• COVID-19: General: FAQs

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  • COVID-19: Face masks/coverings


    • As a doctor, you do not have to provide medical services (even in an emergency) if there is a risk to the health and safety of you, your practice staff or your patients. We recommend you assess the nature of the risk and only refuse treatment if it is reasonably necessary to ensure health and safety.

        According to the Medical Board’s Good medical practice: a code of conduct for doctors in Australia, treating patients in emergencies requires you to consider a range of issues in addition to the patient’s best care:
      • your own safety
      • your skills
      • availability of other options
      • impact on any other patients under your care
      • providing that assistance until your service is no longer required.

    • Work health and safety laws require medical practices to implement control measures to eliminate or minimise the risks of COVID-19 and ensure the health and safety of their workers, patients and others at the workplace.

      This involves undertaking a risk assessment in conjunction with your workers and determining the control measures that are necessary based on that risk assessment.

        In undertaking a risk assessment to determine whether patients must wear face masks/coverings while at work, your practice should consider the following factors:
      • current public health directions
      • advice from state and federal health departments
      • advice from work health and safety bodies
      • rate of community transmission
      • risk of transmission in the particular workplace
      • nature of the services provided
      • consequences of refusing access to the medical service
      • type of patients who use the medical service and whether there is a heightened risk they will suffer severe symptoms if they contract COVID-19 (for example, patients over 60 or patients with pre-existing health conditions)
      • whether the business could put alternative measures in place to protect staff and patients
      • the practice’s COVID-Safe plan
      • how long patients generally stay inside the medical practice when receiving medical services
      • whether it is possible to socially distance in the practice
      • availability of face masks (ideally, you should make them available at your practice for those patients who do not have them).

      If your risk assessment identifies that face masks/coverings are a necessary measure to ensure health and safety, you can require patients to wear a face mask/covering in your practice (unless doing so would amount to unlawful discrimination).


    • We have identified three scenarios you may be faced with when a patient refuses to wear a face mask/covering and provide some recommendations on how to manage these situations.

      Scenario 1: Your patient says: “I object to wearing a face mask/covering.”

      If a patient has provided no reason for refusing to wear a face mask/covering, you can lawfully refuse the patient entry to your practice.

      We recommend that you consider other ways of providing a medical service to the patient (for example, via telehealth) to minimise the risk of a complaint.

      Scenario 2: Your patient says: “I am not required to wear a face mask/covering because I have an exemption.”

      You can ask the patient why they are exempt from wearing a mask.

      If they do not provide a reason, you can lawfully refuse the patient entry to your practice.

      We recommend that you consider other ways of providing a medical service to the patient (for example, via telehealth) to minimise the risk of a complaint.

      For example, you can say to the patient:

      It is not my role to enforce the public health direction about wearing masks. That is a matter for the police.

      It is my role to comply with work health and safety laws and to ensure the health and safety of staff and patients in this practice.

      It is also my role to ensure that patients are not discriminated against on the ground of certain attributes. You have not disclosed to me that you have an attribute, so I am not discriminating against you on the ground of an attribute.

      The Privacy Act does not prevent me from asking you why you are exempt from wearing a face mask/covering. You are not required to provide personal information in response to my query but if you do not disclose to me that you have an attribute, I will not be discriminating against you on the basis of an attribute.

      Scenario 3: Your patient says: “I am not required to wear a face mask/covering because I have a medical condition/other attribute.”

      The patient could allege that the practice has discriminated against them on the ground of their medical condition or attribute if the practice refuses the patient entry to the practice.

      As a first step, you should explain to the patient why the practice requires all patients to wear a face mask/covering and try to negotiate an alternative to the patient being seen face to face in the practice (for example, appointment via telehealth, treatment in the car park or treatment at the practice after hours).

      If the patient continues to insist that they must be seen face to face in your practice but your risk assessment has determined that would be a significant risk to health and safety, you should consider whether there are any other ways you could safely provide treatment. If not, you can refer the patient to other local clinics for treatment.


    • This is a complex issue from a legal perspective, so we suggest you adopt the following approach:

      Step 1: Speak with your staff

      We suggest you start by talking with your staff and addressing their concerns.

      Step 2: Check the current public health directions in your state or territory

      In most cases, it is each person’s responsibility to wear a face mask/covering unless a relevant exemption applies. The public health direction can only be enforced by the police.

      Your practice does not have to enforce the public health direction.

      In some states and territories, the public health directions require businesses to ensure their workers are wearing a face mask/covering while at work (subject to certain exemptions). Businesses are committing an offence if they do not comply with the direction.

      For more information, please see our COVID-19 Resources: State and Territory page.

      Step 3: Ensure you are complying with work health and safety obligations

      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.

      This involves undertaking a risk assessment in conjunction with your workers and determining the control measures that are necessary based on that risk assessment.

        In undertaking a risk assessment to determine whether workers must wear face masks/coverings while at work, your practice should consider the following factors:
      • current public health directions
      • advice from state and federal health departments (consider any guidance about PPE requirements in medical practices)
      • advice from work health and safety bodies
      • ate of community transmission
      • risk of transmission in the particular workplace
      • nature of the services provided
      • consequences of refusing access to the medical service
      • type of people who use the medical service and whether there is a heightened risk they will suffer severe symptoms if they contract COVID-19 (for example, people over 60 or people with pre-existing health conditions)
      • whether the business could put alternative measures in place to protect staff and patients.
      • the practice’s COVID-Safe plan
      • how long people generally stay inside the medical practice when receiving medical services
      • whether it is possible to socially distance in the practice.
      • availability of face masks.
      • whether staff can be re-deployed to safe jobs or work in other ways that keep them safe (for example, working from home).

      If the risk assessment concludes that a COVID-19 vaccination is a necessary measure to ensure health and safety in the workplace, you can require staff to be vaccinated using a reasonable and lawful direction. If your staff fail to comply with a reasonable and lawful direction, you can take disciplinary action including termination of employment.

      Your practice should review and update its risk assessment as circumstances change.

      Step 4: Ensure you are not discriminating against an employee

      It is unlawful for a medical practice to discriminate against workers on grounds including a medical condition or the employee’s age.

      If an employee refuses to wear a face mask/covering for a reason that might constitute unlawful discrimination, the practice should seek specific advice.

      Step 5: You are entitled to give an employee a “reasonable and lawful direction”

      If the practice’s risk assessment determines that face masks/coverings are required in the practice to keep workers and others safe, the practice can issue a reasonable and lawful direction to employees to wear a face mask/covering in the workplace.

      An employee’s failure to comply with a reasonable and lawful direction can result in disciplinary action.

      As an employer, you must have regard to an employee’s reason for not wishing to wear a face mask/covering before taking disciplinary action.

      Step 6: Managing contracted doctors

      You should check the doctor’s services agreement to see if the doctor is required to comply with practice policies and procedures. If so, you can require the contracted doctor to comply with the policy about wearing a face mask/covering.

      If there is no requirement or the doctor continues to object, you should seek specific advice.

      It is unlawful to discriminate against contracted doctors in the provision of practice management services. If a contracted doctor refuses to wear a face mask/covering for a reason that might constitute unlawful discrimination, the practice should seek specific advice.


    • On 22 July 2021, the NSW Government issued a public health order that requires people who cannot wear face masks /coverings due to a medical condition or disability to:
      • carry evidence that they have a physical or mental health illness or condition, or disability, that makes wearing a fitted face covering unsuitable.
      • produce that evidence if requested to do so by a police officer.

      Either a registered health practitioner or registered NDIS provider can provide this evidence.

      Alternatively, the person can sign a statutory declaration, which does not require input from a doctor.

      As a medical practitioner, you can provide a medical certificate or other written evidence if satisfied of the following:
      • the person has a physical or mental health illness or condition, or a disability
      • this illness, condition or disability makes wearing a fitted face covering unsuitable.

      Examples of conditions making a face covering unsuitable include:
      • a skin condition
      • an intellectual disability
      • autism
      • trauma.

      When you are asked to provide a certificate, you should:
      • weigh up (and document) the basis for giving the certificate against the potential harm of spreading or contracting COVID-19.
      • bear in mind that it is a clinical decision as to whether a person’s condition makes wearing a face mask unsuitable.
      • be mindful of your obligations under the Medical Board’s Good Medical Practice: a code of conduct for doctors in Australia, which says you should only sign documents you believe to be accurate.

      Some of the factors we suggest you consider are:
      • Does the patient have an illness, condition or disability which makes wearing a fitted face covering unsuitable at all times, or only at certain times (for example, when they are actually experiencing symptoms of breathing difficulty as opposed to having well controlled asthma)?
      • Do organisations such as the Lung Foundation Australia have advice about the use of face masks/coverings that can be given to the patient if appropriate?

      It is not clear from the public health order whether the certificate must specify the person’s medical condition or simply state that the person has a relevant medical condition. We recommend that you obtain the patient’s consent before you document the specific medical condition for providing the exemption (eg asthma / COPD) in the certificate.

      If the patient does not consent to you specifying the medical condition, you can simply state they have a “physical or mental health illness or condition, or a disability”. However, you should inform the patient there is a risk the certificate will not be accepted.

      You should also advise the patient about the risks of not wearing a face mask/covering (both in terms of contracting and spreading COVID-19) so it is clear they are making an informed decision. This doesn’t have to be included in the letter if it is documented in the medical records but could also be included if you wish. Here is a template letter that you may wish to use in your practice.

      To whom it may concern

      [insert name of patient] has requested confirmation of their physical or mental health illness or condition, or disability for the purpose of seeking an exemption from wearing a fitted face covering.

      I assessed [insert name] who lives at [insert address] on [insert date].

      The purpose of this letter is to confirm [insert name] has [insert details of the specific medical condition if consent obtained, or insert the words “physical or mental health illness or condition, or a disability” if consent not given] 

      This condition makes wearing a fitted face covering unsuitable.

      I have explained the benefits of wearing a face covering to reduce the risk of contracting and spreading COVID-19, as well as the risks of not doing so.

      [Name]
      [Title]
      [Organisation / Health Service]
      [Signature]

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    COVID-19: Telehealth


    • MBS telehealth items introduced on a temporary basis in response to the COVID-19 pandemic are now permanent. There are some changes to individual item numbers.

      There are no changes to the MBS schedule fees for the items that are continuing from 1 January 2022, and rebates for equivalent face-to-face, video and telephone services are unchanged.

      This is a summary of the main changes:

      • A new extended telephone consultation item for attendances 20 minutes or longer for patients in rural and remote communities (Modified Monash 6 and 7 regions) is introduced.
      • The COVID-19 GP ‘hotspot’ telephone items for consultations longer than 20 minutes ceases.
      • Patients who are subject to COVID-19 public health orders requiring isolation or quarantine will continue to have unrestricted access to MBS telehealth services, without needing to demonstrate an established clinical relationship with their telehealth provider.
      • Specific GP nicotine and smoking cessation services including telehealth are extended to 31 December 2023. GP sexual and reproductive health services and non-directive pregnancy support counselling are extended to 30 June 2023. These services do not require an established clinical relationship when provided by telehealth.
      • MBS telehealth items will be included in the calculation of Practice Incentives Program (PIP) and the Workforce Incentive Program - Practice Stream (WIP) payments.
      • Superseded pre-COVID telehealth and associated items will be removed from the MBS to avoid multiple different MBS items for the same service. This includes GP and OMP mental health consultations and general attendances by video. GP and OMP patient-end support items linked to pre-COVID medical specialist and consultant physician telehealth services are no longer available from 1 January 2021.
      • Nurse practitioner, midwifery, nursing and other allied health telehealth consultations continue without change, with the exception of patient-end support services by nurse practitioners and midwives linked to pre-COVID medical specialist and consultant physician.

      Proposed changes to update Medicare compliance rules to include telephone and video services in the prescribed pattern of practice (the 80/20 rule), with a new ‘30/20’ rule for GP and Physician telephone services have now been deferred to start on 1 July 2022.  

      See the Department of Health fact sheets for more details:  MBS online - MBS Telehealth Services from 1 January 2022


    • It remains a legislative requirement in the permanent telehealth items that GPs and other medical practitioners working in general practice can only perform a video or telephone service where they have an ‘established relationship’ with the patient, unless a specific exemption applies.

      Private billing arrangements can still be made for telehealth consultations with appropriate informed financial consent.

      An established relationship means the medical practitioner performing the service:

      • has provided at least one face-to-face service to the patient in the 12 months preceding the telehealth attendance; or
      • is located at a medical practice where the patient has had at least one face-to-face service arranged by that practice in the 12 months preceding the telehealth attendance (including services performed by another doctor located at the practice, or a service performed by another health professional located at the practice, such as a practice nurse or Aboriginal and Torres Strait Islander health worker); or
      • is a participant in the Approved Medical Deputising Service program, and the Approved Medical Deputising Service provider employing the medical practitioner has a formal agreement with a medical practice that has provided at least one face-to-face service to the patient in the 12 months preceding the telehealth attendance.

      The established relationship requirement does not apply to:

      • children under the age of 12 months;
      • people who are homeless;
      • patients receiving an urgent after-hours (unsociable hours) service; or
      • patients of medical practitioners at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service; or
      • people isolating because of a COVID-related state or territory public health order, or in COVID-19 quarantine because of a State or Territory public health order.
      • AND patients accessing specific MBS items for:
        • blood borne viruses, sexual or reproductive health consultations; and
        • pregnancy counselling services;
        • mental health services; and
        • nicotine and smoking cessation counselling.
         

      A patient’s participation in a previous telehealth consultation does not constitute a face-to-face service for the purposes of ongoing telehealth eligibility.

      There is no exemption for circumstances where a general practitioner is isolating or in quarantine themselves.

      You should confirm that patients have received an eligible face-to-face attendance in the preceding 12 months, or meet one or more of the relevant exemption criteria for the service, prior to providing a telehealth attendance. Failure to meet the established relationship requirement may result in incorrect claiming.

      Some common scenarios* include:

      Q: You saw patient X at practice A 10 months ago. Can you provide a telehealth consultation for them from practice B?

      A: Yes, as patient X has had a face-to-face consultation with you in the past 12 months.

      Q: You saw patient X in June 2020 at your practice and you saw them again in January 2021 via telehealth. It is now July 2021 and patient X wants to book a telehealth consultation. Can you provide one?

      A: As patient X has NOT had a face-to-face consultation with you in the past 12 months, they will need to see you again in person before you can bill Medicare for further telehealth consultations. The patient can choose to pay privately for a telehealth consultation in this situation, but you must advise them in advance that they will not receive a Medicare rebate. (This does not apply if there is an exemption as outlined above.)

      Q: Patient X attended practice A 10 months ago and saw another GP, but you weren’t working at practice A at that time. Can you now provide patient X with a telehealth consultation?

      A: Yes, as patient X has had a face-to-face consultation with a GP at practice A within the last 12 months.

      Q: You have had regular telehealth consultations with patient X over the past four months since the pandemic started, developing a good clinical relationship, but you have not yet seen them in person and they have never attended your practice in person in the past. Can you continue to provide telehealth consultations?

      A: No, patient X needs to see you in person before you can continue to provide and bill Medicare for any telehealth consultations. Alternatively, patient X will need to arrange a telehealth consultation with a doctor at their former practice if they attended there in person within the last 12 months. (This does not apply if there is an exemption as outlined above.)

      Q: You saw patient X in her home/nursing home within the last year but otherwise we have had telehealth consultations due to her vulnerability to COVID-19. Can you continue with the telehealth consultations?

      A: Yes, you have had a personal attendance with patient X in the past 12 months.

      Q: Patient X is a new patient. She is unwell and doesn’t want to come into the clinic for fear of contracting COVID-19 as her husband is immunocompromised. You are unable to do a home visit. Can you see her via a telehealth consultation given her anxiety and medical condition?

      A: These reasons do not fall within the exemptions listed above. The patient will need to come and see you face-to-face or attend the hospital or contact her old practice to see if they will do a telehealth consultation if she can’t get in to see you. You have the option of doing a telehealth consultation and privately billing the patient with informed financial consent.

      *These scenarios are based on the assumption that the consultations are not covered by the telehealth items applicable to GPs prior to COVID-19.

      Further information

      MBS changes:

       

    • 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.

      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.


    • 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 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 and 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

      Dear (patient),

      Details of the telehealth consultation to be claimed with Medicare:

      Item number: …. Benefit amount: $

      Date and time of consultation: ……2020 …. am

      Patient name: …

      Provider name: …

      Agreement

      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 wording:

      Yes, I agree to the assignment of the Medicare benefit directly to the provider your (the patient's) name or the name of parent or guardian (where a child is the patient and unable to sign).

      Regards,

      Dr …

      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.


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


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

      Health practitioners providing telehealth services are not required to bulk-bill their patients.

      Bulk billed GP and OMP telehealth services are eligible for incentive payments when provided to Commonwealth concession card holders and children under 16 years of age.

      Where the services are not bulk billed, an additional charge may be rendered subject to obtaining informed financial consent from the patient.


    • 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 being 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 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.

      Example Email Agreement – Privately Billed Telehealth Consultation

      Dear,

       

      Details of the telehealth consultation to be privately billed and paid:

       

      Date and time of consultation: … 2020 … am

       

      Patient name: …

       

      Provider name: …

       

      Cost of consultation: …

       

      Amount of Medicare rebate [if any]: …

       

      Agreement

      If you (the patient) agree to this payment for the telehealth consultation please reply to this email including the following wording:

       

      Yes, I agree to pay for the telehealth consultation on …………… 2020.

      [If a Medicare rebate is payable]

      I acknowledge that I will have to pay out of pocket costs of [$X]and that I will receive a Medicare rebate of [$X]

       

      [if no Medicare rebate is payable]

      I acknowledge that there is no Medicare rebate available for this consultation.

       

       

      your (the patient's) name or the name of parent or guardian (where a child is the patient and unable to sign).

       

      Regards,

      Dr …

       

      Privacy note: Your personal information is protected by law, including the Privacy Act 1988. You can get more information about the way in which we manage your personal information by reviewing our privacy policy


    • 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

      Australian Digital Health Agency Using Online Conferencing Technologies Securely

      The Australian Cyber Security Centre

      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).


    • 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.


    • 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 healthcare.

      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.

      Good medical practice: a code of conduct for doctors in Australia 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.

    • The existing prescribed pattern of practice (80/20 rule) applies to all GP consultation types from 1 July 2022. This means any GP who provides more than a combined 80 services by face-to-face, video or telephone on 20 or more days in a 12-month period will be referred to the Professional Services Review (PSR).

      This rule did not apply to the temporary COVID-19 telehealth items. The start date for this change has been deferred to 1 July 2022 in view of the high rate of COVID-19 cases in the community.

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    COVID-19: Medical certificates


    • The requirement for a person to wear a face covering varies between states and territories and can even vary within a state or territory depending on local community transmission. You should check the current public health directions that apply in your location for the current requirements.

      We can provide the following general information:

      • An exemption certificate from a medical practitioner is generally not required to rely on the exemption but can be useful evidence if a person is questioned about his or her failure to wear a face covering.
      • In some states, a police officer or authorised officer can require evidence of a medical condition which prevents a person from wearing a mask (for example, Northern Territory).
      • You will need to exercise your clinical discretion to determine if the requirement for an exemption under your relevant state/territory public health direction is met. In considering whether to write an exemption certificate, you should carefully weigh up (and document) the basis for giving the exemption against the potential harm of spreading or contracting COVID-19. It is a clinical decision as to whether someone will suffer harm by having to cover their face.

      As with any medical certificate, you need to be mindful of your obligations under the Medical Board’s Good Medical Practice: a code of conduct for doctors in Australia, which says you should only sign documents you believe to be accurate.

      Read our article on this topic.


    • The only type of ‘certification’ a doctor can provide is to the effect that, on the day of assessment, the patient advised they were symptom-free (this relies on a patient history and the patient being honest) and exhibited no clinical features to indicate a viral infection or other symptoms that have been reported with COVID-19. If the patient has had a positive COVID-19 swab, the public health unit must be involved in decisions about when the patient is no longer considered infectious.

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


    • We have received calls from doctors who have been asked to write medical certificates for school students for a range of reasons, including that the student is a vulnerable person, the student lives with a vulnerable person or the student’s parents are concerned about the general risks of COVID-19.

      In Australia, schooling is compulsory for children who are 6 to 17 years old unless an exemption applies (for example, leaving school at 15 to undertake an apprenticeship) or the parent has a reasonable excuse for the child’s non-attendance (as determined by the school’s principal).

      A child’s parents have a legal obligation to ensure their child attends school and can be charged with an offence if the child does not.

      It is generally a reasonable excuse for a child not to attend school if the child is sick or has to attend a medical appointment. A school principal can require medical certification to be satisfied that a reasonable excuse exists.

      In states and territories where Australian schools have fully re-opened, school attendance is expected unless the child has a reasonable excuse.

      It is important to consider the current medical evidence before writing a medical certificate for a child.

      If you are asked to write a medical certificate, you will need to consider whether the child is unfit to attend school due to a medical condition or at a greater risk of contracting COVID-19 or becoming very ill from COVID-19 as a result of their medical condition, or whether the child is likely to transmit COVID-19 to a vulnerable family member.

      For more information see NSW Health and Don’t Forget the Bubbles.


    • The 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. You can find further information here.

      The CDNA guidelines provide further information about the definition of a COVID-19 death.

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    COVID-19: Practice management


    • The Public Health (COVID-19 Gathering Restrictions) Order (No 2) 2021 came into effect on 12 July 2021.

      As a result, all people (other than patients) who enter your practice must provide their contact details electronically. This includes both staff and people attending with a patient.

      Your practice must facilitate this by providing a NSW Government QR code or an alternative digital sign-in sheet for those who do not have a smart phone or are unable to sign-in using the NSW Government QR code.
      This will allow people (other than patients) entering the practice to register their contact information.

        Medical practices must take “reasonable steps” to ensure everyone complies with the requirement to check in. The NSW Government has provided the following examples of “reasonable steps”:
      • display your QR codes in prominent locations
      • remind people to check-in when entering your premises
      • where possible, keep an eye out for new people who have entered your premises
      • ask to see the ‘green tick’ on the Service NSW app and check it relates to your premises.

    • Some premises require a person’s temperature to be measured before allowing access (for example, employees, patients and customers).

      You can only take a person’s temperature with their consent.

      If testing is used for screening for access to the practice, you should have a protocol about temperature testing which includes what will happen if a person’s temperature is above the required temperature or a person refuses to have their temperature taken.

      You should consider whether employees with a high temperature will be paid sick leave.

      You also need to ensure compliance with the privacy laws in respect of information about a person’s temperature.

      The current advice is that temperature testing may be appropriate in high-risk settings such as medical practices but may not be appropriate in other settings. For example, see advice from the Department of Health, Safe Work Australia and Fair Work Ombudsman.

      In some states and territories, public health directions require temperature testing before entry into residential aged care facilities and other places.


    • 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 employer 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 personal/carers leave. The employee can take other forms of paid leave if they run out of paid personal/carers leave.

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

      The following awards include an entitlement to unpaid pandemic leave if an employee is required to self-isolate:

      The new clause (which is Schedule X to the above awards) operates from 8 April 2020 until 31 December 2021.

      Further information about pandemic leave is available on the Fair Work Ombudsman website.

      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.

      4. Government benefits

      Government benefits may be available to employees who are unable to work and not entitled to payment from their employer.


    • 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 public health unit.


    • Sometimes a person’s temperature is measured before allowing access to premises (for example, employees, patients and customers).

      You can only take a person’s temperature with their consent. If testing is used for screening for access to the practice, you should have a protocol about temperature testing which includes what will happen if a person’s temperature is above the required temperature or a person refuses to have their temperature taken. You should consider whether employees with a high temperature will be paid sick leave.

      You should ensure compliance with the privacy laws in respect of information about a person’s temperature.

      The current advice is that temperature testing may be appropriate in high-risk settings such as medical practices but may not be appropriate in other settings. For example, see advice from the Department of HealthSafe Work Australia and Safe Work NSW.

      In some states and territories, public health directions require temperature testing before entry into residential aged care facilities and other places.


    • This will depend on where your practice is located. The requirement for a person to wear a face covering or mask varies between states and territories and can even vary within a state or territory depending on local community transmission. You should check the current public health directions that apply in your location for the current requirements. For more information, please see our COVID-19 Resources: State and Territory page.

      For PPE factsheets, please visit the Department of Health’s website.

      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. Each situation needs to be assessed to ensure reception staff are kept safe and protected.

      In areas of high community transmission, Safe Work Australia recommends that employers undertake a new risk assessment when new risks arise. Read our article on this topic.


    • The requirement for a person to wear a face covering varies between states and territories and can even vary within a state or territory depending on local community transmission. You should check the current public health directions that apply in your location for the current requirements.

      In areas where face coverings are not mandatory, the current advice is that wearing a mask can help protect you and those around you if you are in an area with community transmission, and physical distancing is not possible, like on public transport.

      As an occupier of a private medical practice you are entitled to take reasonable steps to protect your staff and patients on the premises. You can make it a condition of entry that a person wear a face covering on arrival at the practice, unless they have a lawful reason not to wear a face covering or wearing a face mask would be discriminatory.

      In these situations, we recommend that you speak with a patient about their reason for not wearing a face covering before you exclude the patient from your premises. If the patient has a reasonable explanation (for example, a medical condition which prevents them from wearing a face covering safely), you should consider what other risk management strategies you can adopt to keep everyone safe. For example, you might consider asking patients who are not able to wear a mask to sit in a room other than the waiting room.

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    COVID-19: Employment


    • The requirements about working at more than one health facility vary between states and territories, and between the type of facility. You should check the current public health directions that apply in your state or territory for the current requirements.

      It is good practice for healthcare facilities to maintain a register of other healthcare facilities where staff are working.


    • 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 and guidance about using PPE in hospitals and non-inpatient settings.


    • If face coverings are mandatory or recommended in your location, you can generally use your own face covering while transiting to and from work, and while in communal areas such as cafeterias.

      The Department of Health and the state and territory health departments have provided advice about the PPE required when testing or treating confirmed or suspected cases. Some hospitals have also provided advice about the PPE that is recommended.

      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.


    • You should check the award and/or enterprise agreement that applies to your employment as many include requirements about redeployment or alternate duties (for example, clause 22 of the AMA Victoria - Victorian Public Health Sector - Doctors in Training Enterprise Agreement 2018-2021).

      Otherwise, 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.


    • 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.

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    COVID-19: Patient testing and treatment


    • 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.

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