Yes.

The Australian Technical Advisory Group on Immunisation (ATAGI) statement on revised recommendations on the use of the COVID-19 AstraZeneca vaccine in response to new vaccine safety concerns (dated 18 June 2021) states that the Pfizer vaccine is preferred over the AstraZeneca vaccine for adults under the age of 60.

However, ATAGI have also issued subsequent statements about the use of COVID-19 vaccines in an outbreak setting and the NSW outbreak in July 2021. These statements provide additional guidance on the benefits, risks and vaccine brand availability when outbreaks are occurring.

Any discussion surrounding the risks and benefits of any medical management, including COVID-19 vaccination, should be documented in each patient’s medical record.

You may also wish to view the Avant FAQs about indemnity cover for providing COVID-19 vaccinations.

Yes.

The ATAGI statement on revised recommendations on the use of the COVID-19 AstraZeneca vaccine in response to new vaccine safety concerns (dated 17 June 2021) recommends that people who have had the first dose of the COVID-19 AstraZeneca vaccine without any serious adverse effects can be given the second dose.

On 17 June 2021, ATAGI have stated that the Pfizer vaccine is the preferred vaccine for people aged 16 to 59.

You should discuss with your patient what the options are for vaccination and the relative benefits and risks of those options, relevant to the patient’s individual circumstances.

You should also consider the ATAGI statements about the use of COVID-19 vaccines in an outbreak setting and the NSW outbreak in July 2021. These statements give additional guidance in relation to the benefits, risks and vaccine brand availability when outbreaks are occurring.

Your discussion should include the risks of thrombosis with thrombocytopaenia syndrome (TTS).

You may also wish to explain to your patient that you cannot give them definitive advice on when Pfizer (or Moderna) will be available to them, as well as what the prevalence of COVID-19 will be in the future.

You should document all discussions in your records.

The answer to this question is complex.

Your practice may decide that it will have a policy of not offering the AstraZeneca vaccine to patients under the age of 60. This policy will need to be clearly documented and communicated to patients.

Any discussion surrounding the risks and benefits of any medical management, including COVID-19 vaccination, should be documented in each patient’s medical record.

You should also consider the ATAGI statements about the use of COVID-19 vaccines in an outbreak setting and the NSW outbreak in July 2021. These statements give additional guidance in relation to the benefits, risks and vaccine brand availability when outbreaks are occurring.

The Australian Government Department of Health recommends that when you advise patients, including about the risk of TTS, you include the information in the Department of Health’s Consent form for COVID-19 vaccination and Patient Information Sheet on AstraZeneca COVID-19 vaccine and TTS.

You will need to have mechanisms in place to refer patients under the age of 60 who would still like to receive the AstraZeneca vaccine.

For example, you could direct them to the Vaccine Eligibility Checker. If they are eligible to receive the vaccine, it will take them to the Vaccine Clinic Finder where they may be able to locate a clinic that will assist them. The Department of Health has also advised it will provide further information about access to the Pfizer vaccine as an alternative for these patients.

You may also direct them to state/territory vaccination services.

It has been widely reported that with the current strain(s) of COVID-19, the AstraZeneca vaccine has minimal efficacy after the first dose, and that the efficacy after the second dose is reduced if the interval between doses is shortened from the recommended 12 weeks.

ATAGI has recommended a seven-day interval between the COVID-19 vaccine and other vaccines such as the FluVax.

A shorter interval is acceptable in certain circumstances, including when there is increased risk of COVID-19 during an outbreak.

For more information see ATAGI’s advice on seasonal influenza vaccines and COVID-19 vaccines in 2021.

To check whether a patient is eligible for a COVID-19 vaccination, you can use the Australian Government’s COVID-19 Vaccine Eligibility Checker.

Please note that some states are offering the vaccine to other groups, including adults aged under 50. Check the appropriate health department website in your state for details.

No. At present, you should not administer a different brand of vaccine for the second dose.

Some key points:

1. 1. You should not provide any certificate unless you form the clinical opinion that it is appropriate.
2. 2. Specific forms must be issued in some circumstances. They set out the criteria for when an exemption may be granted. For example:
   1. a. entry into the Australian Immunisation Register (Australian Immunisation Register (AIR) - immunisation medical exemption form (IM011) - Services Australia)
   2. b. NSW Government: COVID-19 Vaccine Medical Contraindication
3. 3. Be aware that the states and territories may also introduce other specific requirements.

In order to assess whether it is clinically appropriate to provide a medical certificate granting a COVID-19 vaccination exemption, we suggest you take the following steps.

Step 1: Take a patient history

You should first take the patient’s history, including the patient’s reasons for the request and the context in which they wish to use the certificate.

Step 2: Determine whether it clinically appropriate to provide a certificate

In determining if it is clinically appropriate to provide a certificate, you should have regard to:

Unfortunately, the answer to this question is complex.

To help you navigate this issue and minimise the chances of running into a legal problem, we suggest you consider the following issues before you refuse to treat an unvaccinated patient.

Step 1: Check public health directions in your state and territory

State and territory public health directions do not currently prevent a person from entering a medical practice if the person is not vaccinated against COVID-19. 

Step 2: Obligation to treat a patient

As general rule, a doctor does not have to treat a patient (even in an emergency) if there is a risk to the doctor’s health and safety or the health and safety of other patients under the doctor’s care (see clause 3.5 of Good medical practice: a code of conduct for doctors in Australia).

In NSW, the situation is slightly different because under the Health Practitioner National Law (NSW) it is unsatisfactory professional conduct to refuse or fail to attend a person in need of urgent attention when requested to do so. The exception is when the practitioner has taken all reasonable steps to ensure that another medical practitioner attends instead within a reasonable time.

Step 3: Consider whether not treating a patient could be discrimination

You can refuse to treat an unvaccinated patient except when the patient is unvaccinated for a reason such as:

Consent is more than signing a form. Rather, it is an ongoing process.

Fundamental to the consent process is the discussion you have with your patient..

What is a consent discussion?

A consent discussion should be a shared decision-making process, which aims to understand the patient’s particular situation and concerns, and clarifies their expectations.

You need to give the patient context to understand the potential outcomes (positive, negative or neutral) and what it might mean for them. A patient will give consent to receiving the COVID-19 vaccine on that basis.

Consider the following issues

The Department of Health has confirmed that health professionals are authorised to deliver the vaccine in line with federal and state/territory legislation and requirements (see below as to training requirements).

As a result, the health professional who provides the vaccination can obtain consent from the patient.

It is important to remember that consent is a process, not a form. It is always necessary to ensure the information provided meets the principles stated above.

A doctor can delegate the consent process to an appropriately trained nurse or other authorised healthcare worker. However, under Medicare requirements, the doctor retains responsibility for the administration of the vaccine, and this includes ensuring the consent process is being undertaken appropriately.

For questions about Medicare billing see further below.

There is no legal requirement to use a written consent form for the COVID-19 vaccination. However, your practice or hospital may have a policy that requires a written consent form.

If you wish to use a written consent form, you can modify an existing vaccine consent form or use the template form that has been developed by the Australian Government Department of Health (Department of Health).

If you do not use a written consent form, you should document the consent in the patient’s medical records, as well as the fact you had a consent discussion. It is also good practice to record that you gave an information sheet to the patient. You should also document in the records if a patient declines to have the vaccine.

If you are using a consent form, it is preferable to have an original form signed by the patient.

This will enable you to verify that the form was signed on a particular date and provides evidence that the patient consented to be vaccinated.

However, under Australian law, it is permissible for a patient to sign a consent form electronically. You should ensure you have a record that consent was obtained.

The Department of Health has developed information that includes clinical guidance to enable GPs to have informed discussions with their patients, as well as information sheets for patients.

Practitioners should read the Department of Health’s information carefully and ensure they provide information to patients as outlined in the Department of Health’s material.

Please note that if your patient was not informed of the risk of TTS when they received the first dose of the AstraZeneca vaccine (prior to 8 April 2021), you should obtain a new consent after they have been informed of the risk.

RANZCOG and ATAGI recommend that pregnant women are routinely offered the Pfizer vaccine at any stage of pregnancy. They also advise that the Pfizer vaccine is not thought to be a risk to the breastfeeding infant.

Ultimately, the decision about vaccination rests with the woman based on the available information and their personal circumstances.

The Pfizer vaccine is now provisionally approved by the Therapeutic Goods Administration for administration to children aged 5 to 11 years from 10 January 2022.

The recommended dose is one third of the adult dose and comes in a vial with an orange cap. It is important for vaccination providers to check that every patient is receiving a dose from the correct age-appropriate vial.

ATAGI has advised that the paediatric Pfizer COVID-19 vaccine can be co-administered with other vaccines.

Vaccinators are reminded that they need to complete the paediatric Pfizer training module before they commence the COVID-19 vaccinations program for children aged 5 to 11 years.

For more information see:

ATAGI’s recommendations on Pfizer COVID-19 vaccine for use in children aged 5 to 11 years

Response to ATAGI advice about vaccinating 5 to 11-year-olds against COVID-19 | Australian Government Department of Health

COVID-19 vaccine information and consent form for parents and guardians of children aged 5 to 11 years | Australian Government Department of Health

Each parent has parental responsibility for their child so either parent can provide consent for vaccination, unless there is a parenting order.

A parenting order may be made by a court when parents are no longer together and can allocate responsibility for making decisions about major long-term issues about a child. A decision about vaccination is considered a major long-term issue.

If a parenting order gives sole parental authority to one parent, a decision to vaccinate a child can be made by that parent, subject to any terms in the order to consult with or notify the other parent.

If the parenting order gives sole parental responsibility to the parent requesting the vaccination and there are no terms requiring consultation with the other parent, it is reasonable to proceed with the vaccination based on the consent of that parent.  

If a parenting order gives shared parental responsibility to both parents, a decision to vaccinate a child requires consultation between the parents, and the parents would need to make a genuine effort to come to a decision. If they cannot come to a decision, they need to make an application to the court to resolve their dispute.

There is no legal requirement for a doctor or medical practice to enquire and/or confirm that both parents have consulted about vaccination.

However, if there is a dispute between parents, and one parent makes it known they do not consent to the vaccination, where parents have shared parental responsibility or there are no parenting orders in place it is advisable to delay vaccination of the child until the parents have resolved their dispute over this issue.

The Family Court has put in place a process for parties seeking urgent orders in the COVID-19 List, including vaccination orders. For more information see Family Law Practice Direction – National COVID-19 List | Federal Circuit and Family Court of Australia (fcfcoa.gov.au)

For more information, please refer to our factsheet on Children and consent  and our podcasts on medical records, treatment of children and separated parents.

COVID-19 vaccine information and consent form for parents and guardians of children aged 5 to 11 years | Australian Government Department of Health

A discussion of the risks and benefits of vaccination (and not vaccinating) should occur and be documented. Information provided to parents should reflect what is published by credible sources, including ATAGI.

For more information see ATAGI’s recommendations on Pfizer COVID-19 vaccine for use in children aged 5 to 11 years.

Children aged 5-11 years who have previously had COVID-19 infection can receive the Pfizer vaccine following recovery from their illness or vaccination can be deferred for up to six months. ATAGI has confirmed this includes children with a past history of PIMS-TS or post COVID-19 condition (‘long COVID’).

ATAGI currently recommends the two doses of the Pfizer vaccine be given eight weeks apart.

That interval can be shortened to a minimum of three weeks in the following special circumstances:

ATAGI has recommended that the first dose is the child dose, and the second dose should be an adolescent/adult dose given eight weeks later.

At present, the TGA and ATAGI have not approved or recommended vaccination of children who have not turned 5.

The doses supplied by the Department of Health to vaccine providers are not to be used for this purpose.

It is mandatory for healthcare providers who administer the COVID-19 vaccine to a patient to record details of the vaccination in the AIR.

You cannot force a patient to remain in the practice.

You should treat this like any situation where a patient refuses treatment or discharges themselves against medical advice.

We recommend that you advise the patient why they should stay, and about the risks of leaving, and document this advice in the medical record. Make a note in the patient’s record if the patient leaves contrary to medical advice

If your patient was not informed of the risk of thrombocytopaenia syndrome (TTS)

when they received the first dose of AstraZeneca vaccine (prior to 8 April 2021), you should obtain a new consent after they have been informed of the risk.

As with any course of treatment, if your patient does not complete the course, you should explain the potential outcomes.

You cannot force your patient to have the second dose if they do not wish to have it. We recommend you document your advice and the patient’s decision in their medical record.

Article: Informed consent and communicating information

eLearning course (member only) Consent: informed consent and more

Factsheet: Consent essentials

Factsheet: Children and consent

Factsheet: Capacity essentials

Factsheet: Substitute decision makers

Podcasts: Separated parents – when parents disagree about a child’s treatment

Many doctors and practices will have little or no experience with the use of MDVs. 

The risks include sepsis, transmission of blood-borne infections and dosage errors. 

Tips to minimise these risks include:

For practices participating in the COVID-19 vaccination rollout, there are three types of Medicare item numbers specifically associated with the provision of COVID-19 vaccinations:
• 1 Vaccine Suitability Assessment Services
• 2 In-Depth Patient Assessments
• 3 Flag-Fall Arrangements.

These Medicare items are only available for participating practices.

Vaccinations must be bulk-billed for everyone living in Australia who is Medicare-eligible, including all Australian citizens, permanent residents, and most visa-holders.

Vaccine Suitability Assessment (VSA) Services

The Department of Health has released information about these 16 item numbers.

The services have to be billed in the name of the supervising GP, who must be present at the location at which the service is undertaken (including for the observation time).

The services can be undertaken face-to-face by a suitably qualified health professional. However, the supervising GP must accept full responsibility for the service.

The assessment cannot be done by telehealth.

A supply of the vaccine must be available for immediate administration. However, the item number should be billed if a patient declines the vaccine after the assessment has been performed.

If a patient undergoes a VSA and declines the vaccine at that visit but then returns to have the vaccine on another day, a second VSA can be billed when they return.

In-Depth Patient Assessments

The doctor must attend the patient in person, you cannot delegate this task to anyone else. Please note that you cannot undertake the assessment by telehealth.

Flag-Fall Arrangements

Bulk-billing incentives

Bulk-billing incentives (double for dose one, single for dose two) will be incorporated into the value of the items and will not need to be claimed separately ($10 per dose).

The double payment of the bulk-billing incentive for the first dose is in recognition that some patients will need longer explanations about the vaccine than others.

Where both doses have been provided to the patient by the practice, the practice will be eligible for a PIP incentive of $10 (per patient) on completion of the second dose.

No, it is not permissible under Medicare rules to charge a fee or co-payment for a service that is bulk-billed.

The Department of Health has advised general attendance items cannot be used to triage or screen patients before booking or performing a Vaccine Suitability Assessment.

This means that, for patients who are making bookings to have the vaccine, you cannot routinely book and charge them for a general attendance item first.

You cannot charge any “new patient fee” or similar.

You can only do this if your patient requires a service unrelated to the vaccine. You cannot claim any item other than a VSA, In-depth Assessment or Flag-fall for the administration of the vaccine.

The Department of Health’s prefers that patients presenting with multiple clinical matters be encouraged to book a separate consultation, and preferably with their usual practice. However, there may be some circumstances where deferring treatment is not feasible or in the patient’s best interests. In these situations, standard MBS multiple same-day attendance rules apply.

Your medical record will be important to demonstrate that this is a separate service. We recommend you make detailed notes about each service. The Department of Health recommends that you state: “The additional service [MBS item…] is clinically relevant but not related to the vaccine suitability assessment service [MBS item…].”

The practice must obtain and document the patient’s informed financial consent to ensure that the patient understands there is no cost associated with the COVID-19 vaccine. You must inform patients if any other service that they receive on the same occasion will be bulk-billed or subject to a patient co-payment.

No.

The Department of Health has stated that the new COVID-19 vaccination temporary MBS items have been exempted from the 80/20 rule.

Any general attendance items billed where COVID-19 vaccinations are discussed will still be included in the 80/20 rule.

You can claim other Medicare items numbers when a patient suffers a significant adverse reaction to a vaccine to allow you to provide appropriate treatment.

The Department of Health has confirmed that in situations where doctors at participating practices have a discussion with a patient in relation to their suitability for the vaccine and the vaccine is not available to be given immediately, you can bill general attendance Medicare items.

These general attendances do NOT need to be bulk-billed.

For example, a patient books a normal visit with you and when they arrive they only wish to discuss the vaccine and their suitability, but you do not have a vaccine dose available for them at that time.

All general attendance items will be subject to the 80/20 rule.

However, the Department of Health has advised general attendance items cannot be used to triage or screen patients before booking or performing a Vaccine Suitability Assessment. This means that you cannot routinely book and charge patients who are making bookings to have the vaccine for a general attendance item first. You cannot charge any “new patient fee” or similar.

In circumstances where it is unforeseen that a vaccine is unavailable to be given when a patient attends for a vaccine suitability assessment, the Department of Health has advised that the VSA can be billed at the time and another one can be billed when the patient returns for the vaccine. For example, you may experience a delay due to an unanticipated staff absence. However, valid reasons do NOT include inadequate staff rostering or when there is insufficient supply of vaccine doses.

Yes, however, you cannot charge for this, either to Medicare or by private billing.

You are not expected to provide this service as part of any agreement with the Department of Health.

You may choose to refer patients who are not Medicare-eligible to a state-based vaccine delivery site, to a Commonwealth Vaccination Clinic (previously known as a General Practitioner-led Respiratory Clinic) or to another other clinic as advised by the Department of Health if these facilities are not available. They will not be charged at these clinics.

All practices that are selected as vaccination providers must offer vaccination to people who are not currently patients of the practice. However, practices can certainly encourage their own patients to be vaccinated and can make appointments for those patients.

Doctors at non-participating practices can bill general attendance items for discussions relating to the vaccines. These do not need to be bulk-billed.

Non-participating practices are not able to bill Vaccine Suitability Assessments, In-depth Patient Assessments or Flag-Falls.

The Department of Health has advised that action will be taken for any use of Medicare items that is not in accordance with guidelines and legislation.

In addition to usual Medicare compliance, doctors and practices are being contacted by the National COVID Vaccine Taskforce when complaints have been made about their billing. In some cases, doctors and practices are being required to undertake extensive audits, and to repay considerable amounts to patients or Medicare.

The Taskforce states it may revoke a practice’s participation in the vaccine rollout if necessary.

We recommend that you contact Avant for advice if you are contacted by the National COVID Vaccine Taskforce or Medicare.

Unfortunately, the answer to this question is complex.

To help you navigate this process and minimise the chances of running into a legal problem, we suggest you take the following steps.

Step 1: Ask your patients to comply

As a starting point, you should simply ask patients to provide a recent negative COVID-19 test when they attend the practice. Most patients will be happy to comply.

If a patient refuses to comply, a medical practice can impose a condition of entry on any person entering the practice, provided the practice complies with work health and safety, discrimination and other laws.

For this reason, you should work through Steps 2-5 before you make a final decision to require the patient to provide evidence of a negative COVID-19 test as a condition to entering your practice to receive treatment.

Step 2: Check whether the public health directions in your state mandate a negative COVID-19 test before a person is allowed to attend for medical treatment

If your risk assessment identifies that requiring patients to provide evidence of a negative COVID-19 test before entering your practice is a ‘reasonably necessary’ measure to ensure health and safety, your practice can direct those patients not to attend the practice (unless doing so would amount to unlawful discrimination).

To assess whether using rapid antigen testing could be classified as “reasonably necessary’, please see the Department of Health advice, including the PHLN and CDNA joint statement of SARS-CoV-2 rapid antigen tests.

Step 4: Consider whether refusing entry could amount to discrimination

State and federal legislation prohibits discrimination on the basis of attributes including disability.

The term “disability” is defined differently in each jurisdiction but generally includes the presence in the body of organisms capable of causing illness or disease. COVID-19 would fall into this definition and therefore a person with COVID-19 would be considered a person with a disability for the purposes of discrimination law. A person also has a disability if the person is presumed to have the disability (i.e. the practice presumes that everyone without a negative COVID-19 test has COVID-19).

Step 5: Consider whether the situation is an emergency and you have an obligation to provide medical care

Medical practitioners do not have an absolute obligation to provide medical care to patients, even in an emergency situation.

Unfortunately, the answer to this question is complex.

To help you navigate this issue and minimise the chances of running into a legal problem, we suggest you consider the following issues before you refuse entry to an unvaccinated patient.

Step 1: Check the public health directions in your state and territory

State and territory public health directions do not currently prevent a person from entering a medical practice if the person is not vaccinated against COVID-19. 

Step 2: Obligation to treat a patient

A medical practice does not generally have to allow a person to enter the practice.

Step 3: Consider whether the decision not to treat the patient may be discriminatory

You can refuse to allow an unvaccinated patient to enter your practice except when the patient is not vaccinated for a reason such as:

The patient is responsible for making an appointment for the second dose of the vaccine. Although they are not required to have the second dose of the vaccination at the same practice as the first dose, the Department of Health encourages patients to book both appointments at the same time and return to the same practice for the second dose.

An additional Practice Incentive Payment (PIP) is made when both doses are provided by at the same practice.

If a patient does not book both appointments at the same time, we suggest that you remind them at the first visit to make the appointment for the second dose and offer to make that appointment at the clinic.

If the patient does not attend the practice within the prescribed time for the second dose (e.g. 21 days for the Pfizer vaccine and 12 weeks for the Astra Zeneca vaccine), the practice could send an SMS reminder assuming consent has been provided to communicate via SMS.

Otherwise, we suggest you follow your usual follow-up protocol to recall patients for their second dose.

The Therapeutic Goods Administration is strongly encouraging practices and patients to notify any side effects as part of its role in monitoring the safety of vaccines after they are registered.

For more information on how to report side effects, refer to Reporting suspected side effects associated with a COVID-19 vaccine. It is recommended that you report to your state or territory health department, as they will forward the report to the TGA.

You should notify Avant about serious adverse events that arise in your practice as required under your insurance policies.

Yes. The Department of Health has confirmed that all authorised immunisation providers must have completed the free COVID-19 vaccine specific training to administer the vaccines.

Non-clinical training modules are also required to be completed by non-clinical and administration staff who are involved in vaccine handling, storage and administrative reporting.

There are frequent updates to the content in the training program. You must review these whenever you are advised they are available.

Yes.

However, providing vaccinations in your car park is not something that most practices would be able to set up without significant planning.

ATAGI have issued a statement regarding drive through vaccination clinics. This statement provides extensive guidance, and we recommend that you review and follow this prior to considering providing vaccinations in your practice’s carpark.

The Department of Health has indicated that vaccination with the AstraZeneca vaccine during home visits is possible, as long as either of the following specific procedures are followed:

1. Where possible, you should take a vial to your patient’s home whilst maintaining the cold chain, and draw up the individual dose immediately before administration (process preferred by Department of Health), or

2. A dose may be drawn up into a syringe at your practice for you to take to your patient’s home for administration. If you do this, the syringe must be transported by you at room temperature (under 30 degrees), protected from light and administered within one hour of being drawn up.

See also our FAQs on Medicare and vaccinations above (What Medicare item numbers are available for participating practices to provide the COVID-19 vaccination for patients?), particularly in relation to flag-fall arrangements.

The Department of Health has confirmed that practices will be responsible for appropriately storing and handling the vaccines upon receipt of the vaccine from the Commonwealth’s contracted logistics providers.

The practice is required to report incidents involving lost or broken vials to the Vaccine Operations Centre. More details on the process for reporting incidences and investigation process is provided as part of the Department’s training modules.

Yes.

The Therapeutic Goods Administration has issued guidance about advertising COVID-19 vaccinations.

The TGA, National Boards and Ahpra have also issued a joint statement about promotion of COVID-19 vaccinations, advising practitioners that where promoting COVID-19 vaccines involves advertising of regulated health services, they must continue to comply with the National Boards’ Guidelines for advertising a regulated health service.

If you wish to promote the brand or brands of vaccine are available in your practice:

Unfortunately, the answer to this question is not straightforward and, because the issue is a controversial one, you need to be aware that the law on employers requiring employees to be vaccinated could change at any time.

At present, a privately-owned medical practice may be able to require a healthcare employee to have the COVID-19 vaccine.

The Fair Work Ombudsman (FWO) has released detailed general guidance about mandatory vaccination in the workplace.

If you are a practice, to determine whether you can require a private healthcare employee to have the COVID-19 vaccination, you should consider the guidance that the FWO has provided.

If you are a practitioner, these are the factors that your practice needs to consider in deciding whether to make COVID vaccination mandatory.

In addition, there are laws and regulations on this issue that specifically affect the healthcare sector that you will also need to consider before requiring healthcare employees in your practice have the COVID-19 vaccine.

We suggest you navigate what is a complex legal issue by taking the following steps:

Step 1: Speak with your employees and encourage them to be vaccinated

As a first step, if you are considering requiring your employees to be vaccinated, you should speak with them about vaccination and encourage them to be vaccinated.

You may be able to assist by providing your employees with information about the vaccination and by facilitating time off so they can get vaccinated or by facilitating vaccination at your practice.

If employees refuse, you should consider the following steps.

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

The FWO’s guidance sets out the public health directions and other laws that currently mandate vaccination.

On 18 August 2021, the Federal Government reiterated its position that:

“… vaccination is free and voluntary, unless a state or territory public health order is in place. The Australian Government's position of voluntary vaccination does not detract from individual employers seeking their own advice and mandating for their workforce if they have assessed that it is the right decision for them.”

In many cases, it is the employee’s responsibility to be vaccinated unless a relevant exemption applies. This type of public health direction can only be enforced by the police. Your practice does not have to enforce it. In some states and territories, the public health directions require employers to ensure their employees are vaccinated (subject to certain exemptions). You will commit an offence if you do not comply with the direction.

Step 3: Check awards and enterprise agreements

Awards and enterprise agreements that apply to an employee’s employment may mandate COVID-19 vaccination.

Step 4: Ensure that 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 can be done by undertaking a risk assessment in conjunction with workers and determining the control measures that are necessary based on that risk assessment.

The FWO’s guidance sets out the factors that an employer should consider in undertaking a risk assessment.

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

If the risk assessment concludes that COVID-19 vaccination is a necessary measure, the practice can require employees to be vaccinated.

You can find further information at SafeWork Australia.

Step 5: Ensure that you are not unlawfully discriminating against an employee

Step 6: You are entitled to give an employee a “reasonable and lawful direction”

If the practice’s risk assessment determines that staff vaccination is required in the practice to keep workers and others safe, the practice can issue a reasonable and lawful direction to employees to be vaccinated.

An employee’s failure to comply with a reasonable and lawful direction can result in disciplinary action which may include termination of employment.

As an employer, you must have regard to an employee’s reason for not wishing to be vaccinated before taking disciplinary action (particularly if the reason could be an attribute on which discrimination may be based).

The Fair Work Commission (FWC) recently found that the requirement for an employee to have the flu vaccine was a reasonable and lawful requirement. However, it is important to understand that whether a requirement is reasonable and lawful will depend on the facts of the particular case.

Further information

SafeWork Australia and the Fair Work Ombudsman have issued guidance about mandatory vaccination.

Please see our FAQ - Can a private sector healthcare employee be required to have the COVID-19 vaccine?, which also applies to public sector healthcare employees.

In addition, each state and territory public health system has a policy which explains the mandatory vaccination requirements. These policies explain the possible employment consequences for medical practitioners who do not or cannot have the relevant vaccinations.

If you have a conscientious objection to receiving or administering the COVID-19 vaccine, it is important for you to comply with the joint statement from Ahpra and the National Boards on registered health practitioners and students and COVID-19 vaccination.

A number of states and territories have introduced public health directions which require healthcare workers to undergo mandatory COVID-19 testing. You should check the rules in your location.

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.
If you are a contractor or accredited doctor rather than an employee, you are required to comply with the terms of your agreement or the facility rules/by-laws.

What does ‘lawful’ mean?
A direction is lawful if you can comply with it without breaching any laws. For example, you cannot be required to do anything that you are not registered for or that you are not insured for.

What does ‘reasonable’ mean?

If you are concerned about being redeployed to a new role, you should speak with your hospital supervisor, director or the HR team.

You must comply with the Medical Board’s Social media: How to meet your obligations under the National Law and COVID-19 vaccination position statement when you publish information on your social media accounts. Ahpra recently issued a statement about the use of social media during public debate about the COVID-19 vaccine.

You should ensure your social media use complies with your employer’s policies.

Disciplinary action may be taken against doctors who contravene an employer’s social media policies.

Please refer to Avant’s factsheet Social media for doctors – keeping it professional.

We also suggest you take a look at the Therapeutic Goods Administration’s guidance about advertising COVID-19 vaccinations.

You should speak with your treating medical practitioner about the risks to your health and safety if you work in a COVID-19 vaccine clinic.

A number of colleges and societies have issued advice about pregnancy and the risk of COVID-19, and about pregnant healthcare workers. For more information see:

RANZCOG:

COVID-19 Vaccination in Pregnant and Breastfeeding Women.

COVID-19 and pregnant healthcare workers and other at-risk workers.

Australian and New Zealand Intensive Care Society (ANZICS):

COVID-19 guidelines.

RACP:

COVID-19: Guidance for pregnant healthcare workers.

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.

You are under no obligation to disclose your COVID-19 vaccination status to a patient.

If you feel comfortable disclosing your COVID-19 vaccination status, you can do so.

The practice may wish to place a sign in its waiting room and on its website with the above information.