Novel COVID-19

Update 23 November 2020

MIGA's COVID-19 medico-legal and insurance Q&A covers the most recent developments around the pandemic for our members and clients.

This includes:

  • South Australian healthcare after the end of the 'circuit breaker' on 22 November 2020

  • ​​Victoria's adjustments to mask wearing and elective surgery from 23 November 2020

  • ​WHO advice against the use of Remdesivir in hospitalised COVID-19 patients.

 
Categories include:
  • Insurance cover
  • Healthcare restrictions
  • Telehealth and electronic prescribing
  • Protecting yourself, your colleagues and your patients
  • Managing COVID-19 - testing, certificates, privacy, medications and vaccines
  • Registration issues
  • COVID-19 Premium Relief from MIGA
We encourage you to review our Q&A below, and check back for regular updates.

 

Contact MIGA for advice or assistance
We encourage you to contact :
  • MIGA's Legal Service team it you need advice about how to manage COVID-19 medico-legal issues in your practice (1800 839 280 / claims@miga.com.au, or
  • MIGA's Client Services Officers if you have any questions about your insurance cover (1800 777 156 / miga@miga.com.au)
You can also use MIGA's contact form here.

 

Commonwealth, State and Territory advice and contacts

Access the Commonwealth health department advice, CDNA guidelines, AHPPC and ICEG advice and National COVID-19 Clinical Evidence Taskforce recommendations.    
 
Links to the latest State / Territory information and advice, and public health unit contacts are below:

 
State/Territory General Information Health advice Public health unit Public health directions
ACT Information Health advice (02)51249213
(02)99624155 (AH)
Directions
New South Wales Information Health advice 1300066055 Directions
Northern Territory Information Health advice Local unit numbers Directions
Queensland Information Health advice Local unit numbers Directions
South Australia Information Health advice 1300242272 Directions
Tasmania Information Health advice 1800671738 Directions
Victoria Information Health advice 1800675398 Directions
Western Australia Information Health advice Local unit numbers Directions

Insurance cover

Note - the answers in this section only apply to MIGA policies issued to doctors, Eligible Midwives and healthcare businesses about their insurance cover in relation to COVID-19.
  • Am I covered for treating COVID-19 patients? Updated 3 April 2020

    Yes. Claims and inquiries arising from services provided to patients who may be or are suspected of being infected with COVID-19 are covered by MIGA’s insurance policies. *

    We cover you for healthcare services provided within your insurance category / scope of practice or healthcare business irrespective of the patient’s condition.

    If you are being asked to undertake, or are considering undertaking, a new or different role that may be outside your scope of practice and have any concerns around your medical indemnity insurance or any medico-legal implications, please contact us for assistance. We’ll help to make sure that your cover is appropriate for what you are doing and to guide you on potential medico-legal issues involved.


    * Your individual cover is subject to your chosen category of practice and the terms and conditions of your policy with MIGA.  If you are a doctor whose practice entity employs other doctors, Eligible Midwives or others who bill in their own name, you must ensure that they have their own insurance arrangements in place to cover any disease that they might carry and transmit to others in your practice.

  • Am I covered for providing telehealth? Updated 6 August 2020

    Yes. Claims arising from healthcare services provided to patients in Australia via telehealth consultations are covered by MIGA’s insurance policies *

    Within your scope of practice, our policies do not place limitations on how you provide your care.

    Telehealth is a well-recognised way of providing care in a wide variety of situations and can include consultations via a wide range of video platforms and telephone.

    You need to ensure that you conduct telehealth in accordance with applicable professional guidelines - see Q&A 'Can I use telehealth during the COVID-19 pandemic?' for details of various guidelines.

    * Your individual cover is subject to your chosen category of practice and the terms and conditions of your policy with MIGA.  If you are a doctor whose practice entity employs other doctors, Eligible Midwives or others who bill in their own name, you must ensure that they have their own insurance arrangements in place to cover any disease that they might carry and transmit to others in your practice.

  • Am I covered if I am unknowingly infected and I infect patients resulting in a claim? Updated 17 July 2020

    Yes. Claims arising from healthcare services provided whilst you are infected with COVID-19 are covered by MIGA’s insurance policies *

    Your policy requires you to ensure that you take adequate precautions to prevent the transmission of a virus, bacteria or disease, which means that the steps that you take to prevent transmission must be accepted as competent practice by your peers.

    This would mean that you follow professional obligations for infection control, keep up to date with the potential signs and symptoms of COVID-19, know when to be tested (including the criteria for healthcare worker testing) and follow government requirements for quarantine and isolation (e.g. following travel overseas or to a COVID-19 hotspot, close contact with a confirmed COVID-19 case etc.)

    We recommend that you keep up to date with advice and other information on these issues from Commonwealth Department of Health’s COVID-19 advice for the health sector, your local health department and professional college / association (a range of relevant links are provided on MIGA’s COVID-19 web resources.

    If in doubt about any of these issues, seek advice from your local public health unit.

    If you are aware you are infected or suspect you may be, you should notify your hospital / health service, immediately cease practice, follow public health and other medical advice and complete the necessary isolation period before returning to practice.  

    * Your individual cover is subject to your chosen category of practice and the terms and conditions of your policy with MIGA.  If you are a doctor whose practice entity employs other doctors, Eligible Midwives or others who bill in their own name, you must ensure that they have their own insurance arrangements in place to cover any disease that they might carry and transmit to others in your practice.

  • Am I covered if I change my scope of practice? Updated 1 May 2020

    Yes, if you need to change your scope of practice you are covered provided it is permitted by your Ahpra registration and you are in the appropriate category of cover with us.*
     
    We recommend you take the following steps before starting your new work:
    • Ensure your Ahpra registration does not prevent you from the new scope of practice - the Medical Board has confirmed that doctors with general and specialist registrations are not restricted in their scope of practice because they have specialist registration
    • Be comfortable that you have the necessary skills, training and experience to provide the level of care expected, and your hospital, practice or other workplace agrees (see below Q&A ‘What if am asked to work outside my usual scope of practice to help my hospital deal with COVID-19 cases?’ for further guidance)
    • Confirm with your hospital, practice or other workplace (preferably in writing) that you will have the benefit of any insurance cover you are normally entitled to as an employee or contractor (e.g. as a visiting medical officer for public patients) 
    • Contact MIGA to ensure you have the right category of insurance cover with us. 

     

    * Your individual cover is subject to your chosen category of practice and the terms and conditions of your policy with MIGA.  If you are a doctor whose practice entity employs other doctors, Eligible Midwives or others who bill in their own name, you must ensure that they have their own insurance arrangements in place to cover any disease that they might carry and transmit to others in your practice.

  • How might restrictions on healthcare in a COVID-19 hotspot affect my cover? New 6 August 2020

    Public health directions may restrict healthcare which may be provided, particularly in a COVID-19 hotspot - see Q&A 'Are there restrictions on healthcare I can provide in a COVID-19 hotspot?'  

    We are conscious that this is an extremely challenging time for our members and clients, and that there is potential scope for uncertainty in individual situations.  

    It is important that you take reasonable steps to ensure you only provide healthcare in accordance with applicable public health directions, and regulatory, workplace and peak body guidance.   

    Through our Q&As, we endeavor to provide you with available information around these issues.   

    When in doubt, you should liaise with your local health department, public health unit, relevant peak body and workplace as appropriate.  If you remain in doubt, contact MIGA legal services.  

    * Your individual cover is subject to your chosen category of practice and the terms and conditions of your policy with MIGA.  If you are a doctor whose practice entity employs other doctors, eligible midwives or others who bill in their own name, you must ensure that they have their own insurance arrangements in place to cover any disease that they might carry and transmit to others in your practice.


    * Your individual cover is subject to your chosen category of practice and the terms and conditions of your policy with MIGA.  If you are a doctor whose practice entity employs other doctors, Eligible Midwives or others who bill in their own name, you must ensure that they have their own insurance arrangements in place to cover any disease that they might carry and transmit to others in your practice.

Healthcare restrictions

 
  • What face-to-face healthcare is permissible? Updated 23 Nov 2020

    Below are specifice State-based requirements, followed by general considerations applicable across Australia.

    South Australia

    On 22 November 2020, the South Australian 'circuit breaker' restrictions imposed the previous week on healthcare were removed.

    This means healthcare is no longer limited to specified essential health services.

    There are restrictions in place for healthcare in aged care facilities (see Q&A "What requirements exist around doctors entering aged care facilities to treat their patients?").
     

    Victoria
     
    A broad range of healthcare can now be provided face-to-face in Victoria.   Currently:

    • Fitted masks must continue to be worn indoors when people cannot physically distance outside
    • Businesses must continue to have a COVID Safe Plan
    • A workplace attendance register of all persons at the premises for longer than 15 minutes is required where confidentiality obligations do not apply (ie it is not required to be kept for patients)
    • Elective surgery is at 85% of usual levels.

     
    Queensland – cosmetic injectables
     
    In Queensland, by public health direction cosmetic injections are permitted so long as your practice:

    • Operates in compliance with a COVID SAFE framework (including a COVID Safe checklist)
    • Has public health controls to reduce risks, which may include "environmental cleaning, hygiene measures, regular washing of hands, availablilty of hand sanitiser and avoiding handshaking"
    • For public areas, has no more than 1 person per 2 sqm. 

    Requirements to keep patient contact and attendance details would be met by maintaining necessary clinical records.  Otherwise contact details are required to be kept for other visitors, such as those accompanying patients - more information is available here

    General considerations

    There are no public health restrictions limiting provision of healthcare outside Victoria and Queensland, but you should consider:

    • Use of telehealth where appropriate
    • Compliance with state / territory COVID Safe requirements (number of person on premises, registration) applying to businesses generally (see Commonwealth, state and territory advice and contacts above)
    • Familarising yourself with your peak body guidance on specific COVID-19 pandemic considerations.

     

  • What restrictions are there now on surgery? Updated 23 Nov 2020

    South Australia

    On 22 November 2020, the South Australian 'circuit breaker' restrictions imposed the previous week on healthcare were removed.

    This means elective surgery is no longer limited to emergency, urgent and other specified procedures.


    Victoria
     
    Elective surgery returned to 100% of usual levels from 23 November 2020.

    COVID-19 tests are being undertaken on Victorian public and private hospital elective surgery patients a week before their scheduled elective surgery.  Surgery will be postponed for patients testing positive unless surgery is urgent.  Detailed screening guidelines and FAQs are available. 
     
    Elsewhere 
     
    Elective surgery is at 100% of usual volumes. 
     
    Issues to consider – restrictions, capacity and patient fitness
     
    You should:

    • Know your state or territory requirements and peak body guidance for surgery – for example:
    • Where surgery may be delayed, have a process in place for assessment and ongoing review of degree of urgency for surgery or other procedures for your patients, so you know about and can act on any deterioration or other changes in your patient’s condition.

Telehealth

  • Using Telehealth during the COVID-19 pandemic? Updated 16 Nov 2020

    Teleheallth has been widely used throughout the COVID-19 pandemic.
     
    Telehealth is appropriate to use where:
    • You have a reliable, secure telehealth system
    • You can provide the same level of care and advice you can in a face-to-face consultation
    • You have appropriate arrangements to see the patient face-to-face if necessary.  

    Telehealth can still be used if it does not qualify for a Medicare item where clinically appropriate to do so. 
    Your fees for this should be disclosed to the patient prior to consultation.
     
    For telehealth guidance see:
  • What platforms can I use for telehealth? Updated 16 Nov 2020

    A range of commonly used video platforms and landline / mobile telephone services can be suitable for telehealth.  
     
    Be aware free versions of telehealth platforms may not meet privacy and security requirements. 
     
    To assist in choosing suitable video conferencing platforms, the Australian Digital Health Agency provides:
  • What is the COVID-19 Medicare Telehealth framework? Updated 29 Sept 2020

    New temporary COVID-19 Medicare telehealth items for non-admitted patients are in place until 31 March 2021.
     
    The items extend to all Medicare eligible Australians, so long as the requirements for individual item numbers are met. 
     
    Both you and your patient must be in Australia to use Medicare telehealth items (as is the case for Medicare items generally). 
     
    You do not need to be within your regular practice to provide telehealth.  It can be provided from home.  You should use your provider number for your primary practice location. 

    Your Medicare provider number should only be used for telehealth consultations you undertake yourself.   It cannot be used by other practitioners you work with for their consultations. 
     
    For each service / consultation, the full requirements of a telehealth item must be met.  They cannot be used solely for triaging.  There are also restrictions around when you can initiative a service, and when they need to be patient initiated – see Q&A - "Can I initiate Medicare telehealth services with patients, or should they come to me first?"
     
    In determining whether telehealth is appropriate, Medicare requires the practitioner must:
    • Have the capacity to provide the full service through this means safely and in accordance with professional standards; and
    • Be satisfied that it is clinically appropriate to provide the service to the patient; and
    • Maintain a visual and audio link (or audio only for telephone) with the patient; and
    • Be satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy – see Q&A What platforms can I use for telehealth? 
    • Only use telephone if video cannot be used.
     
    Online chat, messaging and email cannot be used for Medicare telehealth items.
     

    Before using the new items, you should familarise yourself with the requirements for telehealth use generally and each individual item.   This is very important.  This includes:​

    • ​Obtaining informed financial consent before providing telehealth where you are not bulk-billing (the AMA’s Informed Consent guide is here). 
    • Documentation – there are the same record-keeping requirements as for face-to-face consultations – this includes referrals where required
    • Assignment of benefit – for the new telehealth items only, documentation in clinical notes of a patient’s agreement to assign their benefit as full payment for the service is sufficient – other options include posting the completed assignment of benefit form to the patient for their signature and return, or email agreement between the practitioner and patient
    • Multiple attendances on the same day (co-claiming is precluded) – see Q&A below ‘What if I see a patient via telehealth and then need to see them face-to-face’.


    The Department of Health provides an email service for questions around COVID-19 MBS items –AskMBS@health.gov.au.  It has also provided advisories for GPs, physicians and other specialists covering both telehealth and broader MBS claiming questions.

    For GPs:

    • Bulk-billing requirements for COVID-19 telehealth are being lifted from 1 October 2020, but temporary doubling of bulk billing incentives will also end – see Q&A Are there bulk billing requirements for COVID-19 telehealth items?
    • Need for an existing and continuous treating relationship for a wide range of patients - see Q&A – Can I only use COVID-19 telehealth items for existing patients?

     
    The Commonwealth Health Department has released the following Medicare telehealth guidance:

  • Can I only use COVID-19 telehealth items for existing patients? Updated 16 Nov 2020

    GPs and other doctors working in general practice can only claim COVID-19 telehealth items if they have an existing and continuous relationship with a patient.
     
    An existing and continuous relationship involves the patient having seen the same doctor or another medical or health practitioner (including a practice nurse) at the same practice face-to-face in the last 12 months. 
     
    There are a number of exceptions, which are:
    • Patients living under COVID-19 movement restrictions imposed by state or territory public health requirements, including local quarantine requirements
    • Children under 12 months of age
    • Homeless patients – this includes people who live in an inadequate dwelling, have no tenure or a short and non-extendable tenure, or live somewhere where they do not have control of, and access to, space for social relations
    • Patients receiving an urgent after-hours (unsociable hours) service
    • Doctors located at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service
    • Doctors participating in the Approved Medical Deputising Service (AMDS) program if the AMDS provider has a formal agreement in place with a medical practice to provide services to its patients, and that practice has provided, or arranged, at least one personal attendance for the patient in the past 12 months.
     
    Details of GP COVID-19 telehealth claiming requirements are here
     
    Similar restrictions have not been imposed on specialists or other healthcare providers.
  • Can I initiate Medicare telehealth services with patients, or should they come to me first? New 10 Sept 2020

    Where clinically relevant, a practitioner can contact an existing patient for a telehealth consultation as part of appropriate, ongoing care.
     
    Medicare telehealth services cannot be initiated by the practitioner for new patients.  This can only be done by the patient seeking a consultation or on referral by another practitioner. 

     
  • What if I see a patient via telehealth and then need to see them face-to-face? Updated 10 Sept 2020

    For use of Medicare telehealth items, the Commonwealth Health Department has indicated:

    • You need to have the capacity to see the patient face-to-face if required, wherever possible, or otherwise scope to arrange prompt care as required, whether through colleagues at your practice / hospital or other frameworks you have put in place before providing telehealth services
    • If a subsequent attendance on the same day does constitute a continuation of an earlier attendance, the sessions together are considered a single attendance for benefit purposes.
    • If you cannot meet the requirements of a telehealth item without a subsequent face-to-face consultation, you cannot bill Medicare until you have provided a complete MBS service - this could be through billing either a telehealth item or a face-to-face item, whichever took the longer, so long as the individual item requirements are met – you cannot bill both items
    • If two components of a single service are provided by different practitioners, each should bill the appropriate item number fo rhte individual service they provided
    • The new telehealth items are stand-alone items – they cannot be co-claimed with existing face to-face or existing telehealth items - in addition, you cannot claim a telehealth item and a chronic desease management plan item on the same day
    • Multiple Medicare items could only be claimed on the same day by the same practitioner if subsequent attendances are not a continuation of initial or earlier attendances – if you bill multiple items you should state the time of each attendance on the account, and also include in the clinical records time of each service, how each item descriptor was met and explain why they are separate services.

    More information is available here (Provider FAQs). 

    For telehealth that is not Medicare billable, you should ensure that you have the necessary arrangements in place to provide continuity of care within appropriate timeframes for patients who you initially consult with via telehealth, but subsequently need to see face-to-face, where you cannot do this yourself. 
     
  • Are there any bulk billing requirements for COVID-19 telehealth items? Updated 16 Nov 2020

    Practitioners can choose whether to bulk bill or use their regular billing practices.   .
     
    COVID-19 telehealth services provided by GPs and other doctors in general practice are eligible for MBS incentive payments when provided as bulk billed services to Commonwealth concession card holders and children under 16 years of age. 
     
    Rural bulk billing incentives are only payable to practitioners in areas classified as regional, rural and remote under the Modified Monash Model (MMM) classification system (MMM 2 – 7 locations).  Practitioners in metropolitan (MMM 1) areas receive the standard bulk billing incentive payment.
     
    Further information on eligibility and claiming rules is available here (COIV-19 Bulk-billing incentives – FAQs).
     
    Where bulk billing is not being used, the Commonwealth Health Department advises providers should ensure “informed financial consent is obtained prior to the provision of the service”.  Informed financial consent includes details relating to fees, including any out-of-pocket expenses.  The AMA’s Informed Consent guide is here
     
    There can be no non-rebatable deposits charged which are then put towards later consultations.  Fees charged for this (and any MBS service) can only be for the service which is being claimed for.  It cannot include fees for another service.

    More information is available here.

     
  • Can I use telehealth for patients in aged care facilities? Updated 9 Sept 2020

    Yes, the Medicare telehealth items can be used for patients in aged care facilities, subject to individual item number requirements and whether it is clinically appropriate to use telehealth for the patient in question.

    The patient must be present when receiving the telehealth service.  The items cannot be used for consultations with family or care providers without the patient being present.

    Where a patient lacks capacity, their substitute decision-maker (guardian, power of attorney, close relative as relevant) can be involved, whether with the patient or linked in from another location via video or telephone.  MIGA’s resource on Substitute consent provides more information on who should be involved in these situations.  

     

Electronic prescribing

  • How can I use digital image prescribing? Updated 15 October 2020

    Interim image-based prescription arrangements

    An interim image-based prescription model has been introduced, which means:
    • You can create a paper prescription, signed in writing or via valid digital signature (a digital signature cannot be used in NSW, where a handwritten signature is required)
    • A clear digital copy of the entire prescription (photo or PDF) can be sent to the patient’s pharmacy via email, text message or fax (in NSW, the copies cannot be sent via text message)
    • You retain the original prescription for two years (in Victoria and Tasmania, you must make certain records of any digital image being transferred, and you are advised to make records of how you sent the prescription and the pharmacy you sent it to in Queensland).

    Image-based prescribing cannot be used for Schedule 4D or 8 medications, except in:
    • Victoria – where it can be used for all Schedule 4 medications except for drugs of dependence
    • Queensland – restricted drugs of dependency, anabolic steroids and Schedule 8 prescriptions can be sent electronically to a pharmacy so long as the paper prescription is sent to the pharmacy within 7 days and the paper copy is not given to the patient – the paper prescription should be marked as being confirmation of the earlier electronic request
    • WA - Schedule 8 prescriptions may be sent electronically via the same process to a pharmacy, and the original prescription dispatched to the pharmacy within five working days, marked to indicate that it is confirmation of an earlier digital request
    • ACT - Schedule 4D and 8 prescriptions can be sent electronically to a pharmacy. 

    These arrangements have been extended to 27 March 2021 in Victoria, and to 31 March 2021 in other states and territories.

    The Commonwealth Department of Health provides a guide for prescribers and an overview of state and territory rules.  Further information is also available for South Australia, NSW, Victoria, Queensland, WA, Tasmania and ACT.

    If the patient prefers to receive the original prescription themselves to take to the pharmacist to fill, instead of using the interim electronic prescribing arrangement, you can still post it to them for this purpose.
  • Where can electronic prescribing be used? Updated 16 Nov 2020

    Subject to local pharmacy readiness, electronic prescribing, including for Schedule 4D and 8 medications, is available in:

    • Sydney and across Victoria
    • Communities of interest across Australia.

     
    It is important that you ascertain whether local pharmacies are ready to dispense medication using electronic prescribing and that you let your patients know which pharmacies provide this service. 
     
    For more information on electronic prescribing, see Q&A What does electronic prescribing involve?
     
    Both digital imaging and paper prescribing may still be used, depending on pharmacy readiness and patient preference.  

  • What does electronic prescribing involve? Updated 15 October 2020

    Token model – available now
     
    The first phase involves the Token model – a unique QR barcode (token) is sent via app, SMS or email to a patient. 
     
    Patients can send the token / take it in to a pharmacy of their choice for dispensing.
     
    One token is used for each medication.  Once scanned at a pharmacy, it cannot be reused.  Pharmacies sent a new token to the patient for each repeat. 
     
    If your patient requests, you can send the token to someone else caring for them, such as a family member.  It can only be sent to one mobile number or email address by you. 
     
    You should confirm token receipt before the end of the consultation.  If it was not received / sent to the wrong location, cancel the prescription and generate a new token. 

    Active Script List model – under development

    The second phase involves the Active Script List (ASL) model.  
     
    An ASL contains a patient’s active prescriptions which can be dispensed by a pharmacy. 
     
    Patients need to register for an ASL and must provide consent for you to access and view their ASL. 
     
    This model will eliminate the need for a token, and is meant to be particularly helpful for patients on multiple medications.  
     
    Getting ready for electronic prescribing

    To use electronic prescribing:

    • You need a Healthcare Provider Identifier-Organisation and be connected to the Healthcare Identifier service (more information on how to do this is here)
    • Your electronic records system will need to have the necessary capability to connect to a Prescription Delivery Service.  You can liaise with your system provider to confirm this
    • Confirm with your system provider that your system complies with local state / territory electronic prescribing requirements
    • You or your staff should also ensure you have up to date mobile phone and email details for your patient. 

     
    You cannot provide both an electronic prescription and a paper or digital image prescription to a patient.  Only one method of prescribing can be used for each prescription. 
     
    Electronic prescribing use is not mandatory.  You can continue to use paper or digital image prescriptions instead of these new methods.  However both you and your patients may find it easier and quicker to use than existing prescribing methods, particularly when utilising telehealth and for patients who are familiar with using devices.  It also reduces the risk of lost prescriptions. 
     
    More information on the Token and ASL models, including timing for roll-out, is available here
     
    The Commonwealth Health Department has prepared policies on both privacy, and security and access, obligations for healthcare providers using electronic prescribing.
     
    The Australian Digital Health Agency provides a free online electronic prescription course, focusing on the Token model. 
     
    The RACGP has also released electronic prescribing resources.

Protecting yourself, your colleagues and your patients

  • What are the requirements and advice around wearing masks? Updated 23 Nov 2020

    South Australia

    The South Australian Government recommends wearing a mask when in public if unable to physically distance. 

    Victoria
     
    All Victorians must wear a fitted face mask outside their home when indoors or when unable to physically distance outside.  This includes whilst at work, unless one of the lawful excuses or exceptions applies. 
     
    Employers are also required to take reasonable steps to ensure their employees wear a face mask at all times when working on their premises, unless lawful excuses or exceptions apply.
     
    NSW & ACT

    All health workers in NSW Health facilities are required to wear a surgical mask when within 1.5m of patients.
     
    The RACGP has advised all NSW and ACT GPs to wear masks during patient consultations, even if they do not expect to be within 1.5 m of a patient. 
     
    Queensland
     
    In greater Brisbane and Gold Coast hospitals, staff are required to wear masks at all times when treating patients and when social distancing cannot be maintained. 
     
    Other healthcare providers working in a community setting in greater Brisbane (i.e. GPs and specialists) are advised by Qld Health to wear single use surgical masks whenever treating patients or where social distancing cannot be maintained. 
     
    Generally
     
    ICEG has provided recommendations on PPE requirements for areas of significant community transmission and no significant community transmission.
  • Can I ask my patients to wear masks when attending our practice? Updated 23 Nov 2020

    Various state-specific requirements / advice are set out below, followed by MIGA’s advice.  
     

    South Australia

    The South Australian Government recommends wearing a mask when in public if unable to physically distance.

    Victoria
     
    All Victorians are required to wear a fitted face mask outside the home if indoors or if unable to physically distance.  This includes for the purposes of seeking medical care.   It can be removed if necessary to provide health care.  The RACGP has prepared posters you can display at your practice entrance explaining this requirement. 

    NSW
     
    The Commonwealth Health Department advises that people in NSW should consider wearing a face mask in situations where physical distancing is not possible. 
     
    All patients in NSW Health facilities are required to wear a mask, where possible.  NSW Health also recommends the use of masks in indoor settings where physical distancing is hard to maintain and  / or there is a higher risk of transmission. 
     
    Queensland
     
    In greater Brisbane hospitals, all patients and visitors are required to wear single use surgical masks.  The only exception specified is for patients when in their own bed.  Qld Health also recommends community healthcare providers, i.e. GPs and specialists, follow the same approach. 
     
    Generally
     
    On 22 July 2020 Commonwealth Deputy Chief Medical Officer Professor Kidd recommended people wear a mask when leaving home in lockdown areas or other areas where there is high community transmission. 
     
    Safe Work Australia recommends healthcare workers wear face masks when undertaking routine care, including when having frequent, close contact with sick or vulnerable people. 
     
    MIGA advice
     
    MIGA considers it is reasonable for you to request patients wear a face mask when attending your practice, subject to any medical or other valid reasons, where:
    • Face masks are required by public health direction or advised by authorities / peak bodies
    • There are  high levels of community transmission
    • You or your colleagues are vulnerable to COVID-19.
     
    If you are asking patients to wear masks in your practice, it would be appropriate to have stocks available for those patients who do not have one. 
     
    Where a patient is reluctant to wear a face mask, you should consider:
    • Whether there is an appropriate alternative way to provide care to your patient, eg via telehealth where clinically appropriate – see Q&A Using telehealth during the COVID-19 pandemic
    • Whether use by yourself and your staff of appropriate PPE would reduce the risk involved, in liaison with your local public health unit
    • How to ensure necessary continuity of care for your patient.

     

  • My patient seeks an exemption to a requirement to wear a mask - What can I do? New 19 Nov 2020

    The South Australian Government recommends wearing a mask when in public if unable to physically distance.

    In Victoria, there are public health requirements to wear a fitted mask when leaving home if inside or unable to physically distance outside unless certain exemptions apply. 
     
    Elsewhere patients may also be in situations where they are being asked to wear a mask. 
     
    You may be approached by your patients to provide a certificate or written support for them not wearing a mask. 
     
    It is important that you consider whether you have the necessary expertise to comment on whether a patient should be wearing a mask.  It involves balancing the risks associated with wearing one with the risks posed to the patient and others in the community by COVID-19 if they do not wear one when leaving their home, and considering whether there are suitable alternative options (eg staying at home).  You should seek / arrange specialist advice and liaise with your local public health unit as appropriate, and consider any relevant government and peak body guidance. 
     
    For more guidance, see:  
    Victoria – specific considerations
     
    Under the Victorian face mask direction, a person is excused from wearing a face mask when leaving home if inside or unable to physically distance if they have a physical or mental health illness, condition or disability which makes wearing a face mask unsuitable.
     
    Examples given include obstructed breathing, a serious facial skin condition, intellectual disability, mental health illness, or those who have experienced trauma.  However the Victorian Department of Health advisespeople with a disability must wear a face covering [i.e. fitted face mask] unless it is impractical or unsafe to do so for medical, communication or other individual risk factors”.
     
    A person is not legally required to have a doctor’s certificate or letter in support of them not wearing a face mask.  This may only be relevant if your patient is stopped by police, their reason for not wearing or carrying a face mask is not accepted and they challenge any fine issued to them.

     

  • What if our practice doesn't feel it can deal with a suspected COVID-19 case? Updated 16 Nov 2020

    There are situations where a healthcare provider may not be able to deal with a suspected COVID-19 case, or may feel uncomfortable in seeing those patients. 
     
    Doctors and other health professionals should assist where they can in emergency situations, where there is no other appropriate care readily available.  Whether you can assist depends on your own skills and safety, and the impact on other patients under your care.  Your own health and availability of appropriate PPE are also relevant considerations.  
     
    Outside an emergency situation, if you do not feel you are able to deal with COVID-19 patients, consider how you can help the patient get the care they need and ensure continuity of care.  You can contact your local public health unit (see state and territory contacts above),above), local dedicated COVID-19 clinic or hospital emergency department to find out where the patient can be treated and what you can do to facilitate this. 
     
    In a hospital setting, if you are concerned you are unable to treat suspected COVID-19 cases, you should raise this with your colleagues, head of department or director of clinical services as relevant.  The scope of your role may be relevant in deciding what you can and cannot do.
  • Where can I find guidance on PPE to use? Updated 16 Nov 2020

    Government advice on PPE to use is available from the Commonwealth (Health Department, CDNA, ICEG and ACSQHC), ACT, NSW, Qld, SA, Tasmania, Victoria and WA.   
     
    A range of peak bodies have prepared guidance on PPE use. 

  • What information is available on protecting healthcare workers who are vulnerable to COVID-19? Updated 16 Nov 2020

    In supporting healthcare workers who are vulnerable to COVID-19, consider: ASCIA information on COVID-19 and immunosuppression.
  • What services are there to support he profession during this time? Updated 29 Sept 2020

    It is important that you seek any professional and personal support you need. 

    MIGA’s Doctors’ Health website provides a range of resources and links.

    Doctors can access Doctors’ Health Services 24/7 helplines across Australia to help you find the support            you need, which include:
    • Drs4Drs Support Service - crisis support as well as non-urgent mental health support, provided by psychologists, social workers and counsellors – 1300 374 377 or www.Drs4Drs.com.au
    • State and territory doctors’ health services – individual - contact details are here.  

    Midwives can access Nurse & Midwife Support, a 24/7 telephone and online service – contact details are here.
     
    Whether you are a doctor, midwife, practice manager/owner or practice staff member, your college or             association may have its own professional support program you can access. 
     
    Other resources and support include: The Black Dog Institute TEN – The Essential Network app for healthcare workers and further COVID-19 resources here.

Managing COVID-19 - testing, certificates, privacy, medications & vaccines

  • My patient doesn't fit the criteria for COVID-19 testing, but they are demanding a test. Updated 10 Sept 2020

    Except in WA, outside health department criteria for COVID-19 testing, any testing is at the discretion of the clinician.

    You are not compelled to provide care you believe to be unwarranted or inappropriate.

    In WA there are Testing Directions restricting on what COVID-19 testing primary health care providers can order, with an evolving range of exemptions detailed. 

    If in doubt about whether a test is warranted or appropriate contact your local public health unit. 

     
  • Are there special requirements/restrictions on COVID-19 tests? Updated 23 Nov 2020

    Outside notifiable disease obligations for COVID-19, there are various other obligations / restrictions around testing in certain states.
     
    Pathology laboratory obligations
     
    In South Australia, by public health order there are requirements for responsible person for a pathology service to ensure:

    • Notification of COVID-19 testing results to patients within a timely manner, which must be within 72 hours of swabbing
    • SA Health Communicable Disease Control Branch notification of various details of tests, both undertaken to date and on an ongoing basis
    • Appropriate laboratory accreditation, quality assurance (including clinical microbiologist oversight) and following the national COVID-19 surveillance plan.


    Point of care / rapid antigen testing

    The PHLN and CDNA have released a joint statement on COVID-19 rapid antigen tests, indicating they should only be used with medical oversight under public health direction in specific settings, strictly following the manufacturer’s instructions and applicable laws / regulations.

    South Australia, Queensland and Western Australia, certain point of care COVID-19 tests are precluded by public health order.  Western Australia also precludes the use of rapid antigen testing.  Financial penalties apply for their use.  In Western Australia certain exceptions apply, including in certain remote communities.

    Victoria advises against the use of various rapid point of care COVID-19 tests outside a research framework or unless specifically advised by the Victorian Health Department.  Its "test of choice" for the diagnosis of acute coronavirus (COVID-19) infection is the reverse transcription-polymerase chain reaction (RT-PCR) assay confirmed in a laboratory. 

    The TGA has confirmed that supply of self-tests for COVID-19 is prohibited. 
     
    Each of the AHPPC, the TGA, the PHLN and the RCPA have issued guidance on these issues.

     

  • My patient refuses to follow advice for COVID-19 testing or self-isolation. What should I do? Updated 15 October 2020

    These situations may pose a risk to public health and safety.  Contact your local public health unit for advice.

    In some places, a refusal to undergo a test may be a breach of public health orders (e.g. for quarantined close contacts in Victoria, certain travellers in Queensland and Western Australia).

    Your patients should be encouraged to check their local requirements if they are reluctant to undergo testing.  Breaches can lead to financial or criminal penalties for them.
  • A patient wants a medical clearance certificate for COVID-19. Can I give this? Updated 29 Sept 2020

    Patients are approaching their doctors for a range of certificates or clearances associated with the COVID-19 pandemic, particularly following quarantine / isolation, they are vulnerable to COVID-19 or have chronic health conditions.

    Release from isolation

    In Victoria, there are specific requirements around isolation, overseen by the local public health unit.  The DHHS provides clearances once isolation is complete.

    NSW Health provides specific advice on COVID-19 release from isolation.   

    More generally the CDNA and PHLN Revised Australian criteria for the release of persons recovered from COVID-19 from isolation provides detailed information around isolation requirements.


    Vulnerability to COVID-19

    For patients seeking medical certificates around vulnerability to COVID-19:


    Medical certificates generally

    For medical certificates in a COVID-19 context (which also applies more generally to medical certificates), MIGA advises:
    • Be clear on the limits of your knowledge and expertise, both with the patient and in the certificate
    • When writing the certificate, clearly demarcate between patient history on the one hand, and your examination findings, assessment, opinion and recommendations on the other
    • Don’t let the patient ‘drive’ what is in the medical certificate – only ever include opinions you feel comfortable and confident in expressing
    • Generally speaking, the clearer the basis for your opinions and recommendations the more likely those relying on the certificate will be willing to accept them
    • It is generally better to avoid certificates lacking detail about your findings and the basis for your recommendations – if the patient doesn’t want this in the certificate explain to them this could make the certificate less useful, and consider whether you are comfortable providing a certificate lacking detail
    • Be careful about the questions you are answering – if asked to give an opinion on whether the patient fits certain criteria (e.g. ‘vulnerability’), answer based on the definition given, not your own interpretation of what the criteria should be
    • It may be the best certificate you can give is to explain the history given and clinical diagnoses if you can’t address certain questions the patient / employer want answered
    • Be prepared to say to a patient you cannot give the opinion they seek – it may be they need to see someone else with particular expertise on the issue, i.e. specialist physician or surgeon
    • Given the misconceptions around ‘certificates’, it may be better in some situations to provide a short ‘letter’ or ‘report’ instead, not using the terms ‘certificate’ or ‘clearance’.

    For medical certificates generally, the Medical Council of NSW and AMA have each prepared medical certificate guidelines.   

    The RACGP has prepared a template letter to employers, schools and child care centres around issues with requesting medical certificates or clearances.
  • Can I undertake certain practice activities, like COVID-19 testing, outside or in other premises? Updated 10 Sept 2020

    A number of our members and clients are exploring different options for where to provide certain medical services in order to minimise risks of COVID-19 transmission, e.g. outdoor flu clinics, using separate rented premises for some face-to-face clinical presentations. 

    MIGA supports these initiatives where:

    • They are for reasons of patient and / or staff safety
    • ​You are able to provide the same level of care as you would in your usual practice location.  This includes availability of necessary emergency and monitoring equipment, infection control, post-injection monitoring and privacy / confidentiality. 


    NSW Health has provided guidance on drive-through, pop-up and mobile van COVID-19 screening clinics.

    If you are considering running certain face-to-face practice activities from a different physical location (i.e. new rented premises):

    • Consider whether you should seek a separate Medicare provider number
    • ​Make sure the owner is aware of the nature of what is being done.


    Check your other business insurances (e.g. workers’ compensation, public liability, business interruption etc) cover these activities.

  • Can I encourage my patients or staff to use COVIDsafe, the contact tracing app? Updated 22 May 2020

    You can encourage your patients to use COVIDSafe, but you cannot do anything that could be considered coercion or compulsion to do so.

    For example, you cannot make use of COVIDSafe a condition of attending your practice or remaining your patient.

    Similarly, you cannot compel your staff to use COVIDSafe as a workplace requirement.

    Breaches of these restrictions may lead to financial and/or criminal penalties. 

    More information about COVIDSafe is available here.
  • What requirements exist around doctors entering aged care facilities to treat their patients? Updated 23 Nov 2020

    Across Australia there are various restrictions in place around entry to aged care facilities. 

    Doctors and other healthcare workers are permitted entry, but a range of restrictions apply around any  recent travel, close contact of a confirmed COVID-19 case, presence of respiratory symptoms and whether they have been vaccinated against seasonal influenza.
     
    Further details from the Commonwealth Health Department are available here
     
    You should also check current state or territory restrictions where you practice, as these can change in response to levels of community transmission – see for ACT, NSW, NT, Queensland, SA, Tasmania, Victoria and WA.  Specific state requirements include:

    • South Australia - Any doctors and other healthcare workers in an aged care facility are required to wear appropriate PPE (masks) "in accordance with the Australian Guidelines for the Prevention and Control of Infection in Healthcare 2019" at any time you cannot maintain a distance of 1.5m from the resident you are treating, or when you are providing care to a resident awaiting a COVID-19 test result
    • Victoria – masks need to be worn when working in an aged care facility, consistent with the requirement to wear one whenever leaving home – see Q&A What are the requirements around wearing masks? 
    • Queensland
      • Wear appropriate PPE when providing direct healthcare to patients in accordance with Queensland Health’s Residential Aged Care Facility and Disability Accommodation PPE Guidance
      • Health care workers who wear appropriate PPE and follow recommended infection control precautions are not considered ‘known contacts’ of confirmed COVID-19 cases for the purposes of entry to a residential aged care facility.
    ICEG has also provided COVID-19 guidelines for infection prevention and control in residential care facilities.
  • Where can I find information on the development of COVID-19 vaccines? Updated 23 Nov 2020

    National Cabinet has endorsed an Australian COVID-19 Vaccination Policy, which details vaccine developments and plans for roll-out to the community, including priority populations – these include those at increased risk (such as healthcare workers and vulnerable patients) and those working in “services critical to societal functioning"

    The TGA provides information on COVID-19 vaccine regulatory status.
     
    NPS MedicineWise provides detailed information on COVID-19 vaccine development.
  • Are there restrictions on medications for managing COVID-19? Updated 23 Nov 2020

    There is a range of regulatory and peak body advice on COVID-19 clinical management, including for:


    Further advice:

  • What are the new Victorian notification and response requirements if there is a COVID-19 case in my staff? Updated 29 Sept 2020

    Notifying WorkSafe Victoria

    Victorian employers must notify WorkSafe Victoria immediately on becoming aware that an employee, an independent contractor or the contractor’s employee has a confirmed COVID-19 diagnosis and has attended the workplace within the infectious period – this is 14 days prior to the onset of symptoms or a confirmed diagnosis, whichever comes first.  

    If you are self-employed, you have the same obligation to notify WorkSafe Victoria if you receive a confirmed COVID-19 diagnosis and attended your workplace during the infectious period.

    Failure to notify can involve fines of almost $40,000 for individuals, and almost $200,000 for organisations.  

    Details on how to notify WorkSafe Victoria are available here.

    Other necessary steps

    From 6 August 2020, Workplace Directions set our a range of expected responses if you have a suspected or confirmed COVID-19 case in your workplace, including isolation, risk assessment and management, and notifying the Victorian Department of Health and Human Services.

     

  • My patient died from COVID-19. How do I certify cause of death? New 9 April 2020

    The Australian Bureau of Statistics has provided Guidance for Certifying Deaths due to COVID-19.   This includes example medical certificates involving ‘chains of events’ and chronic conditions. 

Registration and training issues

  • What if I am working outside my usual scope of practice? Updated 16 Nov 2020

    We are conscious that a range of our members are undertaking a broader range of work in helping to respond to the challenges of COVID-19. 
     
    The Medical Board indicates:

    • Individual doctors, as well as organisations who engage them, will need to make decisions about scope of practice
    • Decisions should prioritise patient safety and take into account your qualifications, training, experience and transferability of their skills to deliver safe care
    • Consider the conditions in which you will be working, including facilities and access to supervision and training
    • The Board does not prescribe what individual doctors can and cannot do – these are decisions for you and your hospital, practice or other workplace, prioritising patient safety.

     
    We recognise practitioners are often equipped to work across a number of specialties or fields of practice. 

    You should:

    • Make sure your Ahpra registration does not restrict or preclude new or broader work
      • The Medical Board has confirmed that doctors with general and specialist registration are not restricted in their scope of practice because they have specialist registration
      • If your registration does restrict you (e.g. you are limited to certain fields of practice)you would have to apply to Ahpra for changes to your registration before commencing work
    • Consider whether you have the necessary skills, training and experience to provide the level of care expected in the new context
    • Contact MIGA to ensure you have the right insurance category for your new work
    • Ensure you do not incorrectly represent your qualifications, training and experience – the Medical Board has confirmed working in a different scope of practice does not permit you to use a title for which you do not have specialist registration  See Ahpra and the National Boards guidance on Titles in health advertising – Getting it right.   


    If you have concerns about being able to work in a new area, you should raise them with senior colleagues, your hospital or health service.

  • I am returning to practice as part of Ahpra's pandemic sub-register. Are there limitations on what I can and cannot do? New 3 April 2020

    Similarly to your practising peers, you are required to follow your profession’s code of practice (doctors or midwifery) and work within your scope of practice. 
     
    Although the Medical Board has indicated does not define scope of practice for those with unconditional general registration, it expects doctors will exercise their professional judgement and work within their level of competence to ensure they have the necessary knowledge and skills to provide appropriate and safe care.
     
    Midwifery scope of practice is defined in the Nursing and Midwifery Board’s Midwife Standards for Practice.

     
    Outside other conditions you may have on your practice, you are not restricted by the pandemic sub-register in the location or context of your work. 
     
    Ahpra provides a range of FAQs about returning to work under the pandemic sub-register.
  • I am only going to return to work in the public sector. Do I need cover from MIGA? New 3 April 2020

    Doctors employed in the public hospital system will usually have cover for civil damages claims from their employer, but this does not normally include cover for legal expense or assistance with responding to other issues, such as professional disciplinary matters (i.e. a Medical Board / Ahpra notification) or workplace disputes.  Assistance available in relation to coronial investigations and inquests may also be limited.
     
    Before starting work, you should confirm the nature and extent of your insurance cover or indemnity with your hospital or health service.  We recommend you consider insurance cover from MIGA for matters for which you are not covered.

  • If I return to private practice will I lose eligibility for Commonwealth Government run-off cover scheme? New 3 April 2020

    A special exemption has been agreed to allow doctors and midwives to return to private practice and not lose their eligibility for the Commonwealth’s run-off cover scheme (ROCS).  

    This is a temporary exemption for the COVID-19 pandemic.  It ceases one month after the pandemic ends.  If you continue in private practice after that time, the special ROCS exemption will no longer apply and you will need to obtain run-off cover for past practice at your own expense. 

    Practitioners returning to public practice only do not lose ROCS eligibility.

COVID-19 Premium Relief with MIGA

  • My Gross Income has dropped and is lower than I estimated due to COVID-19, what does this mean for my premium for the 2020/21 financial year? Updated 17 July 2020

    MIGA’s policies include an option to adjust the premium if your actual Gross Income (or Sessions) is higher or lower than what you expected.

    If your Gross Income has reduced but it’s not significantly lower than anticipated, we suggest that you leave your estimated Income as is for the year and adjust it after the end of the year.

    Alternatively, if your Gross Income is significantly lower than anticipated contact us and we can review your annual premium now.  In this situation a different Income/Sessions Band may apply and you may be entitled to a premium adjustment.

    Please see the Question below 'What is MIGA doing to support Members and Clients who are suffering financial hardship arising from COVID-19?'

    Please call our staff to discuss the above or e-mail us at COVIDrelief@miga.com.au.  Our staff will guide you through your options.


    * The definition of Gross Income can be found in MIGA’s Categories Guide.
  • What is MIGA doing to support Members and Clients who are suffering financial hardship arising from COVID-19? Updated 17 July 2020

    MIGA is committed to supporting our Members and Clients who suffer financial hardship as a result of the impact of COVID-19.

    We understand the challenges faced by many as we deal with the unprecedented change that COVID-19 has brought.

    With concerns over the financial impact of the current crisis, MIGA’s Boards have agreed a COVID-19 Premium Relief arrangement to support our Members and Clients during these extraordinary times.

    It involves a number of mechanisms to respond to the changing financial circumstances of eligible members and clients whilst maintaining our financial strength. Eligible clients may include doctors in private practice, Healthcare clients and Midwives.

    Under our COVID-19 Premium Relief arrangement, you may have access to:
    • Eligibility for a premium reduction, if your practice and/or the level of activity of your practice has materially changed
    • If you are suffering significant financial hardship
      • If you meet our Eligibility Criteria you may be able to access additional financial relief from MIGA in terms of your annual premium or direct debit 
      • The Eligibility Criteria are if you have ceased working, if your practice has closed and/or if your income has or will reduce by 50% or more over what it would normally be.

    Please call our staff to discuss if you are eligible and your specific situation or e-mail us at COVIDrelief@miga.com.au.  Our staff will guide you through your options.

    Rest assured, supporting you is a key priority for us as we understand how important this is particularly for those who are significantly impacted.

    As a member owned mutual helping our Members and Clients through difficult times is very important to us and always front of mind.

    * The definition of Gross Income can be found in MIGA's Categories Guide.
  • I have ceased practice and am not currently working, do I still have to have insurance? Doctors and Midwives Updated 22 April 2020

    Yes, under your registration requirements as a doctor or a midwife, you must maintain run-off cover for matters that would otherwise be uncovered arising from your previous practice.

    If you cease practice, your Policy with MIGA can be amended to run-off cover only, to cover you for claims that may still be made against you that arise from your prior practice.

    If you change your policy to run-off, you will need to notify us prior to returning to practice to arrange ongoing insurance cover.

Insurance policies are issued by Medical Insurance Australia Pty Ltd.  MIGA has not taken into account your personal objectives or situation.  Before you make any decisions about our policies, please review the relevant Product Disclosure Statement (which can be found here) and consider your own needs.