Premium adjustments for reduced billings for eligible members

✓ Transfer to an Absentee category for eligible members unable to practice with medical indemnity premiums waived until practice resumes

✓ A range of installment options, including monthly payment options

For members or practices who are experiencing significant financial hardship and are not able to meet payments, Avant may be able to assist you.

Please contact us on 1800 128 268 to discuss how we can support you.

A: Yes. Your practitioner policy covers you for this. However, it is important that you take precautions and follow all available advice to ensure that you can prevent transmission where possible. There is no cover under your policy if you know, or should have reasonably known or suspected, that you had the virus and then transmitted it to a patient. Therefore, if you are aware that you are infected, or suspect that you might be, it is important that you cease practising immediately and inform your hospital/local health service immediately.

A: Many interns are at the coal face of the COVID-19 pandemic, which may impact their training. In recognition of this, Ahpra (the Board) have made changes to the internship requirements, which will ease the pressure during this period.

Rotation requirements waived

On 3 April 2020, the Board announced they will waive the usual rotation requirements in general, surgery and emergency medicine for interns in 2020.

To apply for general registration, the Board will accept the following supervised clinical experience:

• at least 40 weeks full-time equivalent service (reduced by seven weeks to allow for isolation/sick leave etc.)
• clinical experience in accredited and non-accredited positions.
• any experience you have already gained in supervised rotations will be accepted.

At the end of your internship

Once you have completed your internship year, the Board will accept a report that you performed satisfactorily from the Director of Medical Services, Director of Training or another person who is authorised to sign off your intern reports.

Substantial experience and time missed

If the level of clinical experience or time you miss is substantial, and you are unable to meet the learning outcome requirements, you may need to complete more clinical experience once the pandemic is less acute.

Employer responsibilities

During this period, your employer must continue to supervise and provide you with as much meaningful educational clinical experiences as possible. They must also continue to teach and support you during this challenging and difficult time.

A: The Medical Board of Australia and other National Boards are working with AHPRA to streamline the return to work process for practitioners who have been off the Register of practitioners, or who have held non-practising registration since 1 January 2017. Details of their current advice are available on the AHPRA website.

In addition to registration you will also need medical indemnity insurance if you are practising privately. Avant will be able to arrange insurance cover for doctors returning to practice.

Avant is pleased to support non-practising or retired doctors who may be considering returning to medical practice to assist with the crisis, by providing medical indemnity cover at no cost during the COVID-19 emergency period. To express your interest, please complete this application form and then email to applications@avant.org,au for more information.

On 31 March 2020, regulations were passed to provide certainty for doctors who return to practice and currently hold run-off cover. Importantly, doctors will not need to arrange cover for prior practice and the regulations provide an exemption for doctors to maintain their cover through the Run-Off Cover Scheme while returning to practice for the period of the COVID-19 crisis.

A: Telehealth activities are covered under your practitioner policy. This includes consultations conducted via video conference and telephone, as well as SMS. You are covered anywhere in Australia.

Where there is a pre-existing clinical relationship with your patient, you are covered for telehealth activities where you are outside of Australia (for less than 120 days) and the patient is in Australia, or where the patient is outside of Australia (for less than 90 days) and you are in Australia (please refer to the policy wording for all details).

A: Your policy covers you for up to $20 million for claims for compensation made against you under your practitioner policy. It also provides cover for legal fees and expenses for disciplinary matters, including Medical Board inquiries and investigations.

A: You are covered under your practitioner policy for defending complaints in relation to breaches of workplace health and safety laws, as well as any fines and penalties as a result.

A: Yes. If you are an Avant member and a doctor in training, you are covered for the healthcare you provide in private practice where:

• it forms part of your training program; or
• it falls outside your training program, but it is consistent with your qualifications and experience.

You are also covered for volunteer work that is consistent with your qualifications and experience.

Cover is subject to the full terms, conditions and exclusions of the Avant practitioner policy.

If you are employed by a hospital/or health service, you will generally be indemnified by your employer for the work that you do, including for compensation claims.

However, not all employers cover the expenses for legal advice and representation for employment disputes, training disputes and coronial matters, amongst other things. It is important that you know whether you have the cover that you need through your employer. If you would like to find out more, please contact Avant Member Services on 1800 128 268.

A: Yes. Generally, you will be covered by your employer under your employment contract for treating patients in a private setting. However, if your employer does not provide you with this cover then your Avant practitioner policy will be able to provide this cover without you having to make any changes to your policy. If you need to update your category of practice e.g. if you move from a GP registrar to a hospital registrar, please contact us. Cover is subject to the full terms, conditions and exclusions of the Avant practitioner policy.

A: Yes. If you are an Avant member and a doctor in training, you are covered for the healthcare you provide in private practise where:

• it forms part of your training program; or
• it falls outside your training program, but it is consistent with your qualifications and experience.

You are also covered for volunteer work that is consistent with your qualifications and experience. If you are employed by a hospital or health service, you will generally be indemnified by your employer for the work that you do, including for claims of compensation by patients. However, not all employers provide this cover so please contact Avant Member Services on 1800 128 268 to update your policy if required.

If you are not working at all and you need to make update your policy to reflect this, please contact us to make this change. Cover is subject to the full terms, conditions and exclusions of the practitioner policy.

A: Yes. If you are an Avant member and a doctor in training, you are covered for the healthcare you provide under your practitioner policy where:

• it forms part of your training program; or
• it falls outside your training program, but it is consistent with your qualifications and experience.

As long as the work is consistent with your training and qualifications you will have cover and you don’t need to update your policy. If you need to update your category of practice e.g. if you move from a GP registrar to a hospital registrar, please contact us. If you are employed by a hospital or health service, you will generally be indemnified by your employer for the work that you do, including for claims of compensation by patients. However, not all employers provide you with cover that you need. If you do not have cover through your employer and need to update your policy, please contact Avant Member Services on 1800 128 268.

A: Yes. Your practice policy also has cover for telehealth activities.

A: Yes. Your practice policy provides cover for claims for compensation made against the practice which relate to the healthcare services you provide. Legal fees and expenses for disciplinary matters (e.g. tribunal or registration board) are also covered under your practice policy.

A: New MBS telehealth items were introduced on 13 March 2020, with some items coming into effect from different dates. The new items are listed on the Department of Health website, and can be used until 30 September 2020.

From 30 March 2020, there is no longer a requirement that the patient must have been seen by the GP or the GP’s practice in the last 12 months, and the previous requirements that the patient be at risk of COVID-19 or the practitioner be at risk of COVID-19, have now been removed.

From 6 April 2020, there is no longer the requirement that all telehealth consultations be bulk-billed.

From 20 April 2020, specialists and allied health service providers are no longer required to bulk-bill these new telehealth items.

However, it remains a requirement that the new telehealth services, where they are provided by GPs and Other Medical Practitioners (OMP), must be bulk-billed to:

(a) a person who is a patient at risk of COVID-19 virus; or
(b) a person who is a Commonwealth concession card holder; or
(c) a person who is under the age of 16.

A “patient at risk of COVID-19 virus” means a person who:

(a) is required to self-isolate or self-quarantine in accordance with guidance issued by the Australian Health Protection Principal Committee in relation to COVID-19; or
(b) is at least 70 years old; or
(c) if the person identifies as being of Aboriginal or Torres Strait Islander descent—is at least 50 years old; or
(d) is pregnant; or
(e) is the parent of a child aged under 12 months; or
(f) is being treated for a chronic health condition; or
(g) is immune compromised; or
(h) meets the current national triage protocol criteria for suspected COVID-19 infection.

The Department of Health has stated that health providers may apply their usual billing practices to the telehealth items for patients who do not fit the above criteria. Providers are expected to obtain informed financial consent from patients before providing the service; providing details regarding their fees, including any out-of-pocket costs.

A: Yes. Whole population telehealth services are now available, from 30 March 2020. Services can now be provided by telehealth by all practitioners including GPs, specialists, allied health practitioners, nurse practitioners and midwives. Urgent after-hours services are also included.

A: From 30 March, you can consult any patients using telehealth (audio-visual consultation) or, where audio-visual is unavailable, the telephone.

From 6 April 2020, there is no longer the requirement that all telehealth consultations be bulk-billed.

From 20 April 2020, specialists and allied health service providers are no longer required to bulk-bill these new telehealth items.

However, it remains a requirement that the new telehealth services, where they are provided by GPs and Other Medical Practitioners (OMP), must be bulk-billed to:

(a) a person who is a patient at risk of COVID-19 virus; or
(b) a person who is a Commonwealth concession card holder; or
(c) a person who is under the age of 16.

A “patient at risk of COVID-19 virus” means a person who:

(a) is required to self-isolate or self-quarantine in accordance with guidance issued by the Australian Health Protection Principal Committee in relation to COVID-19; or
(b) is at least 70 years old; or
(c) if the person identifies as being of Aboriginal or Torres Strait Islander descent—is at least 50 years old; or
(d) is pregnant; or
(e) is the parent of a child aged under 12 months; or
(f) is being treated for a chronic health condition; or
(g) is immune compromised; or
(h) meets the current national triage protocol criteria for suspected COVID-19 infection.

The Department of Health has stated that health providers may apply their usual billing practices to the telehealth items for patients who do not fit the above criteria. Providers are expected to obtain informed financial consent from patients before providing the service; providing details regarding their fees, including any out-of-pocket costs.

A: There are separate billing codes for specialists, physicians, psychiatrists, paediatricians, geriatricians, public health physicians and neurosurgeons. The requirements are:

• you still need a referral from a GP (existing referrals remain valid)
• the patient must be an out-patient.

There are specific requirements depending on the item number used, so check each item number carefully and ensure your documentation supports your use of the particular item number.

From 20 April 2020, specialists and allied health service providers are no longer required to bulk-bill these new telehealth items.

A: Yes. You can provide services to your patients by telehealth or telephone as long as you have the capacity to provide “… the full service through this means safely and in accordance with professional standards”, and you are satisfied that it is clinically appropriate to provide the service to the patient.

A: Yes. The previous requirements that the patient or the doctor be at risk of COVID-19 or vulnerable, have been removed.

A: Medicare telehealth services include urgent after-hours services, requested by a patient or a responsible person and where the patient’s medical condition requires urgent assessment. It is a specific requirement that the after-hours item numbers apply to a service only if the practitioner keeps a record of the assessment of the patient. In other words, you must keep a record of your assessment of the patient that identifies the basis for the patient’s need for urgent assessment.

A: The patient needs to consent to having a consultation by telephone or video conference. This consent can be obtained verbally at the time of the consultation and recorded in the medical records.

Because telephone consultations may only be used where telehealth (video) consultations are unavailable, you may need to communicate with the patient before the first telehealth medical consultation to establish whether or not the patient has the technology to participate in a video consultation.

The Department of Health has stated that health providers may apply their usual billing practices to the telehealth items for patients who do not fit the criteria for bulk-billing. Providers are expected to obtain informed financial consent from patients before providing the service; providing details regarding their fees, including any out-of-pocket costs.

The Australian College of Rural and Remote Medicine provides a helpful guide to outline the risks/benefits of telehealth for patients, with a consent form which can be completed if considered necessary, but this is not a legal requirement.

A: The advice from the Department of Health is that patients are still required to consent to their telehealth service being bulk-billed, as per normal practice for bulk-billed services.

Where practicable, each individual provider should make efforts to obtain a patient’s signature in whichever way is appropriate to their needs. There are several options available to providers performing these services:

• Provider to post the completed assignment of benefit form to the patient to obtain their signature and return.
• Request assistance from a supporting practitioner (when there is one and possible).
• Email agreement between the provider and patient.

However, the Department of Health’s position is that, under these exceptional and temporary circumstances, for the new temporary MBS telehealth items only, the practitioner’s documentation in the clinical notes of the patient’s agreement to assign their benefit as full payment for the service, would be sufficient.

This means that agreement can be obtained through one of three options being in writing, by email, or verbally through the technology with which the attendance is conducted.

This agreement can be provided by a patient, or another person, such as the person’s carer or family member. The practitioner should keep their own record that the patient agreed or acknowledged that the service was provided, and that the Medicare benefit could be paid directly to the practitioner.

The Department of Health has indicated that it may investigate potentially fraudulent claims by seeking to verify that the service was provided to a patient. However, the Department has stated that it is not intending to undertake compliance activity directly focused on whether the assignment of benefit process aligned with the usual requirements.

The General, Specialist and Diagnostic (assignment of benefit) form (DB4) is available through Medicare Bulk-Bill Webclaims using HPOS.

The Department of Health provides the following guidance for a patient to assign their right to a Medicare benefit to you by email.

For privacy reasons, the Department of Health advises that you should not include the patient’s Medicare card number or the doctor’s provider number in your email to the patient.

Step 1

At the telehealth consultation, tell the patient you wish to bulk-bill Medicare for the service. To do this the patient will need to:

• agree to the service being bulk-billed
• check the details in the email sent to their nominated email address
• reply to your email, which will be considered a signature agreeing to assign the benefit.

Step 2

Before submitting the claim, you need to send an email to the patient that includes all of the below:

• the details of the service
• item numbers or a description of the services
• benefit amount for both the base and derived fee items
• date and time of the services
• patient's name (don’t include the Medicare card number)
• practitioner's name (don’t include the provider number)

Include in your email this statement:

'If you (the patient) agree to the assignment of the Medicare benefit directly to the provider (bulk bill), reply to this email including the following words:

Yes, I agree to the assignment of the Medicare benefit directly to the provider, and your (the patient's) name'

and this privacy note:

'Your personal information is protected by law, including the Privacy Act 1988, and is collected by the Australian Government Department of Human Services for the assessment and administration of payments and services. This information is required to process your application or claim. Your information may be used by the department or given to other parties where you have agreed to that, or where it is required or authorised by law (including for the purpose of research or conducting investigations). You can get more information about the way in which the department will manage your personal information, including its privacy policy.

Step 3

When you get a reply email from the patient with the required information:

• complete a General, Specialist and Diagnostic (assignment of benefit) Voucher form (DB4)
• for manually submitted claims write in the signature block ‘unable to sign, written email agreement provided’
• for electronic claims, you don’t need to note the email signature, but you must keep the patient's email consent on file
• submit the claim to us in accordance with the Health Insurance Act 1973, 1975 Health Insurance Regulations and MBS
• send a completed copy of the General, Specialist and Diagnostic (assignment of benefit) Voucher form (DB4) to the patient
• keep the email with the patient's consent and email signature, in hard copy or electronic form for audit purposes for at least two years.

By noting 'email agreement' on the manual General, Specialist and Diagnostic (assignment of benefit) form (DB4), you acknowledge you’ve followed steps 1-3 above. This process complies with section 10 of the Electronic Transactions Act 1999, which outlines the steps to be taken for an electronic signature to be recognised. It also meets the legal requirement of needing a patient signature to assign a Medicare benefit.

Example email

A: The Department of Health advises that you should use the provider number for your primary location.

A: Where the COVID-19 telehealth and telephone services are bulk-billed, no additional charge may be rendered for the service (regardless of how the charge is described).

From 20 April 2020 the options available to GPs/other medical practitioners and specialists for charging COVID-19 telehealth and telephone services differ.

GPs and other medical practitioners who render the temporary COVID-19 items must bulk bill certain patients:

(a) a person who is a patient at risk of COVID-19 virus; or
(b) a person who is a Commonwealth concession card holder; or
(c) a person who is under the age of 16.

In other cases, GPs and other medical practitioners are not required to bulk-bill the COVID-19 items and may render an additional charge subject to obtaining informed financial consent from the patient.

Specialists and allied health service providers, from 20 April 2020, are no longer required to bulk bill these new telehealth items even when rendered to the patient groups listed above. Where the COVID-19 services are not bulk-billed, an additional charge may be rendered subject to obtaining informed financial consent from the patient. If you choose to do this, you should inform patients that other practices may bulk-bill the service under the COVID-19 telehealth items so they are aware of their options.

A: Yes. Bulk-billing incentive items can be claimed with face-to-face attendances or with the new COVID-19 telehealth and telephone services, where the conditions of the bulk-billing incentives are met. From 20 April, there are two new bulk-billing incentives introduced for vulnerable patients (items 10981 and 10982). These bulk-billing incentives will be equivalent to 10990 (metropolitan/urban) and 10991 (regional).

Vulnerable means a patient at risk of COVID-19, so a person who:

• is required to self-isolate or self-quarantine in accordance with guidance issued by the Australian Health Protection Principal Committee in relation to COVID-19; or
• is at least 70 years old;
• if the person identifies as being of Aboriginal or Torres Strait Islander descent—is at least 50 years old; or
• is pregnant; or
• is the parent of a child aged under 12 months; or
• is being treated for a chronic health condition; or
• is immune compromised; or
• meets the current national triage protocol criteria for suspected COVID-19 infection

A chronic health condition is medical condition that has been present (or is likely to be present) for at least six months or is terminal. The Department of Health website provides additional detail about chronic conditions. The diagnosis of immune compromised is a clinical decision made by the patient’s treating doctor. Please note this is guidance only, and does not constitute MBS claiming advice.

For clarification, the new bulk-billing incentives cannot be claimed in addition to existing bulk-billing incentive items. So, for example, if a medical service is provided to a patient who is both a holder of a Commonwealth concession card and falls under the definition of a vulnerable patient because they are 75 years old, only one relevant bulk-billing incentive may be claimed. Similarly, if a medical service is provided to a patient who is both under 16 years old and falls under the definition of a vulnerable patient because they are pregnant, only one relevant bulk-billing incentive may be claimed.

A: Yes.

There are three ways you can bill your patients when using telehealth services:

1. Bulk-billing.
2. Private billing where the patient receives a Medicare rebate and pays an out of pocket amount.
3. Private billing outside the Medicare system.

For patients who are not entitled to be bulk-billed, you can bill patients in the usual way, but you need informed financial consent from your patients before providing the service. You should therefore provide your patients with:

• Details of your fees, including any out-of-pocket costs.
• Details of the amount of any Medicare rebate.

Some practices are choosing to privately bill patients outside the Medicare system, who may otherwise be entitled to be bulk-billed under the MBS COVID-19 telehealth item numbers. A doctor and patient can agree that there will be no Medicare benefit for the service (and the doctor will issue a receipt which cannot be used by the patient to claim a Medicare benefit). If you choose to do this, you should inform patients that other practices may bulk-bill the service under the COVID-19 telehealth items so they are aware of their options.

A: If you bill privately, patients need to know details of your fees, including any out of pocket expenses and what Medicare rebate, if any, they will receive.

Informed financial consent can be given verbally and documented in the medical records or confirmed in an email (see below for a suggested email agreement).

If you are privately billing the whole amount of your fees (for example because the patient is not Medicare-eligible, or you decide to privately bill outside the Medicare system) we suggest you indicate on your receipt issued to the patient that there is no Medicare benefit payable for the service.

You should also inform patients if they would be entitled to be bulk-billed under the COVID-19 telehealth items if they attended another practice.

Example Email Agreement – Privately Billed Telehealth Consultation

A: GPs and specialists/physicians/consultant psychiatrists can provide service via telephone or video consultations if the criteria are satisfied. Telephone consultations should only be used where audio-visual (telehealth) consultation is unavailable.

To claim ‘telehealth’ items, practitioners must have video conferencing. There are separate item numbers for video and telephone consultations.

The Department of Health has advised that for the new temporary obstetric telephone services provided under items 91855, 91856, 91857 and 91858, these services must not be performed in cases where the practitioner and patient have the capacity to undertake an attendance by video conference.

A: There is no particular platform that you must use for telehealth.

The Department of Health has confirmed that:

• For Medicare purposes, no specific equipment is required to provide Medicare-compliant telehealth services.
• Services can be provided through widely available video calling apps and software such as Zoom, Skype, FaceTime, Duo, GoToMeeting and others.
• If video is not available, you can offer audio-only services. There are separate items available for audio-only/telephone services. The Department of Health has noted that this would not include online chat box/messaging and email as there is no visual or audio link.
• Free versions of the video/audio applications (i.e. non-commercial versions) may not meet applicable laws for security and privacy.

Under privacy legislation you are required to take reasonable steps to protect the privacy and security of the information that you hold. This means that you need to satisfy yourself that the platform you choose has adequate security measures to ensure that your patients’ health information is protected.

The platform provider’s terms and conditions or specifications should include relevant information about privacy and security. Have a look for:

• Compliance with Australian privacy laws and the Australian Privacy Principles (APPs).
• Security features such as multi-factor authentication and encryption. The Australian Cyber Security Centre advises that web conferencing solutions that exclusively support Transport Layer Security version 1.2 and 1.3 inherently offer more protection for data transmitted across the internet.
• The ability to use password-protection and unique links/invitations to video conferences.
• Details about the information the service provider collects and where it keeps that information. Is the service provider (or its servers) based in Australia?

As well as commonly available platforms such as Skype, Zoom and FaceTime, there are several bespoke telehealth platforms, and many medical software companies are incorporating video conferencing within their practice software. There is further information about these platforms in the resources listed below. Your IT provider is also a good source of information.

When you are using telehealth, consider your own privacy and the privacy of your staff. Use a practice account and be mindful that if you use your personal mobile phone or computer, patients may be able to access your personal number and email address. Also ensure that you have sufficient security in place for your practice systems to reduce the risk of a privacy breach or cyber security incident. For more information see our Cyber security resources.

Resources

The Australian Cyber Security Centre

• Web Conferencing Security
• COVID-19: Cyber Security Tips When Working From Home

Hoxton MPM Telehealth Road Test: What platform is best for your practice? *
PULSE+IT Technology resources for COVID-19
ACRRM eHealth and Technology Directory
RACP Telehealth resources
RACGP Telehealth
RANZCP position statement on telehealth in psychiatry

*Disclosure: Avant is affiliated with and has a shareholding in HMPM Pty Limited (Hoxton).

A: Some practices are already set up already for telehealth consultations with specialists. For those practices requiring guidance, the RACGP’s video consultation guidelines provide helpful information on getting started.

You need to consider what you need to do if you are conducting the consultation from the practice or from home. Some of these things are:

• How are you going to provide patients with the ability to contact you by phone or video conference?
• Do you have remote access to your medical records system from home? If you don’t have access, you will need to keep records that can be scanned into the system, including billing information. You also need to be mindful of the limitations of the advice you can provide without immediate access to the patient’s medical records.
• How will prescriptions and medications be provided to patients if they cannot visit the practice or pharmacy? Some of the options include getting consent for a family member to collect the prescription or sending them to a local pharmacy and arrange for delivery of the medications to the patients.
• Do you have a printer at home if you need to send a letter?

Telehealth and telephone consultations will be a new experience for many patients, so the RACGP recommends communicating with patients about the process and the benefits before they take part. A template patient brochure is available from the RACGP website.

A: It is a MBS requirement that you have the capacity to provide the full service through telehealth or telephone safely and in accordance with professional standards. The MBS telehealth item number descriptors also require general practitioners to undertake the following in each telehealth or telephone consultation:

• take an appropriate patient history
• arrange any necessary investigation
• implement a management plan;
• provide appropriate preventative health care;

Always be aware of the limits of what you can achieve via the phone or video link if you are unable, for example, to check a patient’s blood pressure or temperature (and they cannot reliably do this remotely).

You will need to consider whether a physical examination is necessary and have a plan in place for referral of the patient if you are in self-isolation. This may be to a colleague in your practice if they are available to see the patient, the local hospital if appropriate or to another practice in the area if your practice is closed or the doctors cannot see additional patients.

The Good medical practice code of conduct applies to telehealth consultations as it does for face-to-face consultations. Doctors providing care via any form of technology are also required to follow the Medical Board’s Guidelines for Technology-Based Patient Consultations.

What this means in practice is:

• you need to be able to verify the identity of the patient
• the usual principles apply for obtaining your patient’s informed consent and protecting their privacy
• you need to keep appropriate records of the consultation
• if providing prescriptions you need to have enough information about the patient’s past medical history and current medical conditions, and medications to satisfy yourself that the prescription is appropriate and not contra-indicated.

A: As a healthcare worker, you should not attend work if:

You cannot attend work during any period of self-isolation, but you can work from home (if possible).

To return to work in a health care setting, you must meet a higher standard because health care is regarded as a “high risk setting” as outlined in the CDNA guidelines. Before health care workers can return to work in a healthcare setting, they must meet all of the following criteria:

The CNDA guidelines contain detailed and up to date information relevant to self-isolation, returning to work, and managing both negative and positive diagnoses.

Before returning to work:

After leaving isolation, ensure you comply with any State or Territory public health directions.

A: You can attend work. However, you and your employer should take steps to ensure your health and safety while at work.

Advice about vulnerable healthcare workers

The Australian Health Protection Principal Committee (AHPPC) has advised that the following people are at higher risk of serious illness if they are infected with COVID-19:

• Aboriginal and Torres Strait Islander people 50 years and older with one or more chronic medical conditions.
• People 65 years and older with ‘chronic medical conditions’.
• People 70 years and older.
• People of any age with compromised immune systems.

Although there is limited evidence at this time regarding the risk in pregnant women, RANZCOG has recommended reducing the exposure of pregnant healthcare workers to confirmed or suspect cases. RANZCOG also urges employers to be sensitive to the fact that pregnant women are, appropriately, often anxious about their own health and protective of their unborn baby. Consideration should be given to reallocation to lower-risk duties, working from home or leave of absence.

The AHPPC recommends that where vulnerable workers undertake essential work, a risk assessment must be undertaken. Risk needs to be assessed and mitigated with consideration of the characteristics of the worker, the workplace and the work. This includes ensuring vulnerable people are redeployed to non-customer based roles where possible. Where risk cannot be appropriately mitigated, employers and employees should consider alternate arrangements to accommodate a workplace absence.

The AHPPC also recommends that special provisions apply to essential workers who are at higher risk of serious illness and, where the risk cannot be sufficiently mitigated, they should not work in a high-risk setting.

Avant supports vulnerable doctors to seek changes to their work to minimise the risk of contracting or becoming seriously ill with COVID-19.

Practical steps you can take

If you have a genuine concern that you are at a higher risk of contracting COVID-19 or of suffering serious illness as a result of COVID-19, you should speak with your employer.

Your employer may request information from your treating practitioner about the nature of your medical conditions and the risks of COVID-19 exposure. If so, you should provide the requested information.

Your employer may agree that you are not required to attend work or may allocate you to another role which is less likely to have contact with suspect or confirmed cases of COVID-19.

Many state and territory governments and healthcare organisations have implemented specific guidance for vulnerable healthcare workers. Make sure you stay up to date with your own local guidelines.

We have set out the legal position below, but it is up to each practice to determine how best to manage the situations that arise with their staff. Many Australian employers are choosing to provide paid special leave to employees who are required to self-isolate.

Any worker who can work from home during a self-isolation period should do so and should continue to be paid as usual.

If a worker is not able to work from home (e.g., due to the nature of their role), the business will need to consider how to pay the worker, taking into account the legal position below.

1. The employee is sick

If the employee has contracted COVID-19 or is otherwise sick, the employee is entitled to paid sick leave. The employee can take other forms of paid leave if they run out of paid sick leave.

2. The employee is required to self-isolate due to government requirements

On 8 April 2020, the Fair Work Commission varied the following awards to include an entitlement to unpaid pandemic leave if an employee is required to self-isolate: see the decision and reasons for decision:

• Health Professionals and Support Services Award 2010
• Nurses Award 2010
• Aboriginal Community Controlled Health Services Award 2010
• Medical Practitioners Award 2020

The new clause currently operates from 8 April 2020 to 30 June 2020. It says:

X.2.1 Unpaid pandemic leave

(a) Subject to clauses X.2.1(b), (c) and (d), any employee is entitled to take up to 2 weeks’ unpaid leave if the employee is required, by government or medical authorities or acting on the advice of a medical practitioner, to self-isolate and is consequently prevented from working, or is otherwise prevented from working by measures taken by government or medical authorities in response to the COVID-19 pandemic.

(b) The employee must give their employer notice of the taking of leave under clause X.2.1(a) and of the reason the employee requires the leave, as soon as practicable (which may be a time after the leave has started). 2

(c) An employee who has given their employer notice of taking leave under clause X.2.1(a) must, if required by the employer, give the employer evidence that would satisfy a reasonable person that the leave is taken for a reason given in clause X.2.1(a).

(d) A period of leave under clause X.2.1(a) must start before 30 June 2020, but may end after that date.

(e) Leave taken under clause X.2.1(a) does not affect any other paid or unpaid leave entitlement of the employee and counts as service for the purposes of entitlements under this Award and the National Employment Standards.

NOTE: The employer and employee may agree that the employee may take more than 2 weeks’ unpaid pandemic leave.

Unions representing healthcare workers submitted that healthcare workers should be entitled to paid pandemic leave on each occasion they are required to self-isolate:

• because they are at an increased risk of contracting or being exposed to COVID-19 and having to self-isolate; and
• to encourage healthcare workers not to go to work if there is a risk they may have COVID-19.

The Fair Work Commission will convene a conference with the relevant parties to discuss these submissions further. It is possible that the awards will be amended further following that conference.

3. The employee is required to self-isolate by the employer

Given the unique circumstances of COVID-19, a practice can require an employee to self-isolate if the practice is concerned that the employee may be a COVID-19 risk. However, the practice must pay the employee their usual wages for the relevant period without deduction from leave entitlements.

A: Annual leave

• An employer does not have a right to cancel an employee’s annual leave which has already been approved. Annual leave can only be cancelled/postponed by agreement.
• An employer must not “unreasonably refuse” an employee’s request for annual leave under section 88 of the Fair Work Act. An employer should consider issues such as the need for staff to work during a pandemic/health crisis and balance this against the personal circumstances of the employee (e.g. leave requested for their child’s wedding).

Long service leave

Long service leave is a state-based entitlement. For example, in Queensland:

• An employer does not have a right to cancel an employee’s long service leave which has already been approved. Long service leave can only be cancelled/postponed by agreement.
• An employer and an employee must agree about taking long service leave. An employer must not “unreasonably refuse” an employee’s request for long service leave. An employer should consider issues such as the need for staff to work during a pandemic/health crisis and balance this against the personal circumstances of the employee (e.g. leave requested for their child’s wedding).

A: There are a range of options that an employer can consider if it does not have enough work to maintain the working hours of existing employees.

1. Alternate work

An employer should consider whether there is any useful work the employee can do. This might include doing their usual job in a different way (for example, working from home) or doing other duties which are within the scope of their employment. If so, the employer and employee can make an agreement about doing work in a different way.

Employees who do other useful work should be paid as normal. If the employee is performing higher duties, the employee should be paid for those higher duties in accordance with award requirements.

For more information, see Safe Work Australia's information on workplace health and safety requirements when working from home.

2. Personal/carer’s leave

Employees who are sick or need to take carer’s leave are entitled to paid personal/carer’s leave.

3. Agreement to take paid or unpaid leave

An employer cannot unilaterally require an employee to take paid or unpaid leave (except in the circumstances set out below).

An employee and employer can reach agreement about taking leave. An employer must not act unreasonably or coerce employees into reaching agreement. Any agreement should be documented in writing.

4. Direction to take annual leave

An employer can direct an employee to take annual leave under the Health Professionals and Support Services Award 2010 and the Nurses Award 2010. These awards allow an employer to direct an employee to take paid annual leave or annual leave in advance during any period when a medical practice is temporarily closed. The clauses say:

Health Professionals and Support Services Award 2010: 31.4 Close down periods—dental and medical practices

Where an employer temporarily closes a dental or medical practice, an employee may be directed to take paid annual leave during part or all of this period provided such direction is reasonable. Where an employee does not have sufficient accrued annual leave for this period, they may be required to take annual leave in advance where such requirement is reasonable.

Nurses Award 2010: Clause 31.9 Close down periods—medical practices

Where an employer temporarily closes a medical practice, an employee may be directed to take paid annual leave during part or all of this period. Where an employee does not have sufficient accrued annual leave for this period, they may be required to take annual leave in advance.

Both awards say that an employee may be required to take annual leave in advance. The awards do not require an employer to provide paid annual leave in advance.

5. Other provisions about annual leave

Set out below are other provisions of the awards that may assist. It is important to read each clause carefully and to comply with its requirements.

Health Professionals and Support Services Award 2010

An employer and employee can agree in writing that an employee can take annual leave in advance – clause 31.3.

An employer and employee can agree in writing that the employee’s annual leave will be cashed out – clause 31.5.

An employer can direct an employee to take annual leave if the employee has more than 8 weeks’ annual leave – clauses 31.6, 31.7 and 31.8.

For the period from 8 April 2020 to 30 June 2020, an employer and employee can agree that the employee will take twice as much annual leave at half pay.

Nurses Award 2010

An employer and employee can agree in writing that an employee can take annual leave in advance – clause 31.10.

An employer and employee can agree in writing that the employee’s annual leave will be cashed out – clause 31.11.

An employer can direct an employee to take annual leave if the employee has more than 10 weeks’ annual leave – clauses 31.2, 31.3 and 31.4.

For the period from 8 April 2020 to 30 June 2020, an employer and employee can agree that the employee will take twice as much annual leave at half pay.

6. Direction to take long service leave

Long service leave is different in each state. In some states, an employer can direct an employee to take long service leave in certain circumstances.

7. Agreement to reduce hours of work

An employee and employer can agree to reduce the hours an employee works. Any agreement must be in writing.

8. Direction about changes to rosters or hours of work

The Health Professionals and Support Services Award 2010 and the Nurses Award 2010 allow an employer to change an employee’s roster or ordinary hours of work following a consultation process. Appropriate notice of roster changes and hours of work must be given.

Health Professionals and Support Services Award 2010

8A. Consultation about changes to rosters or hours of work

8A.1 Clause 8A applies if an employer proposes to change the regular roster or ordinary hours of work of an employee, other than an employee whose working hours are irregular, sporadic or unpredictable.

8A.2 The employer must consult with any employees affected by the proposed change and their representatives (if any).

8A.3 For the purpose of the consultation, the employer must:

(a) provide to the employees and representatives mentioned in clause 8A.2 information about the proposed change (for example, information about the nature of the change and when it is to begin); and

(b) invite the employees to give their views about the impact of the proposed change on them (including any impact on their family or caring responsibilities) and also invite their representative (if any) to give their views about that impact.

8A.4 The employer must consider any views given under clause 8A.3(b).

8A.5 Clause 8A is to be read in conjunction with any other provisions of this award concerning the scheduling of work or the giving of notice.

Nurses Award 2010

8A. Consultation about changes to rosters or hours of work

8A.1 Clause 8A applies if an employer proposes to change the regular roster or ordinary hours of work of an employee, other than an employee whose working hours are irregular, sporadic or unpredictable.

8A.2 The employer must consult with any employees affected by the proposed change and their representatives (if any).

8A.3 For the purpose of the consultation, the employer must:

(a) provide to the employees and representatives mentioned in clause 8A.2 information about the proposed change (for example, information about the nature of the change and when it is to begin); and

(b) invite the employees to give their views about the impact of the proposed change on them (including any impact on their family or caring responsibilities) and also invite their representative (if any) to give their views about that impact.

8A.4 The employer must consider any views given under clause 8A.3(b).

8A.5 Clause 8A is to be read in conjunction with any other provisions of this award concerning the scheduling of work or the giving of notice.

9. Unpaid pandemic leave

If an employee is required to self-isolate, the employee is entitled to two week’s unpaid pandemic leave in accordance with the Health Professionals and Support Services Award 2010 and the Nurses Award 2010 (see above).

10. Paid special leave

Many Australian employers are providing paid special leave to their employees. This is something your practice may wish to consider.

11. Stand down

An employer can only stand an employee down if the employer has a right to do so under an enterprise agreement or legislation.

Enterprise agreement

If your practice has an enterprise agreement, you should consider whether there are any provisions in the agreement about stand down of employees.

Legislation

Section 524 of the Fair Work Act 2009 (Cth) allows an employer to stand an employee down without pay if the employee cannot usefully be employed because of a stoppage of work for any cause for which the employer cannot reasonably be held responsible.

If an employer stands an employee down without pay in breach of section 524, the employer may later be required to repay any underpayment of wages.

The Fair Work Ombudsman has provided the following guidance about standing down employees in the context of coronavirus:

In summary, an employer cannot stand an employee down without pay simply because of a deterioration of business conditions.

However, an employer can stand an employee down if an enforceable government direction means there is no work at all for employees to do (this may include for example, the government’s direction about cessation of non-urgent elective surgery).

12. Redundancy

View our answer to the FAQ: What steps do I have to follow to make an employee’s position redundant? for information on redundancy.

A: Based on current expert advice, masks are not required if reception staff are not likely to be in close contact with suspected or confirmed cases, and if measures such as social distancing, standard precautions including hand hygiene, screens and triaging protocols, are implemented.

Work health and safety laws require medical practices to implement control measures to eliminate or minimise the spread of COVID-19 and ensure the health and safety of their workers, patients and others at the workplace, so each situation needs to be assessed to ensure reception staff are kept safe and protected.

If staff themselves feel unwell, they should stay at home, let their supervisor know and seek further medical advice.

• Healthcare workers looking after patients in hospitals (Department of Health)
• Health care workers looking after patients in non-inpatient settings (Department of Health)
• The use of surgical masks in a variety of settings (Department of Health)
• Distribution of PPE through PHNs (Department of Health)
• Health care general work health and safety information (Safe Work Australia)
• COVID-19 workplace checklists (Safe Work Australia)

A: The Fair Work Act 2009 (Cth) (FW Act) requires an employee to tell their employer that they are sick or they need to take carer’s leave and will not be at work.

An employer may ask the employee for evidence “that would satisfy a reasonable person” that they are sick or must take carer’s leave.

View the Fair Work Ombudsman’s guidance about the evidence required.

Medical certificates or statutory declarations are examples of acceptable forms of evidence. While there are no strict rules on what type of evidence needs to be given, the evidence has to convince a reasonable person that the employee was genuinely entitled to the sick or carer’s leave.

Medical certificates

A medical certificate is a certificate signed by a medical practitioner.

Statutory declarations

A statutory declaration is a written statement where someone declares that something is true, and signs it in the presence of an authorised witness. An employee can declare they were absent for a genuine reason using a statutory declaration.

There are legal penalties for making false declarations.

The form of a statutory declaration varies from state to state.

Certificates from other health professions

An employee must provide “evidence that would satisfy a reasonable person”. This can include certificates from a registered health practitioner such as pharmacists, osteopaths, chiropractors, dentists, nurses, occupational therapists, physiotherapists, podiatrists, psychologists, optometrists and Chinese Medicine practitioners.

It is ultimately a matter for the employer to determine whether a certificate from a registered health practitioner is reasonable.

A: There are a number of practical steps that practices can adopt to minimise the risks of data/privacy breaches. These include:

• Ensure that staff are aware that all practice policies (including privacy policies) apply when staff are working from home.

• The practice should consider what additional requirements or adaptations are required for employees working from home. Practices should let all employees working from home know what the additional requirements or adaptations are (in writing).

• The practice should prepare and distribute guidelines for safety and security when transporting laptops between the practice and home.

• The practice should consider how staff members can gain access to practice software from home - VPN access may be required.

• The practice should remind staff that confidential medical information should not be accessed by other people in the household.

• For further guidance, see:

• Patients should be made aware that staff are working from home and appropriate protocols are in place to ensure the privacy of patient information.

• Privacy requirements apply to all personal information including information about staff pay, staff contact details, doctor earnings etc as well as to patient medical records.

• Remind staff to check everything they do carefully. The computer systems will be slower at home and this can inadvertently lead to errors.

A: Avant has received many calls from practice owners seeking advice about whether they should close their practice.

There is no ‘one size fits all’ approach to this question. The answer will depend on the individual circumstances of each practice.

The practice will need to consider issues such as:

• how it can manage continuity of care for patients of the practice if it closes (in whole or in part);
• whether it can maintain a supply of essential items (for example, bandages and medication);
• whether telehealth is an option, including as new telehealth options become available;
• whether reputational damage may occur if a staff member or patient is a confirmed case.

Practices should carefully monitor their financial circumstances. Difficult decisions many have to be made if the practice is not making enough money to cover its costs.

As a general rule companies must ensure that they do not trade while insolvent. This can have serious implications for the company and its directors. The Federal Government has announced some relief with these measures for a six-month period.

Practices should continue to pay their suppliers in a timely manner so that supply is not affected. Some suppliers may close if they are not financially stable.

The Federal Government has made financial and other incentives available for small business. Practices should consider what incentives may be available for their business.

Practice owners should reflect on their own personal issues and concerns. In addition to considering others, you should consider your own needs (financial, health and other) and the needs of your family members.

Some staff may wish to continue working. If your practice closes (wholly or partially), you may be able to speak with your medical colleagues to secure short-term work for your staff.

More information on coronavirus and workplace laws is available from the Fairwork website.

A: The Office of the Australian Information Commissioner has stated that yes, you may inform staff that a colleague or visitor has or may have contracted COVID-19 but you should only use or disclose personal information that is reasonably necessary to prevent or manage COVID-19 in the workplace.

For example, depending on the circumstances, it may not be necessary to reveal the name of an individual in order to prevent or manage COVID-19, or the disclosure of the name of the individual may be restricted to a limited number of people on a ‘need-to-know basis’. Whether disclosure is necessary should be informed by advice from the Department of Health.

A: Redundancy should be considered as a last resort. The following steps apply in a redundancy process.

Services Australia has information on redundancy for employers on its website.

These are the minimum legal requirements. An employer can elect to provide more beneficial redundancy terms.

A: An employee can take carer’s leave to provide care or support to a member of the employee's immediate family, or a member of the employee's household, who requires care or support because of a personal illness or personal injury, affecting the member or an unexpected emergency affecting the member. View section 97 of the Fair Work Act 2009.

• The definition of a “personal illness” includes diagnosed COVID-19.

• An “emergency” includes school or child care closure without notice.

An employee (other than a casual employee) is entitled to take paid carer’s leave if the employee has a paid personal/carer’s leave entitlement.

An employee (including a casual employee) is entitled to take two days of unpaid carer’s leave for each occasion if they do not have an entitlement to paid personal/carer’s leave. View section 102 and section 103 of the Fair Work Act.

A: On 21 April 2020, the Prime Minister announced, on the advice of the Australian Health Protection Principal Committee (AHPPC) that National Cabinet agreed that, from 27 April, category 2 and “some important” category 3 procedures can recommence across the public and private sectors. For more information about resuming elective surgery, including the types of procedures, please refer to the AHPPC’s statement dated 23 April 2020.

It is a clinical decision for practitioners about what procedures to perform and which patients to select. It is up to members to decide this on a case-by-case basis, taking into account:

Practitioners should make clinical decisions in the context of the Medical Board of Australia’s Good medical practice: a code of conduct for doctors in Australia and have regard to peer standards. Decisions should be supported by good documentation, and appropriate consent processes.

A: It is a clinical decision for practitioners about whether it is appropriate to perform or re-commence non-surgical procedures (in contrast to elective surgery), taking into account:

Practitioners should make clinical decisions in the context of the Medical Board of Australia’s Good medical practice: a code of conduct for doctors in Australia and have regard to peer standards. Decisions should be supported by good documentation, and appropriate consent processes.

A: Yes. Avant’s Practitioner Indemnity Insurance policy will cover you for the work you do as a healthcare professional within your category of practice and that you are appropriately trained and qualified to do, subject to the terms, conditions and exclusions of the policy.

Coverage will not be refused where you exercise clinical judgment and your clinical decision to provide healthcare is determined to be inconsistent with the available advice in this fluid and uncertain environment. We recommend and trust that our members endeavor to follow the advice of government, their places of work, relevant professional bodies, colleges and societies, as well as peak decision-making bodies like the Australian Health Protection Principal Committee.

A: Yes. The Department of Health has provided advice about the non-inpatient care of suspected, probable or confirmed cases of COVID-19, including about care and management in your office or rooms, and the use of personal protective equipment (PPE). The Communicable Disease Network Australia’s National Guidelines for Public Health Units contain information about managing patients with suspected or confirmed COVID-19 in a non-inpatient setting.

The RACGP advises: “Key for GPs and practice teams is to ensure good triage protocols and avoid having patients suspected of having the virus, in the waiting room with other patients. Practices can utilise the available patient alert posters to quickly identify, and appropriately manage, patients presenting with symptoms.”

The RACGP has also recommended that GPs should not treat or test patients suspected of COVID-19 unless they have appropriate Personal Protective Equipment (PPE), so if your practice does not, direct patients to local hospitals or collection centres.

For up-to-date information, visit the Australian Federal Government Department of Health website and the current national guidelines for public health units.

A: Yes. You may place signs telling people to call the reception desk and/or tell reception staff the moment they come in if they have symptoms suggestive of COVID-19 or if they have any clinical or epidemiological evidence for COVID-19. Visit the RACGP’s website for patient alert posters.

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

Discrimination laws prevent medical practice staff from discriminating against patients on the basis of disability/impairment (e.g. COVID-19) or ethnic origin. However, you could refuse to see a patient if it is reasonably necessary to protect the health and safety of any person (including medical practice staff).

In determining whether discrimination is “reasonably necessary” you need to consider the up-to-date expert advice. View the Department of Health’s guidelines about managing patients with suspected COVID-19 in a GP setting.

The RACGP also issued guidance about the use of PPE when managing patients with suspected COVID-19 in a GP setting. The guidelines state:

“GPs should not treat or carry out testing on suspected coronavirus patients if they do not have the correct PPE equipment. They should seek advice from their local public health unit on where to send the patient for treatment or testing and how to minimise the risk of infection while the patient is being transported.”

In our view, it is reasonable to refuse to see patients with symptoms of COVID-19 if the practice cannot comply with the safety guidelines provided by the Department of Health and RACGP.

A: The Department of Health does not currently classify pregnant women as a high-risk category and has not provided any guidance about the need for pregnant healthcare workers to self-isolate or not attend work. View current advice from the Department of Health about vulnerable healthcare workers attending work.

The RACGP has not provided any guidance about the need for pregnant healthcare workers to self-isolate or not attend work.

The advice from RANZCOG is that "At this time, pregnant women do not appear to be more severely unwell if they develop COVID-19 infection than the general population. It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms”.

RANZCOG recommends that, where possible, pregnant health care workers be allocated to patients, and duties, that have reduced exposure to patients with, or suspected to have, COVID-19 infection. All personnel should observe strict hygiene protocols and have full access to Personal Protective Equipment (PPE). The College also urges employers to be sensitive to the fact that pregnant women are, appropriately, often anxious about their own health and protective of their unborn baby. Consideration should be given to reallocation to lower-risk duties, working from home or leave of absence.

View RANZCOG’s guidelines.

The Australian and New Zealand Intensive Care Society has released COVID 19 guidelines which state at page 24:

Staff members who are at higher risk caring for COVID-19 patients

The international experience is that mortality is higher in older patients, particularly with comorbidities related to cardiovascular disease, diabetes mellitus, chronic respiratory diseases, hypertension and malignancy.

We recommend that staff who are judged to be of high risk should not enter the COVID-19 isolation area. This includes staff who are pregnant, have significant chronic respiratory illnesses or are immunosuppressed.

Staff member risk decisions should be made on a case by case basis by the unit director with the support of the local occupational health and safety unit. We recommend that these staff would be reallocated to other roles and not enter COVID-19 areas.

If you have a genuine concern that you or your baby are at a higher risk of contracting COVID-19 or of suffering serious illness as a result of COVID-19 because you are pregnant, you should speak with your employer/practice principal about the situation. They may agree that you are not required to come to work or may allocate you to another role which is less likely to have contact with suspected or confirmed cases of COVID-19.

If your employer/practice principal insists that you come to work, they must consider what reasonable adjustments can be made to the workplace to accommodate your specific needs (i.e. being the additional protections that are necessary because of your medical conditions). You will need to consider whether the proposed measures are sufficient to keep you safe. If not, you can refuse to attend work on health and safety grounds.

For employed doctors who are pregnant, there is legislation entitling you to transfer to a safe job or not attend work in certain circumstances. You should seek specific advice about your personal circumstances.

This is general advice. You should consider whether there are any specific conditions or requirements in your contract of employment, services agreement and policies and procedures.

A: If a patient cannot be tested at the practice they should be informed to:

- go straight to the pathology collection service or Emergency Department from the GP’s rooms

- wear a surgical mask

- not travel to the collection centre or ED by public transport

- be advised about good respiratory etiquette and hand hygiene.

The practice should call ahead to the pathology provider to advise a patient is on their way. For example, NSW Health has a list of collection centres that are providing specimen collection for COVID-19 testing, or you can phone your local collection centre to check before referring your patient.

Please note that if a patient does present at your practice with symptoms and there is a medical emergency, the patients should be assessed to ascertain what assistance is required. The doctor should wear suitable PPE during this treatment.

A: As we anticipated, the testing guidelines are changing. This reflects what is currently known about the clinical and epidemiological profile of cases of COVID-19 presenting in Australia and internationally. Health authorities are constantly monitoring the spectrum of clinical symptoms and nature of illness.

The guidelines to date have focused on testing higher risk groups, for example close contacts of people diagnosed with COVID 19, returned travellers, healthcare workers, aged or residential care workers, hospitalised patients, and others. Wider testing is now being recommended in some communities and areas. Doctors should continue to use their clinical discretion and recognise there may be situations in which testing patients outside of the guidelines may be clinically appropriate.

To review the current national testing criteria you should check the current version of the Communicable Disease Network Australia’s National Guidelines for Public Health Units.. We are also aware that the states/territories, and local public health units and districts, are distributing their own testing guidelines, so you should also be aware of testing criteria at your local level. You can find links to advice from each state and territory health department in our resources section below.

A: Patients can’t demand that doctors undertake testing. The decision to test a patient is a clinical one based on the circumstances of each patient taking into account current national, local and state guidelines.

To review the current national testing criteria, check the current version of the Communicable Disease Network Australia’s National Guidelines for Public Health Units. The states/territories, and local public health units and districts, are distributing their own testing guidelines, so you should also be aware of testing criteria at your local level.

You can find links to advice from each state and territory health department in our resources section below. The guidelines highlight that doctors can use their clinical discretion and judgment to decide if a test is required or clinically necessary in situations where a patient does not meet the strict criteria for a ‘suspected case. Patients can also be referred to the screening services or collection agencies for advice.

A: No. Without patient consent, a doctor cannot generally perform testing. If you are concerned about a patient who has refused testing, you should contact the public health unit for advice. There are powers under state and territory-based legislation to compel testing in certain circumstances.

A: Yes, PPE must be worn when treating any suspect case. The national guidelines explain what PPE is required.

Specific guidance is available about using PPE in hospitals and non-inpatient settings.

A: Legally, yes. However, we acknowledge and appreciate the very difficult ethical dilemma this can create for doctors.

A practice/hospital cannot lawfully direct a worker to treat patients with suspected or confirmed COVID-19 unless the recommended PPE is provided.

This is because a practice/hospital and worker must ensure the workplace health and safety of the worker and other persons at the workplace as far as reasonably practicable by eliminating or minimising risks.

In considering how to manage risk, all parties should have regard to expert advice (such as the national guidelines for PPE advice for testing and guidance about using PPE in hospitals and non-inpatient settings).

A: The current Department of Health advice is that PPE is required when testing or treating confirmed or suspect cases. If you are not being provided with the recommended PPE for the type of work you are doing, you can ask your employer if you can wear your own PPE.

PPE is in short supply, so it is important for doctors to consider very carefully whether they need it in particular circumstances. This includes PPE sourced by doctors personally. Wearing PPE when it is not recommended may set a confusing precedent in the practice or hospital (for fellow health care workers and the public/patients) and may undermine attempts to conserve PPE for high risk encounters.

A: Notify your local public health unit immediately after being notified of a positive COVID-19 result. Patients with mild symptoms do not need to be sent to the Emergency Department, unless there is another reason why they may require hospital treatment. The patients should be referred for co-management with the local infectious disease physician and the public health unit.

A: You may need to self-isolate if you had close contact with the patient and you were not wearing appropriate PPE at that time. For specific guidance about the management of any contact you may have had with a “confirmed”, “probable” or “suspect” COVID-19 case, you should review the Contact Management section in the current Communicable Disease Networks Australia’s National Guidelines for Public Health Units.

We are aware that the states/territories, and local public health units and districts, are distributing their own guidelines on self-isolation and testing, so you should be aware of the advice at your local level. You can find links to advice from each state and territory health department in our resources section below.

A: The only type of ‘certification’ a doctor can provide is to the effect that, on the day of assessment, the patient was symptom free (this relies on a patient history and the patient being honest) and exhibited no clinical features indicating a viral infection or other symptoms that have been reported with COVID-19.

As the understanding of the disease evolves the spectrum of reported symptoms linked with this disease is changing. Detail of the currently known spectrum can be found in the Communicable Disease Networks Australia’s National Guidelines for Public Health Units.

For more information, read our article on medical clearance certificates.

A: Due to the public health importance of COVID-19, the new coronavirus strain (COVID-19) should be recorded on the medical cause of death certificate where the disease caused, or is assumed to have caused, or contributed to death.

View the Australian Bureau of Statistics’ ‘Guidance for Certifying Deaths due to COVID-19.’

• Record COVID-19 in Part I of the Medical Certificate of Cause of Death. All conditions and symptoms should be included. For example, in cases when COVID-19 causes pneumonia and fatal respiratory distress, both pneumonia and respiratory distress should be included along with COVID-19 in Part I alongside the duration of each disease and symptom. Certifiers should include as much detail as possible based on their knowledge of the case, medical records, laboratory testing, etc.

• Existing conditions, especially those which are chronic in nature, that may have also contributed to death should be certified in Part II of the Medical Certificate of Cause of Death. Chronic conditions may include, but are not limited to: coronary artery disease, COPD, diabetes, cancer or disabilities.

• The use of World Health Organization terminology COVID-19 or Coronavirus Disease 2019 should be certified on the death certificate. Terminology such as SARS-CoV-2 can be used, but it must be clear that it is the 2019 strain of disease. WHO terminology is preferred.

• The term ‘coronavirus’ should not be used in place of COVID-19 or Coronavirus Disease 2019. This will introduce uncertainty for coding cause of death which may lead to under reporting in national statistics.

A: The CDNA national guidelines explain when a person should be tested for COVID-19 with guidance about testing of symptomatic healthcare workers, and those who are confirmed, probable or suspect cases of COVID-19. The guidelines are regularly updated. There are some differences in the testing guidelines in different states and territories. You can find links to advice from each state and territory health department in our resources section.

Some hospitals and healthcare facilities are undertaking random testing. From a work health and safety perspective, it will generally be a reasonable requirement for you to participate in random testing.

If you are unwell, you should consider seeking medical advice and should undertake a COVID-19 test if recommended.

While awaiting your COVID-19 test results, you should not work and should self-isolate. If you are being released from isolation including if you are a confirmed case, testing will be required before you are allowed to return to work in healthcare.

A: You should not swab yourself.

The Medical Board’s Good medical practice: a code of conduct for doctors in Australia says that you should seek independent, objective advice when you need medical care, and being aware of the risks of self-diagnosis and self-treatment.

A: Some student placements have been paused or cancelled as health service providers prepare for the pandemic. Depending on the severity of the pandemic, students may need to provide assistance to the workforce in response to the pandemic.

The Australian Government, through the health and education portfolios, Ahpra, National Boards and accreditation authorities, are encouraging student placements to continue where it is safe and possible. To address this, they have set out national principles to guide the decisions of professions, accreditation authorities, education providers and health services about student clinical education during the pandemic response.

A: Colleges understand that COVID-19 may impact training and are implementing measures to reduce the impact where possible. You should check with your college for specific information.

Australasian College of Dermatologists
Australasian College for Emergency Medicine
Australian College of Rural and Remote Medicine
Australian and New Zealand College of Anaesthetists
Royal Australian College of General Practitioners
Royal Australian College of Medical Administrators
Royal Australasian College of Physicians
Royal Australasian College of Surgeons
Royal Australian and New Zealand College of Ophthalmologists
Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Royal Australian and New Zealand College of Psychiatrists
Royal Australian and New Zealand College of Radiologists
Royal College of Pathologists of Australasia

A: If your employer asks you to work in another role, you should speak with your Training Supervisor, or discuss with the training division of your college. It may be that you are able to fulfil some of your training requirements whilst in the alternative role.

A: As an employee, you are required to comply with the lawful and reasonable directions of your employer. If a direction is not lawful and reasonable, you are not required to comply with it.

Lawful: A direction is lawful if you can comply with it without breaching any laws. This would include the laws regarding your registration and professional indemnity insurance.

Reasonable: There is no single test to determine whether a direction is reasonable. The reasonableness of a direction will depend on a range of factors. In the case of a direction to work in a role outside your chosen specialty, you should consider issues such as:

• Do you have the relevant (and current) skills and experience needed to work in the role?
• Will appropriate supervision be provided?
• Will you be able to ensure patient safety in the role?
• Can you perform the role safely, particularly if you are a vulnerable healthcare worker?
• Will the hospital provide the appropriate resources (including PPE) for you to work safely in the role?
• Will the hospital provide the relevant training you need to be able to work in the role?
• Will you be indemnified for your work in the role?

If the answer to any of these questions is “no”, the requirement for you to work in the role may be unreasonable.

If you are concerned about being redeployed to a new role, you should speak to your Training Supervisor in the first instance, or your training college. It is important to remember that in your new role, you will need to have supervision in areas that you cannot work independently, and access to senior advice as you would in your normal scope of practice.

A: The General Practice colleges have advised that GP registrars should expect to be provided with the same level of supervision and support as required under the relevant college’s training standards. Patient and registrar safety remain key.

You should contact your relevant regional training organisation for more information on managing remote supervision.

A: Many interns are at the coal face of the COVID-19 pandemic, which may impact their training. In recognition of this, the Medical Board of Australia (the Board), have made changes to the internship requirements, which will ease the pressure during this period.

Rotation requirements waived

On 3 April 2020, the Board announced it will waive the usual rotation requirements in general, surgery and emergency medicine for interns in 2020.

To apply for general registration, the Board will accept the following supervised clinical experience:

• at least 40 weeks full-time equivalent service (reduced by seven weeks to allow for isolation/sick leave etc.)
• clinical experience in accredited and non-accredited positions.
• any experience you have already gained in supervised rotations will be accepted.

At the end of your internship

Once you have completed your internship year, the Board will accept a report that you performed satisfactorily from the Director of Medical Services, Director of Training or another person who is authorised to sign off your intern reports.

Substantial experience and time missed

If the level of clinical experience or time you miss is substantial, and you are unable to meet the learning outcome requirements, you may need to complete more clinical experience once the pandemic is less acute.

Employer responsibilities

During this period, your employer must continue to supervise and provide you with as much meaningful educational clinical experiences as possible. They must also continue to teach and support you during this challenging and difficult time.

For further support, view our key support services for doctors’ health and wellbeing and access expert advice via email: nca@avant.org.au or call our Medico-legal Advisory Service available after hours and weekends in emergencies.

A: Avant is offering a range of options on indemnity policy premiums, to members whose incomes have been impacted due to COVID-19. Each member will have their own unique circumstances and we are offering solutions that best meet individual needs, which can include:

✓ Premium adjustments for reduced billings for eligible members

✓ Transfer to an Absentee category for eligible members unable to practice with medical indemnity premiums waived until practice resumes

✓ A range of installment options, including monthly payment options

For members or practices who are experiencing significant financial hardship and are not able to meet payments, Avant may be able to assist you.

Please contact us on 1800 128 268 to discuss how we can support you.

A: Medical indemnity insurance premiums are based on several factors. Your annualised billings is one of these factors. If these have changed significantly from what is noted in your current policy documents, we can amend them which could reduce your premium. Please call us on 1800 128 268 to discuss possible changes.

A: Yes. However, if you have stopped all practice of medicine, you may be eligible to change your category of practice to Absentee. This category continues to provide you with cover for claims against you that relate to your prior medical practice but does not provide cover for any current healthcare that you provide. The premium for Absentee cover is $200 for any period up to 12 months. You should only consider changing your policy to Absentee if you plan to stop all medical practice. You will need to notify us prior to returning to your practice to arrange appropriate cover.

A: Businesses affected by coronavirus (COVID-19) can apply for the JobKeeper Payment, a wage subsidy from the Federal Government, to continue paying their employees.

The JobKeeper Payment scheme is administered by the Australian Taxation Office (ATO) and ends on 27 September 2020. Employers can enrol for the JobKeeper payment here.

For more information, visit the ATO’s website and the AMA’s website.