You recently hired a
receptionist to work at your practice on a permanent employment contract.
After she starts work, the receptionist tells you that she was not vaccinated
as a child. She holds strong views about vaccinations and immunisation, and
says that she will not agree to be immunised. The issue of staff immunisation
is not addressed in her employment contract and was not discussed during the
You are concerned about her working on reception in
case she contracts illnesses, and also spreads these to patients visiting the
clinic and to other staff.
Things to consider
There are a
number of factors for you to consider in this scenario including:
- the health of the employee and your health and safety workplace
obligations to her;
- the health and wellbeing of patients attending
- your obligations to run a safe workplace, including
the health and wellbeing of other staff at the practice;
employment relationship with the receptionist, and what you can reasonably
request of her; and
- relevant industry guidelines.
These are considered in more detail below:
The RACGP’s newly released, Standards for general practices (5th Edition)
provide guidance on staff vaccination, in the context of protecting staff
members from being infected with vaccine-preventable infectious diseases and
from transmitting these infections to patients. These note that practices
should encourage members of the practice team to obtain immunisations
recommended by the Australian
Immunisation Handbook (10th Edition) based on their duties and
immunisation status. The guidelines say, ‘The exact immunisation requirements
will depend on the risk of infection based on the practice’s location, patient
population and each practice team member’s duties.’
guidelines, any natural immunity to vaccine-preventable diseases or
immunisation status of practice team members should be recorded, with their
consent. It cannot be assumed that staff will seroconvert post-immunisation
(for example, hepatitis B). Therefore, it is recommended that
post-immunisation status is serologically confirmed wherever possible and that
further vaccinations are provided as required. Post-immunisation immunity, if
known, should be documented.
Refer to section 3.3.7 of the Australian
Immunisation Handbook for role-specific
recommendations for groups with occupational risk.
set out the following immunisations that can be considered for office-based
health professionals – hepatitis B, influenza, pertussis, MMR (if non-immune),
varicella (if seronegative).
Medical Board of Australia: Good medical
Practice: a code of conduct
Section 9.2 of the Medical
Board of Australia’s Good medical practice: a code of conduct for doctors in
Australia states, ‘Good medical practice involves making sure that you are
immunised against relevant communicable diseases.’
minimises the risk of a healthcare worker contracting or disseminating
infection in the course of their work.
It is entirely reasonable that a
practice should have the same aspiration.
Ideally, you should discuss the practice’s requirement
for immunisation during the interview process and resolve any issues then. You
should not base any recruitment decision on a person’s refusal to be vaccinated
as this could potentially lead to a discrimination claim.
employment offer letter and/or contract should require the employee to have
immunisation against relevant illnesses appropriate to their role as a
condition of employment. Evidence of immunisation should be provided before
commencing work, if this is a requirement for the role.
If an employee
objects to immunisation, you should meet with the employee and encourage
immunisation against certain illnesses. You should explain the reasons for
encouraging immunisation (for example, level of patient interaction, risk of
becoming sick and/or spreading illness and that it is in the best interests of
employees to be immunised to ensure their own workplace health and safety and
the workplace health and safety of others at the practice.
remember that you are not in a treating relationship with the employee in the
course of these discussions. You may wish to recommend that the employee seeks
appropriate medical advice.
You should fully document your discussion
with the employee and any response that you receive.
Your options if
the employee still refuses vaccination
If an employee continues to
refuse to be vaccinated, you should consider your options in light of the risks
that arise from the employee not being vaccinated. These risks will be
different depending on the employee’s position at your practice (for example,
whether they are a receptionist or a nurse). There are a number of legal risks
if you terminate an employee’s employment because they will not be vaccinated,
and these risks must be weighed up against the risks to your practice under
workplace health and safety legislation if you are unable ensure the health and
safety of your employees because an employee is not vaccinated. You should seek
legal advice in relation to the risks of termination if this is something you
decide you want to pursue.
In light of the
practice standards set out by the RACGP, practices need to have a system in
place to consider the vaccination status of their staff, to comply with GP
accreditation requirements. However, you should bear in mind that the RACGP
guidelines specify that ‘informed consent’ is needed from staff members,
meaning that they may refuse to disclose their immunisation status.
Immediate steps forward
- Review your application
forms/interview protocols so that you speak with prospective employees about
this issue during the recruitment stage.
- Review your employment offer
letters and contracts, induction checklists, policies and procedures.
- Insert wording where required into your template contracts/offer letters
for future employees, requiring them to be vaccinated against certain
illnesses in roles that you deem to be higher risk and ensure your policies
reflect the expectation and obligation on staff members regarding
- Revisit the systems that you have in place for
considering the vaccination status of staff members and the recording of any
refusal to vaccination or natural immunity, bearing in mind the RACGP
guidelines set out above.
- Ensure you have a system in place to offer
immunisation to staff members based on job risk.
If you would like further information regarding employment
issues, visit our website
or for immediate advice, call our Medico-legal Advisory
Service on 1800 128 268, 24-7 in emergencies.
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