Novel COVID-19

Update 22 September 2020

This regularly updated information reflects the most recent developments in relation to COVID-19 medico-legal and insurance matters for our members and clients to consider.

It represents our latest advice on this issue and provides answers to a wide range of common questions.

Latest developments covered include:

  • Extension of Medicare funded tlehealth to 31 March 2021, and removal of certain bulk billing requirements

  • ​Staged lifting of Victorian elective surgery restrictions

  • Melbourne and regional Victoria's progress towards its COVID-19 reopening roadmap


We encourage you to review our new and updated advice as these issues arise for you, and to return and check for updates on a regular basis. 
 
We include important links to authoritative Government information on COVID-19, and further information prepared by key professional groups which we recommend you use.  Keeping up to date with Government health advice and information remains imperative.  
 

Contact MIGA for advice or assistance

 
We encourage you to contact:

  • MIGA’s Legal Services Department if you need advice about how to manage COVID-19 related 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
 

Frequently Asked Questions


Below are answers to a range of frequently asked questions that you may have in relation to COVID-19 and how to manage it in your practice. 
 
They are generally categorised as follows:

  • Insurance cover
  • Minimising the risk of COVID-19 transmission and being ready for COVID-19 cases – guidelines for practices
  • Telehealth
  • Your health – COVID-19 risks, illness and personal support
  • My patients
  • Surgery, procedures and essential medical services including elective surgery
  • Registration and training issues
  • Returning to the workforce
  • COVID-19 Premium Relief from MIGA

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 April 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.

COVID-19 hotspots - working in and recent travel from them

 
  • My patient, my staff member, or I have recently been to a COVID-19 hotspot. What should I do? Updated 22 Sept 2020

    It is imperative that you / your staff member / patient are aware of and follows local state or territory public health directions around travel, isolation and quarantine for COVID-19 hotspots, both for those who live there and those who have recently travelled to them.  

    Victoria
    Victorian doctors should keep up-to-date with local Chief Health Officer / health department advice.   Details of current Victorian restrictions are here.  

    NSW
    NSW Health advises that:
    • Anyone who has been in Victoria in the last 14 days and exempted from hotel quarantine or has a permit must self-isolate and abide by permit conditions.  They must not visit sensitive or high risk settings, including aged care facilities and hospitals (more information here)
    • Heatlhcare workers and students who have travelled from Victoria in the last 14 days, reside in a NSW/Victorian border zone, or have been in NSW localities of communict transmission should follow the advice for high risk settings (more information here).

    South Australia
    SA Health provides advice in its health alerts about those returning from areas of community transmission, including restrictions on where they can work.

    ACT
    The ACT Chief Medical Officer has provided advice for high-risk settings and health professionals regarding interstate COVID-19 outbreaks, covering:
    • Seeking a patient’s travel history and whether they have been directed to quarantine / self-isolate
    • Vigilance for potential COVID-19 symptoms following recent travel to geographical areas of risk
    • Advice for those who should not visit or work in high risk settings.

     

  • What is the position on using masks and other PPE in practice in a COVID-19 hotspot? Updated 22 Sept 2020

    Victoria

    From 4 August 2020, all Victorians must wear a face covering when leaving home.  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 covering at all times when working on their premises, unless lawful excuses or exceptions apply.

    The Victorian Department of Health and Human Services directs that all Victorian healthcare workers must:

    • Wear a minimum of level 1 surgical mask and a face shield (where practical) - the requirement to wear a mask includes non-public facing staff
    • Wear a N95 / P2 respirator:
      • In settings where suspected or confirmed COVID-19 patients are cohorted, where frequent prolonged episodes of care are provided (i.e. a dedicated COVID-19 ward)
      • In uncontrolled settings where suspected or confirmed COVID-19 patients are cohorted, to avoid the need for frequent changes of N95/P2 respirators
      • Where suspected or confirmed COVID-19 patients are cohorted and there is a risk of unplanned aerosol generating procedures (AGPs) and/or aerosol generating behaviours
      • When undertaking an AGP on a suspected or confirmed COVID-19 positive patient
    • Otherwise wear a minimum of level 1/type 1 surgical masks in the workplace at all times.
    There is also specific guidance on PPE when providing mental health care, particularly for difficulties in obtaining a patient history and for behavioural disturbances.


    NSW & ACT

    On 24 July 2020, NSW Health issued a directive requiring all health workers in its facilities to wear a surgical mask when within 1.5m of patients.  FAQs relating to this directive are here.

    The NSW Clinical Excellence Commission has also published COVID-19 Safe Work Practice for Health Workers Using a Shared Space.

    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 - significant community transmission

    For areas of significant community COVID-19 transmission, the Commonwealth Government’s Infection Control Expert Group has provided recommendations on minimum PPE requirements:

    • Routine clinical care:
      • Use standard precautions, eye protection and a surgical mask in all clinical settings
      • Contact and droplet precautions, and eye protection, for routine non-hospital and hospital care of patients:
        • With suspected, probable or confirmed COVID-19
        • Who have acute respiratory symptoms
        • Are in quarantine.
    • Challenging patient behaviours in specific settings:
      • In emergency departments, COVID-19 wards, other inpatient settings, healthcare workers may consider tusing contact and droplet precautions with a particulate filter respirator (PFR) where one or both of the following apply:
        • For the clinical care of patients with suspected, probable or confirmed COVID-19, who have cognitive impairment, are unable to cooperate or exhibit challenging behaviours
        • Where there are high numbers of suspected, probable or confirmed COVID-19 patients and a risk of challenging behaviours and/or unplanned aerosol generating procedures AGPs (e.g. including intermittent use of high low oxygen)
    Use of a PFR in these situations, for up to four hours, will avoid the need for frequent changes of face covering
    • Aerosol generating procedures:
      • Avoid performing unnecessary AGPs 
      • If an AGP is required, use contact, droplet and airborne precautions (including eye protection)
      • Ensure procedures are conducted in a closed door single negative pressure room, if available
      • Ensure only essential healthcare workers remain in the room during the procedure
      • After the procedure, the room should remain empty for at least 30 minutes and undertake environmental cleaning.


    Generally – No significant community transmission
     
    In areas where there is no significant community transmission of COVID-19, ICEG recommends:

    • Performancing a risk assessment to determine PPE use, based on the patient’s presenting condition
    • Eye protection, gloves, masks and gowns are recommended for clinical consultations, physical examinations and specimen collection for patients who:
      • Are under quarantine or investigation for COVID-19
      • Are suspected or confirmed COVID-19 cases
      • Have respiratory symptoms.

     

  • Can I ask my patients to wear masks when attending our practice? Updated 9 Sept 2020

    Victoria
    From 4 August 2020, all Victorians are required to wear a face covering when leaving home.  This includes for the purposes of seeking medical care.   The Victorian Department of Health and Human Services has advised that patients should wear face masks.   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.  

    On 24 July 2020, NSW Health issued a directive requiring all patients at its health services to wear a mask, where possible.  FAQs relating to this directive are here.  It 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. 


    MIGA advice
    MIGA considers that in situations where face coverings are required by public health direction or there is high levels of community transmission, it is reasonable for you to request patients wear a face covering when attending your practice, subject to any medical or other valid reasons.  

    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 covering, 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 Can I use telehealth during the COVID-19 pandemic?
    • Whether use by yourself and your staff of appropriate personal protective equipment 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 22 Sept 2020

    In Victoria, there are now public health requirements to wear a mask / face covering when leaving home unless certain exemptions apply.   

    Elsewhere patients may also be in situations where they are being asked to wear a mask / face covering.

    In both cases, you may be approached by your patients to provide a certificate or written support for them not wearing a mask / face covering.

    It is important that you consider whether you have the necessary expertise to comment on whether a patient should be wearing a mask / face covering.  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 alternative face coverings / protection, 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 example, Lung Foundation Australia advises:

    If wearing a mask is not tolerable due to symptoms such as breathlessness, you should carefully consider the need to leave your home. For people living in an area which is experiencing community transmission of COVID-19 the best precaution is to stay at home.

    The RACGP has also published an article about discussing the wearing of masks with patients.

    The NSW Clinical Excellence Commission has also published guidance on Mask Wearing and Sensitivity, detailing steps to reduce adverse effects of mask wearing.

    Victorian requirements – specific considerations

    Under the Victorian face covering direction, a person is excused from wearing a face covering when leaving home if they have a physical or mental health illness, condition or disability which makes wearing a face covering 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 and Human Services (DHHS) advises “people with a disability must wear a face covering unless it is impractical or unsafe to do so for medical, communication or other individual risk factors”.

    DHHS also indicates “A face mask is the recommended face covering … If a face mask is not available other forms of face covering may be used such as a scarf or bandana”.  The direction also refers to face coverings including face shields.

    A person is not legally required to have a doctor’s certificate or letter in support of them not wearing a face covering.   This may only be relevant if your patient is stopped by police, their reason for not wearing or carrying a face covering is not accepted and they challenge any fine issued to them.

     

  • How can electronic prescribing now be used in Greater Melbourne? New 20 August 2020

    The restriction on use of electronic prescribing in communities of interest (see Q&A "When will electronic prescribing become available?") has now been lifted for Greater Melbourne.

    Subject to your local pharmacies being ready for electronic prescribing, it can now be used for all medications, including Schedule 4D and 8.  

    For more information on electronic prescribing, see Q&A When will electronic prescribing become available?).

    Both digital imaging and paper prescribing may still be used, depending on pharmacy readiness and patient preference.  
     
  • What are the Medicare mental health changes for COVID-19 hotspots? New 4 August 2020

    From 7 August 2020 patients who have already used their 10 Medicare subsidised psychological therapy sessions can access an additional 10 sessions with their psychologist, psychiatrist, GP or other eligible allied health worker in the following circumstances:

    • They live in an area subject to public health orders restricting their movement made after 1 July 2020
    • They are required to isolate or quarantine under public health orders.


    Patients will need to have a Mental Health Treatment plan and a review with their GP to access the additional sessions.  

    More information is available here.

     

  • Are there restrictions on healthcare I can provide in a COVID-19 hotspot? Updated 22 Sept 2020

    What you can and cannot do in a COVID-19 hotspot is determined by state/territory public health orders and any other government/regulatory decisions.

    Even if something is not precluded by public health restriction, there may be medico-legal considerations for what healthcare remains appropriate.
     

    Public health restrictions – metropolitan Melbourne 

    From 6 August 2020 onwards, there are a range of restrictions on healthcare, which are: 
    • The ‘default’ position is that on-site workplaces are closed unless specifically permitted
    • Non-urgent elective surgery remains suspended until 28 September 2020.  Only category 1, the most urgent category 2 surgery and IVF treatments are permitted (from 28 September, a staged resumption of elective surgery is planned - See Q&A "What restrictions are there now on elective surgery?"
    • You and your staff are only permitted to work on-site at your workplace if it is not reasonably practicable to work from home - this includes considering appropriate use of telehealth
    • Permitted on-site healthcare includes: 
      • Telehealth services (but only if it is not reasonably practicable to provide this from your home)
      • COVID-19 testing facilities and any other services related to the COVID-19 health response
      • Primary health services specific to general practitioners, pharmacy, nursing and midwifery
      • All Ahpra registered health workers to provide on-site services that prevent a significant change/deterioration in functional independence necessitating escalation of care – examples given include:
        • Requirement for specialist input/review
        • Increase in care needs and/or alternate accommodation
        • Avoiding a hospital admission or emergency department presentation Note - Telehealth may continue to be used for consultations which do not meet this criteria
      • Medical specialists where urgent on-site specialist consultation is required (Telehealth may be used for consultations which do not meet this criteria)
      • IVF services
      • Hospitals
      • Mental health services
      • Laboratories, pathology and diagnostic services
      • Maternal and child health
      • Immunisation services.

    The Victorian Department of Health and Human Services (DHHS) and Victorian Health Complaints Commissioner have confirmed that cosmetic procedures, including injectables, are not permitted while the Stage 4 restrictions are in place.

    DHHS confirms clinical placements for medical and other health students may continue, but preference should be given to placements which are critical for students to progress in their training and graduate, and that remote learning should continue where it can be done.  The following restrictions apply:

    • Clinical placements cannot be undertaken in COVID-19 wards or COVID-19 specific emergency departments
    • Students should not undertake placements in emergency departments or urgent care centres where there is no separate COVID-19 emergency department or entry point for respiratory or suspected COVID-19 patients to be assessed.

    DHHS advises keeping staff in high-risk areas to the minimum required to provide appropriate care and ensure patient safety, and wherever possible avoid situations where other staff attend these areas and/or use critical PPE (i.e. P2/N95 respirators).  It also advises minimising contact with patients and face-to-face contact with other staff where this does not impact quality of care.

    If in any doubt about whether something you propose to do on-site is permissible, you should liaise with DHHS and your relevant peak body, document those communications and exercise reasonable professional judgment in making a decision on what to do.  

    Permitted on-site healthcare premises with 5 or more workers on-site must have a COVID Safe Plan in place and keep a workplace attendance register of all persons at the premises for longer than 15 minutes.  A Permitted Worker Permit must be completed by the employer for each on-site worker, unless they are a hospital or health worker with photo ID issued by their organisation which identifies their place of work.
     
    More information is available about COVID Safe Plans and the Permitted Worker Scheme.

    Public health restrictions – regional Victoria

    Recent changes to regional Victorian public health and elective surgery restrictions mean a broad range of healthcare can be provided face-to-face, consistent with remaining restrictions and in circumstances where telehealth is not appropriate.  
     
    From 17 September 2020 regional Victoria is under Step 3 of the COVID-19 re-opening roadmap, which provides
    • There are no restrictions on leaving home, but masks must continue to be worn  
    • People should continue to work from home where reasonably practicable
    • Businesses must continue to have a COVID Safe Plan
    • Beauty and personal care facilities can operate where a face covering can be worn for the duration of service.
     
    On 17 September 2020, the suspension since 5 August of non-urgent category 2 and all category 3 elective surgery in regional Victoria public and private hospitals was lifted so that
    • Elective surgery can increase to 75% of usual levels from 17 September 2020
    • It can increase to 85% of usual levels from 28 September 2020
    • Specialist clinic consultations can increase in line with elective surgery activity, but telehealth should be used where possible to reduce face-to-face consultations. 
    Elective surgery is planned to return to 100% of normal levels at the Last Step of the roadmap, tentatively planned for 23 November 2020.   
    For more information, see Q&A What restrictions are there now on elective surgery?

    Medico-legal considerations and potential use of telehealth

    MIGA recognises that clinicians are very busy providing a broad range of essential medical services, both COVID-19 and non-COVID-19 related, in COVID-19 hotspots that must continue, both face-to-face and via telehealth.

    The Victorian Government has emphasised that people should not neglect necessary healthcare, including cancer screening and other urgent medical care.  It supports ensuring patients can present to hospitals for necessary medical care and the use of telehealth to supporting ongoing healthcare.  

    For areas of significant community COVID-19 transmission, the Commonwealth Government’s Infection Control Expert Group advises avoiding performance of unnecessary aerosol generating procedures. 

    Unless restricted by public health order, it is legal for medical and healthcare services to continue to operate.  However public health considerations, elective surgery restrictions and other restrictions on a wide range of non-essential activities mean you should carefully consider whether what you are doing face-to-face is an essential healthcare service.   This includes consideration of issues such as:

    • Peak body and professional advice 
    • Potential risks to patients, doctors, nurses and staff
    • Scope for complaints and claims
    • Issues of perception and reputation.  


    Depending on your circumstances, it may be consideration should be given to providing services via telehealth, where clinically appropriate, if the patient is comfortable with it and you are able to provide continuity of care (i.e. ability for either you or your colleague to see the patient face-to-face when needed).

  • What arrangements are there for people travelling interstate for essential healthcare? Updated 22 Sept 2020

    Travel to Queensland

    Queensland permits patients to travel there for essential healthcare not available in the patient’s state or territory, or which cannot be reasonably provided in their home state or territory via telehealth. 
     
    Examples given of essential healthcare include:

    • Continuing a routine clinical relationship with your dentist, GP, treating hospital or community clinic
    • Appointments with Queensland Children’s Hospital
    • Specialist rehabilitation services or cardiac care.


    More information is available from Queensland Health here.

    Travel from NSW to Victoria
     
    With a permit, NSW residents are permitted to obtain healthcare in Victoria outside the border zone
    where

    • Healthcare is necessary to treat or maintain a patient’s health
    • The necessary care is not available locally or remotely, if they have a permit. 

     
    A range of restrictions apply to the patient whilst in Victoria. 
     
    The permit requires a declaration from a doctor that the care is necessary to treat or maintain health and  needs to access healthcare in Victoria. 
     
    The doctor’s declaration and more information is available here.

     

  • Are there restrictions on Victorian doctors and students working across different health settings? Updated 9 Sept 2020

    MIGA understands that issues have been arising about Victorian doctors and medical students working across different health services / settings.

    Doctors
    From 6 August, an employer must not require or permit a worker to work at more than one work premises (excluding their home) unless it is not practicable to limit the worker to one premises only.  Although healthcare is listed as an example of an exception, you should consider where it is reasonably necessary to have you and your staff working at more than one on-site workplace.

    The Victorian Department of Health and Human Services (DHHS) indicates:

    Health services do not have the general authority to restrict or prohibit healthcare worker movement outside of or across health services where that forms part of their ordinary work and is necessary for the provision of care or services. Restrictions will occur if the healthcare worker or health service employee is unwell or if exposed or in close contact with a coronavirus (COVID-19) suspected or confirmed case. State directions may restrict individual movement as for any other member of the public.

    DHHS also indicates that:
    • Where possible, planned rotations to other health services should be limited  
    • Its health services may impose a condition of service on future work that staff are only authorised to work at a particular site and / or implement procedures to limit staff working or moving across multiple departments / wards. 

    Students
    DHHS advises that students working and living in different restriction zones can complete their placements, but where possible education providers should consider alternative placements in the same restriction zone where a student lives.

     

     

  • What are the new Victorian notification and response requirements if there is a COVID-19 case in my staff? Updated 9 Sept 2020

    Notifying WorkSafe Victoria

    From 28 July 2020, 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.

     

  • What are the requirements around release from isolation in a COVID-19 hotspot? New 20 August 2020

    Any provision of clearances or other certificates should only occur in accordance with local requirements for 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.   

    If there is any uncertainty you should liaise with your local public health unit.

Minimising the risk of COVID-19 transmission and being ready for cases - Guidelines for practices

  • What should my practice do to minimise transmission risk and be ready to deal with COVID-19 cases? Updated 10 August 2020

    The Commonwealth Health Department continues to update and provide detailed information and advice to the health profession on managing COVID-19 here, including working arrangements (keeping staff and business safe), hygiene and cleaning, personal protective equipment, and providing care both face-to-face and remotely.  The Australian Commission on Safety and Quality in Health Care also provides detailed guidance on COVID-19 infection prevention and control risk management.
     
    State and territory health departments and a range of colleges and professional associations (links below under ‘Other information and resources’) are also providing detailed information on managing suspected and diagnosed COVID-19 cases.  It is important to keep up to date with new information from these sources.  

    In a community setting, consider what you need to do around triage and alerts for possible COVID-19 symptoms.The response to patients presenting with symptoms or risk factors for COVID-19 infection (these are identified and regularly updated on government health websites - see 'Other Information and resources' below) should be planned and communicated clearly to all staff in the practice so they are clear on what should be told to patients (by email, practice website or online booking facility).
     
    Things to consider include:
    • Being clear on current health department advice on criteria for a suspected COVID-19 case- Communicable Diseases Network Australia (CDNA) provides updated definitions of suspect, probable and confirmed cases – you should also check your updated local health department criteria
    • How you can have patients alert you to possible COVID-19 symptoms – i.e. when booking for an appointment (whether by telephone or online) or presenting for appointments or walk in visits
    • Consider what presentations may be suitable for telehealth (see Q&A below on telehealth)
    • Information to provide on your practice website, online booking website and on the door outside your practice
    • Preparing all staff  to deal with a suspected COVID-19 case – necessary equipment (see Q&A 'Where can I find guidance on personal protective equipment to use?), caring for the patient, protecting other patients, contacting local public health units, local dedicated COVID-19 clinics and / or local emergency departments
    • Ensuring all staff are aware of what they should do if they are suffering symptoms of a potential COVID-19 illness, have had close contact with a COVID-19 case or have recently travelled overseas or to a COVID-19 hotspot:
      • For Victoria, see Q&A 'What are the new WorkSafe Victorian notification requirements if there is a COVID-19 case in my staff?'
      • WHS notification requirements across Australia are detailed here
      • Elsewhere and generally, see here for more information around when healthcare workers can and cannot work, and should be tested, and here for CDNA guidance on healthcare worker symptom monitoring and here for the RACGP fact sheet on responding to COVID-19 cases, both in patients and practice staff
    • Supporting staff who might be more vulnerable to COVID-19 – this may involve considering how to modify their work to limit their risks of contracting COVID-19
  • Can I ask my patients to wear masks when attending our practice? New 27 July 2020

    From 23 July 2020, people in Melbourne and the Mitchell Shire in Victoria are required to wear a face covering when leaving home.  This includes for the purposes of seeking medical care.

    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.

    The Commonwealth Health Department advises that people in NSW should consider wearing a face mask in situations where physical distancing is not possible.

    On 27 July 2020, NSW Health issued a directive requiring all patients at its health services to wear a mask, where possible.  FAQs relating to this directive are here.

    MIGA considers that in situations where face coverings are required by public health direction or there is high levels of community transmission, it is reasonable for you to request patients wear a face covering when attending your practice, subject to any medical or other valid reasons.

    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 covering, 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 'Can I use telehealth during the COVID-19 pandemic?'
    • Whether use by yourself and your staff of appropriate personal protective equipment would reduce the risk involved, in liaison with your local public health unit
    • How to ensure necessary continuity of care for your patient.
  • What if our practice doesn't feel it can deal with a suspected COVID-19 case? Updated 30 March 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 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 protective equipment 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 contact numbers under 'Other information and resources' below), 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.

  • What if I don't have the necessary equipment to manage possible COVID-19 cases? Updated 1 May 2020

    Health care professionals should not be put in positions where their own health and safety is at risk. It is important that you, your colleagues and staff are appropriately protected, and that patients can still access the care they need, even if via another method or source. 

    For more information on PPE guidance from Australian governments and peak bodies, see Q&A 'Where can I find guidance on personal protective equipment to use?'
     
    If you have concerns about personal protective equipment (PPE) availability, these need to be considered and potential responses worked out before there is a shortage.  We recommend you: 
    • Engage with your hospital, local primary health network or other supplier to understand any potential impacts on equipment supply
    • Discuss with your department, colleagues and / or practice what to do if there is an equipment shortage
    • Consider how telehealth can be used appropriately to conserve PPE
    • Have in place procedures to ensure that if necessary PPE is unavailable, patients can still access necessary care in a timely way, i.e. via telehealth, contact with another local practice with sufficient PPE, a COVID-19 clinic or referral to a local hospital emergency department.

     
  • Where can I find guidance on personal protective equipment to use? Updated 22 Sept 2020

    Commonwealth, state and territory governments, and various colleges, associations and societies, have published guidance on appropriate personal protective equipment (PPE) for a variety of clinical settings.  These are being updated regularly in response to developments.

    For Commonwealth Government and agency guidance:


    Available state and territory government specific guidance:


    The RACGP has also prepared COVID-19 infection control principles, RACS has produced Guidelines for PPE and ANZCA a statement on PPE.

    Links to other college, association and society guidance is available under 'Other information and resources' below.
  • Is there guidance on what can be used in cases of equipment or ventilator shortages? Updated 9 Sept 2020

    All healthcare workers should have available to them the equipment they need to protect themselves and provide the care their patients need. 
    The TGA has provided a range of guidance on issues of PPE and ventilator shortage, including:
     


    You should also familarise yourself with relevant professional college / association / society guidelines (see Other Information and Resources below for links) and local requirements (i.e. health department or local hospital) if and when these concerns eventuate. 

    A Critical Health Resource Information System (CHRIS) will operate in all public and private hospitals with ICUS, showing where ICU beds and ventilators are available. 

    For PPE shortages, please also see our Q&A - What if I don’t have the necessary equipment to manage possible COVID-19 cases? 

  • What if I am asked to work outside my usual scope of practice to help my hospital deal with COVID-19 cases? Updated 1 May 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, e.g. critical care specialists (peak bodies have prepared a consensus statement these issue), doctors in training. 
     
    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.
  • Can I undertake certain practice activities, like COVID-19 testing, outside or in other premises? Updated 9 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.

  • I have been asked to work interstate to assist with COVID-19. What should I be aware of? Updated 9 Sept 2020

    We are aware some of our members are being invited to work elsewhere in Australia to help respond to the challenges of COVID-19.  

    To ensure you follow legal requirements and have the right insurance cover in place, we recommend you consider the following before starting work elsewhere:
     
    • What border and quarantine restrictions are in place both where you propose to work, and where you live (i.e. applying when you return home).  Some places provide travel, quarantine and isolation exemptions for ‘essential travellers’ like doctors and other health professionals – see here for more information, including links to specific state and territory requirements
    • If you are being asked to work outside your usual scope of practice, consider our Q&A ‘What if am asked to work outside my usual scope of practice to help my hospital deal with COVID-19 cases?’
    • You can provide Medicare services from a new location using your existing provider number for less than 12 weeks, if you return to your usual location after this – more guidance on provider numbers changes is here
    • Check with the hospital or health service where you will be working if they will be providing any insurance cover to you
    • If you will be working in a different category of insurance and / or your estimated Gross Income will change, contact MIGA to ensure you have the right cover in place.
     
     

Telehealth

  • Can I use telehealth during the COVID-19 pandemic? Updated 9 Sept 2020

    Yes.  If you are confident that a reliable, secure telehealth system will allow you to provide the same level of care and advice you can in a face-to-face consultation with a patient, and you have appropriate arrangements to see the patient face-to-face if necessary, it is an appropriate alternative approach.  
     
    Ahpra and the National Boards have developed Telehealth guidance for practitioners, setting out expectations for using telehealth during the COVID-19 pandemic.

    The Commonwealth Health Department has also prepared advice on when to provide care face-to-face and remotely

    A range of commonly used video platforms and landline / mobile telephone services can be suitable for telehealth. 

    Ahpra and the National Boards have advised “No specific equipment is required to provide telehealth services. Services can be provided through telephone and widely available video calling apps and software platforms such as Skype, FaceTime, Duo, GoToMeeting and others”.  They caution that “free versions of these applications (i.e. non-commercial versions) may not meet applicable laws for security and privacy. Practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws”.

    Healthdirect Australia, on behalf of various Australian governments, is providing a video consulting platform for primary health services, including GPs.  More information is available here

    To assist in choosing suitable video conferencing platforms, the Australian Digital Health Agency provides:


    For telehealth generally:

  • How has Medicare expanded Telehealth during the COVID-19 pandemic? Updated 22 Sept 2020

    New temporary Medicare telehealth items for non-admitted patients have been introduced progressively since March 2020.  They now provide a ‘whole of population’ telehealth model, allowing a range of GPs, specialists and certain other health practitioners to use telehealth for a range of appropriate clinical situations. 
     
    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. 
     
    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?" 

    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 How have bulk billing requirements for COVID-19 telehealth items changed?
    • 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 22 Sept 2020

    From 20 July 2020, GPs and other medical practitioners 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 such as in metropolitan Melbourne and regional Victoria - this also includes local quarantine requirements
    • Children under 12 months of age
    • Homeless patients - this include people who live in an inadequate dwelling, have no tenure or a short and non-extendable tenure, or live somewhere where they do no have control of, and access to, space for social relations
    • Patients receiving an urgent after-hours (unsociable hours) service
    • Medical practitioners located at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service
    • Medical practitioners 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 9 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. 

     
  • How can I use the new Medicare Telehealth items for my patients? Updated 9 Sept 2020

    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 (MIGA considers this would generally include a range of commonly used video platforms and landline / mobile telephones)
    • Only use telephone if video cannot be used.

     
    For more information on choosing a telehealth platform, see Q&A Can I use telehealth during the COVID-19 pandemic? 
     
     
    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:

    • ​Knowing what must be bulk-billed (see below Q&A - What patients must be bulk billed under the new telehealth items?)
    • 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. 

     
  • What if I see a patient via telehealth and then need to see them face-to-face? Updated 9 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. 
     
  • How have bulk billing requirements for COVID-19 telehealth items changed? Updated 22 Sept 2020

    General practice consultations - changes from 1 October 2020

    From 1 October 2020, COVID-19 telehealth bulk billing requirements that applied to GPs and other doctors in general practice are being lifted. 

    The temporary doubling of bulk billing incentives for those services will also cease from 1 October 2020. 

    This means than from 1 October 2020 GPs and other doctors in general practice can choose whether to bulk bill or use their regular billing practices for the following:
    • Commonwealth concession card holders
    • Children under 16 years of age
    • Patients who are more vulnerable to COVID-19, who are
      • Required to self-isolate or self-quarantine
      • At least age 70
      • Of Aboriginal or Torres Strait Islander descent and at least 50 years old
      • Pregnant
      • Parent of a child aged under 12 months
      • Being treated for a chronic health condition - a condition present or likely to be present for at least 6 months, or which is terminal – more information is here
      • Immune compromised – this is a clinical decision made by the patient’s treating doctor; or
      • Meets the current national triage protocol criteria for suspected COVID-19 infection – this is based on the CDNA National Guidelines for Public Health Unit available here.

    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.
     
  • How can I use digital image prescribing? Updated 17 July 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. 

    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.
  • When will electronic prescribing become available? Updated 9 Sept 2020

    New electronic prescribing processes are being progressively rolled out across the country.

    Outside Melbourne, use is presently limited to established 'communities of interest', where GPs and pharmacies ready to use electronic prescribing are in close proximity.  Details on locations of communities of interest are here.  Elsewhere, patients may not be able to get their electronic prescription dispensed if their chosen pharmacy is not yet ready.  MIGA recommends you ensure you are in a community of interest, check your local pharmacy is ready and advise your patients where they can go to fill their electronic prescription.

    Token model – progressively rolling out 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 – progressively rolled-out from late September 2020

    The second phase involves the Active Script List (ASL) model, scheduled for progressive roll-out from late September 2020.   

    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.  

  • Can the Medicare telehealth items be used if either I or my patient are overseas? New 19 June 2020

    No.  Both you and your patient must be in Australia to use Medicare telehealth items.  This is the case for any use of Medicare.
  • Can my practice use my Medicare provider number to bill telehealth consultations undertaken by other practitioners in the same practice? New 19 June 2020

    No. Your Medicare provider number should only be used for telehealth consultations you undertake yourself.

    Your are responsible for meeting Medicare billing requirements for an item billed using your provider number.

    If incorrectly or inappropriately billed for services provided by another, you would be responsible for meeting any repayment to Medicare, and could also face Medicare restrictions or professional disciplinary action.
  • 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.  

     

  • Can I use Telehealth if it doesn't qualify for Medicare? New 30 March 2020

    Telehealth can still be used if it does not qualify for a Medicare item where clinically appropriate to do so. 
     
    This can include providing care to patients via telehealth from your home if you are self-isolating or otherwise remaining at home.  Your fees for this should be disclosed to the patient prior to consultation.  Ideally this would occur during the telehealth booking process.  
  • I am an international medical graduate with limited or provisional registration. Can I use telehealth? New 1 May 2020

    The Medical Board has temporarily varied the definitions of level 1 and 2 supervision to allow international medical graduates (IMGs) under level 1 and 2 supervision to participate in telehealth where appropriate supervision can be assured, including where:
     

    • Level 1 – your supervisor is contactable 100% of the time you are consulting and you consult your supervisor in person, via video or teleconference before each patient consultation ends
    • Level 2 – your supervisor is contactable at least 80% of the time you are consulting, and you discuss with your supervisor patients you have consulted on at least a daily basis, and more frequently if necessary
    • Levels 3 and 4 – telehealth is already permissible under these supervision requirements.

Your health - COVID-19 risks, illness and personal support

  • I'm feeling ill and think I might have been exposed to COVID-19. What should I do? Updated 22 May 2020

    You should:

    • Not go to work if you have a fever or any symptom (however minor) of respiratory illness
    • Be tested for COVID-19 if you develop fever or respiratory symptoms
    • Stay home in self isolation until you receive your test result – you should not be at workContact the National COVID-19 Helpline on 1800 020 080 
    • Seek advice from your GP, local public health unit or dedicated COVID-19 clinic
    • Familiarise yourself with the latest health department advice
    • Alert your hospital or practice
    • Ensure you follow government and professional advice and guidance on isolating yourself and when you are able to return to practice. 


    More information is available from the Commonwealth Health Department and CDNA.   You should also follow any additional requirements specific to your state or territory. 
     
    You should also familiarise yourself with health department advice on isolation requirements following COVID-19 diagnosis, close contact or recent travel.The CDNA’s guidelines cover return to work following isolation for healthcare workers.  

     

  • I'm worried about returning to work after a period of isolation. Updated 22 May 2020

    If your concerns are health-related, speak to your GP or local public health unit.
     
    For employment or contract issues, the Fair Work Ombudsman has information on COVID-19 related issues here.  Consider raising your concerns with your employer, hospital or practice as relevant. 

    Safe Work Australia also has healthcare specific advice on work health and safety during the COVID-19 pandemic. 
     
    Consider raising your concerns with your employer, hospital or practice as relevant. 

  • This is an incredibly stressful time for me. What services are there for personal support? Updated 4 August 2020

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

    The Commonwealth Department of Health provides a range of information about looking after yourself and links to various support services here.

    Doctors can access Doctors’ Health Services 24/7 helplines across Australia to help you find the support you need, which includes:

    • 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. 

    NSW Health staff can contact COVID Connexion a 24/7 service staffed by mental health professionals.

    Doctors’ Health SA has also prepared ‘Self-care for doctors in a Covid world’, available here.

    Doctors’ Health Advisory Service WA has also provided “Managing your Mental Wellbeing” during this pandemic, available here.

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

    The Pandemic Kindness Movement has been created by Australian clinicians to support healthcare workers, providing resources and links to services to support healthcare worker well-being.

    Beyond Blue has also developed a 24/7 Coronavirus Mental Wellbeing Support Service.

    The Black Dog Institute (in partnership with a range of other organisations) has released TEN – The Essential Network.  This is an app for healthcare workers providing a one stop resource and help centre for a range of mental health issues.  It will include an online clinic screening tool and facilitate streamlined online referral processes for telehealth consultations.   Further Black Dog Institute COVID-19 resources are available here

    The Australian Government’s Head to Health provides a range of resources on COVID-19 and mental health here

     

My Patients

  • My patient doesn't fit the criteria for COVID-19 testing, but they are demanding a test. Updated 17 July 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 9 Sept 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 testing

    In South Australia, Queensland and Western Australia, certain point of care COVID-19 tests are precluded by public health order.  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. 

    The TGA has confirmed that supply of self-tests for COVID-19 is prohibited. 

    Each of the Australian Health Protection Principal Committee, the TGA, the Public Health Laboratory Network and the RCPA have issued guidance on these issues.  NSW-specific information is available from NSW Health Pathology. 

  • My patient refuses to follow advice for COVID-19 testing or self-isolation. What should I do? Updated 17 July 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 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 20 August 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 Revised Australian criteria for the release of persons recovered from COVID-19 from isolation from the Communicable Diseases Network Australia and Public Health Laboratory Network.  These indicate:

    • Current evidence is that people are no longer infectious after approximately 10 days since becoming ill with COVID-19 
    • A 10-day period from onset of symptoms in mild cases, and 72 hours after resolution of the acute illness, whichever is the later, is sufficient to indicate that transmission will not occur from a recovered case - this applies regardless of the setting the recovered case may be returning to
    • For cases with more severe illness who are hospitalised, the criteria required for release from isolation for these people are 10 days from hospital discharge and complete symptoms resolution for 72 hours, whichever is the later
    • People who have recovered from COVID-19 are no longer required to meet additional laboratory testing criteria prior to going into high-risk settings (previously two negative PCR test results collected 24 hours apart) 
    • For significantly immunocompromised people, negative PCR tests are required following COVID-19 illness, before they are released from isolation.  They must:
      • Meet the clinical criteria, and
      • Test PCR negative for SARS-CoV-2 on at least two consecutive respiratory specimens collected at least 24 hours apart, at least 7 days after symptom onset.


    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.
  • I've had patients not be honest about their symptoms in order to see me. This puts me and our practice staff at risk. What can I do? New 3 April 2020

    Health care professionals should not be put in positions where their own health and safety is at risk. 

    It is important that:

    • You, your colleagues and staff are appropriately protected
    • ​Patients can still access the care they need, even if via another method or source.

    We encourage you to consider what you can do to minimise the chance of this happening as part of your practice’s COVID-19 response (see our Q&A ‘What should my practice do to be ready for possible COVID-19 cases?’

    You may wish to consider emphasising on your website / via telephone booking / triage / practice signage:

    • The responsibility you and your practice have to ensure the health and safety of staff
    • ​The need for accurate reporting of symptoms, as otherwise your practice may not be able to treat the patient and need to refer them elsewhere.

    If a patient has deliberately misreported symptoms to you, outside an emergency situation MIGA considers that this can provide appropriate grounds to terminate care.  It is important to ensure that you take steps to ensure the patient can still access the care they need, eg providing other care options or any necessary referral.

  • Can I encourage my patients or staff to use COVIDsafe, the new 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 22 Sept 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, particularly in areas of significant community transmission. 

    In Western Australia, you cannot provide healthcare at a residential aged care facility unless it is not reasonable practicable to provide care via telehealth. 
     
    There are various state requirements around use of personal protective equipment (PPE) by health workers when seeing patients in aged care facilities

    • South Australia - use appropriate PPE whenever a distance of 1.5m between the worker and patient cannot be maintained
    • 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 is the position on using masks and other PPE in practice in a COVID-19 hotspot? 
    • 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.

    The Australian Health Protection Principal Committee has provided advice on entry to aged care facilities.

  • Are privacy and confidentiality affected by COVID-19? Updated 27 July 2020

    Obligations of privacy and confidentiality continue to operate for patients with suspected or diagnosed COVID-19. 
     
    COVID-19 is a notifiable disease to state and territory health departments.  This is not a breach of privacy or confidentiality. 
     
    There may be other situations where it is necessary to disclose the occurrence of COVID-19. 
     
    For example, it would be necessary to disclose certain information within a hospital or workplace to potential close contacts of the COVID-19 case.  Disclosure would be limited to what is reasonably necessary in the circumstances.  Before doing this, advice should be sought from your local public health unit, which would be involved in and guide this process. 
     
    The OAIC has prepared a useful resource here on privacy obligations and COVID-19.

    The OVIC and Health Complaints Commissioner have also released information for Victorian agencies on Privacy and COVID-19 relating to health privacy and confidentiality requirements

  • Are there restrictions on COVID-19 clinical management? Updated 22 Sept 2020

    There is a range of regulatory and peak body advice on COVID-19 clinical management, including guidance / restrictions on dexamethasone, remdesivir and ivermectin usage, and restrictions on hydroxychloroquine usage which vary across Australia.  

    More information is available on Q&As dealing with dexamethasone, remdesivir, hydroxychloroquine and Ivermectin.  

    The National COVID-19 Clinical Evidence Taskforce has ‘living guidelines’ that provide recommendations on use of antiviral and other disease modifying treatment.  These are being frequently updated and represent the most up-to-date Australian position on COVID-19 treatments and clinical management.  There are a range of treatments they indicate should not be used.

    Choosing Wisely Australia has also provided guidance on each of dexamethasone, hydroxychloroquine and anti-viral medications in COVID-19.

    Each of the AMA, NSW Health, the Victorian Health Department and the WA Health Department have also produced guidance on COVID-19 therapies.

     

  • What restrictions / advice exist for dexamethasone? Updated 22 Sept 2020

    The COVID-19 Clinical Evidence Taskforce has made recommendations relating to dexamethasone (or certain other steroids if dexamethasone is unavailable) in a range of COVID-19 patients. 

     

  • What restrictions / advice exist for Remdesivir? Updated 4 August 2020

    On 10 July 2020, the TGA granted provisional approval for use of Remdesivir in adults and adolescents hospitalised with severe COVID-19 symptoms.  

    It is only available to those who are “severely unwell, requiring oxygen or high level support to breathe, and in hospital care".

    Criteria for access to Remdesivir from the National Medical Stockpile is here.

    The TGA indicates Remdesivir “has not been shown to prevent coronavirus infection or relieve milder cases of infection”.

    The National COVID-19 Clinical Evidence Taskforce is regularly updating its guidance on Remdesivir.

     

  • What restrictions / advice exist for hydroxychloroquine? Updated 20 August 2020

    There are a range of restrictions precluding hydroxychloroquine prescription.  

    From 1 May 2020, the Pharmaceutical Benefits Scheme (PBS) listing for hydroxychloroquine provides that both initial and continuing PBS listings will be Authority Required (STREAMLINED).  This includes a requirement that initial prescription be authorised by an Ahpra registred specialist in dermatology, intensive care medicine, paediatrics and child health, as a physician, or in emergency medicine.  More information is available here.

    Prescription of hydroxychloroquine has been restricted by the TGA and by Victorian public health order so that:

    • Only authorised specialists can prescribe hydroxychloroquine to new patients – these include dermatology, intensive care medicine, paediatrics and child health, physician and emergency medicine
    • Other doctors, including GPs and hospital doctors in training, can only prescribe hydroxychloroquine if continuing a treatment authorised by an approved specialist.  


    In NSW these hydroxychloroquine restrictions have been further modified so that:

    • Doctors practicing in a public hospital may prescribe hydroxychloroquine for hospital patients
    • Any prescription must clearly indicate it has been issued under clause 37 of the Poisons and Therapeutic Goods Regulation 2008
    • Hydrochloroquine cannot be self-administered.


    In Queensland, hydroxychloroquine restrictions have been further modified so that:

    • A prescriber initiating treatment can be a doctor training to prepare for specialist registration (i.e. a registrar) in an authorised specialty working under the supervision of an authorised specialist 
    • A prescriber can continue treatment for a chronic condition where initiated by an authorised specialist (in Queensland these also include registered dentists with a registered specialty in oral medicine) or doctors in training as above.


    The National COVID-19 Clinical Evidence Taskforce advise that hydroxychloroquine should not be used for the treatment of COVID-19, but that it may still be considered in the context of randomised trials with appropriate ethical approval, such as combination therapies that include hydroxychloroquine.

    NPS MedicineWise is also providing up-to-date information about hydroxychloroquine and COVID-19 here.

     

  • What advice exists for Ivermectin? New 9 Sept 2020

    NPS MedicineWise advises:
    • Currently there are limited data to support the use of ivermectin for the treatment of COVID-19
    • There are currently no known published data from randomised, controlled clinical trials on the efficacy or safety of ivermectin for treatment of COVID-19
    • Randomised controlled trials are needed to investigate further.
     
    The RACGP has also released information on Ivermectin, which includes advice that it should only be used for COVID-19 in the context of a clinical trial.

     

  • 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. 

Surgery, procedures and essential medical services

  • Are there limits on what the health profession can do during this time? Updated 4 August 2020

    For COVID-10 hotspots, particularly Victoria, see our Q&A 'Are there restrictions on healthcare I can provide in a COVID-19 hotspot?'

    Outside COVID-19 hotspots, where elective surgery and other 'business' restrictions have been eased, medical and other healthcare services have been gradually returning to full capacity in a way that reduces the risk of COVID-19 transmission.

    See our Q&A 'What should my practice do to minimise COVID-19 transmission risk and deal with cases?' for ensuring your practice is taking the necessary steps to reduce the risk of COVID-19 transmission in your patients and staff.

    If undertaking surgeries or procedures, you should review our Q&A on these issues below.

  • What restrictions are there now on elective surgery? Updated 22 Sept 2020

    Metropolitan Melbourne
     
    All non-urgent category 2 elective surgery across public and private hospitals in metropolitan Melbourne is suspended until 28 September 2020.  Only category 1 and the most urgent category 2 surgeries are permitted.  IVF treatments, including egg retrievals, can continue. 
     
    From 28 September 2020, elective surgery will resume at 75% of usual levels.  The following further increases are planned:

    • 85% of usual levels at the Third Step of the COVID-19 reopening roadmap – presently scheduled for 26 October 2020
    • 100% of usual levels at the Last Step of the roadmap – presently scheduled for 23 November 2020.
    Specialist clinic consultations can increase in line with elective surgery activity, but telehealth should be used where possible to reduce face-to-face consultations.

    Information on elective surgery categorisation from Australian Governments, including details on usual urgency categories for various procedures, is available here
     
    You should consult your professional college or association and hospital/s where you work if in any doubt about categorisation for individual surgeries. 
     
    COVID-19 tests are being taken 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. 
     
    Regional Victoria
     
    On 17 September 2020, the suspension since 5 August of non-urgent category 2 and all category 3 elective surgery in regional Victoria public and private hospitals was lifted so that:
    • Elective surgery can increase to 75% of usual levels from 17 September 2020
    • It can increase to 85% of usual levels from 28 September 2020
    • Specialist clinic consultations can increase in line with elective surgery activity, but telehealth should be used where possible to reduce face-to-face consultations. 

    Elective surgery is planned to return to 100% of normal levels at the Last Step of the roadmap, tentatively planned for 23 November 2020.  
     
    Outside Victoria
     
    Outside Victoria, elective surgery is now generally at 100% of pre-COVID-19 elective surgery volumes. 
     
    Issues to consider – restrictions, capacity and patient fitness
     
    You should:

    • Know your state or territory requirements for surgery – for example in NSW there is specific advice around patients who have recently been to COVID-19 hotspots or areas of significant community transmission, pre-surgery screening and infection control
    • 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.

     
    For patients recovering from COVID-19, joint guidance on delays to elective surgery post-recovery have been released by RACS, ANZCA, RANZCOG and RANZCO, indicating that patients with COVID-19 infection diagnosed within 7 days before or up to 30 days after surgery are at risk of post-operative complications.
     
    The Australian Commission on Safety and Quality in Health Care has provided guidance on COVID-19: elective surgery and infection prevention and control precautions and FAQs for clinicians on elective surgery.

  • What steps should I take to ensure I am aware if my patient's elective surgery becomes an emergency or otherwise urgent? Updated 14 May 2020

    If your patient had been booked for, or is likely to need, elective surgery which is not presently permitted where you practice, or is otherwise delayed due to surgical backlogs arising from past COVID-19 restrictions, it is important you have a process where any deterioration or other changes in your patient’s condition which may create a need for urgent surgery are brought to your attention so you can consider any necessary re-categorisation.

  • Can I undertake non-surgical cosmetic procedures? Updated 22 Sept 2020

    Undertaking non-surgical cosmetic procedures is subject to any local state or territory requirements, peak body guidance, medico-legal considerations and local issues (such as if you are in a COVID-19 hotspot - see Q&A Are there restrictions on healthcare I can provide in a COVID-19 hotspot?).

    Metropolitan Melbourne – cosmetic procedures cannot be performed

    The Victorian Department of Health and Human Services and Victorian Health Complaints Commissioner (HCC) have confirmed that cosmetic procedures, including injectables, are not permitted while the Stage 4 restrictions are in place in metropolitan Melbourne.  

    The HCC has indicated that further action may follow if it becomes aware of cosmetic treatment services being provided under Stage 4 restrictions.

    For more information on permissible healthcare in metropolitan Melbourne, see Q&A Are there restrictions on healthcare I can provide in a COVID-19 hotspot? 
     
    Queensland – additional requirements
     
    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)
    • For public areas, has no more than
      • 1 person per 2 sq m (up to 50 total) for spaces of 200 sq m or less
      • 1 person per 4 sq m for larger spaces. 

    Requirements to keep patient contact and attendance details would be met by maintaining necessary               clinical records. 
     
    Peak body guidance – outside metropolitan Melbourne
     
    In terms of peak body guidance and advice:
    • The Australasian Society of Aesthetic Plastic Surgeons and the Australasian Society of Cosmetic Dermatologists have released a cosmetic injectables guide, including the advice that they “recommend a cautious approach during the reintroduction of Cosmetic Injecting treatments using neurotoxins and tissue fillers keeping patients and practices safe whilst not wasting valuable resources
    • The Cosmetic Physicians College of Australasia has released guidelines on returning to cosmetic medicine (non-surgical) practice.

Registration and training issues

  • What if I am having difficulty paying my medical registration fees? New 17 July 2020

    The Medical Board has announced a payment plan for doctors experiencing genuine financial hardship due to COVID-19, based on a doctor’s individual circumstances.

    To be eligible you must be unable to reasonably provide necessities such as food, accommodation, clothing, education and/or medical treatment for yourself, your family or other dependents, and by extension, the costs associated with your registration and:

    • Be currently unemployed or unable to work because of caring responsibilities or illness, and/or
    • Not be eligible for and/or not receiving any available Australian Government upport payments (e.g. JobSeeker or JobKeeper).


    Eligible doctors will be able to pay half their registration fee on renewal before 30 September 2020, and the remainder in early 2021.

    Applications for the payment plan need to be made before renewal.

    More information is available here.

  • Am I still required to complete the same continuing professional development? Updated 9 Sept 2020

    The Medical Board has confirmed it generally will not take action if you cannot meet continuing professional development (CPD) registration requirements on this year’s registration renewal.
     
    A range of colleges and associations have already released information around COVID-19 impacts on CPD requirements (see links below under Other information and resources).
  • How might the COVID-19 pandemic impact my medical student training? Updated 14 May 2020

    MIGA is aware that the COVID-19 pandemic has had significant impacts on many of its medical student members. 

    Medical Deans of Austalia and New Zealand, the Medical Board and Australian Medical Council have released a joint statement on supporting future doctors during COVID-19, indicating:
     
    • It is vital that students’ progression through their medical training continues
    • Reducing clinical placement experience to the extent that it affects progression and graduation will impact the supply of work-ready and pandemic-cognate graduates for 2021 onwards
    • Everything possible needs to be done to ensure clinical placements are maintained
    • Where student participation has been paused, to allow time for new forms of placements and workforce roles to be established, schools are ensuring students are well-prepared and well-supported.

    The Australian Medical Students’ Association is also providing regular updates to medical students. 

    If you are approached about or considering a role outside a clinical placement or an elective, such as an assistant in medicine role, you should contact MIGA.
  • I am concerned about completing my internship. What information is available? Updated 22 Sept 2020

    The Medical Board has published information for interns around waiving usual rotation requirements for 2020, setting out revised requirements.  These include level of full-time equivalent work, rotations, supervision and teaching.   It also covers evidence required for granting general registration following internship.
  • Where can I find out about changes to my college/association training requirements due to COVID-19? New 1 May 2020

    Although colleges and associations have been providing information about changes to specialist training due to COVID-19, the AMA Council of Doctors in Training has prepared a resource, being updated regularly, to support current and aspiring specialty trainees to keep up-to-date with examinations, career progression, fees and leave. 

  • As an international medical graduate, how might COVID-19 affect my registration? New 1 May 2020

    The Medical Board has confirmed that it will not refuse to renew the registration of an international medical graduate (IMG) for 20202 solely because of inability to set an Australian Medical Council or college exam / assessment from March 2020.

    The Board has also streamlined processes around IMG redeployment in hospitals.  More information is available here.
  • I have conditions or undertakings on my registration. Am I still required to comply with them? Updated 22 May 2020

    Yes, you must continue to comply with conditions or undertakings on your registration.

    The Medical Board has published guidance on a range of issues relating to compliance with conditions and undertakings during the COVID-19 pandemic.

    For NSW doctors, information about compliance with conditions, and impact of COVID-19 on these, is available here.

Returning to the workforce

  • 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.

Other information 

Updated 4 August 2020

Details of public health directions for states and territories are available below:

Victoria
New South Wales
Queensland
South Australia
Western Australia
Tasmania
ACT
Northern Territory

A range of professional groups have been assisting the profession respond to the challenges of COVID-19, including AMA, RACGP, ACRRM, RACP, ACEM, ANZCA, ASA, RANZCO, ANZICS, RANZCR, RACS, RANZCOG, AOA, CSANZASID, GESA, ASPS, ACCS, ACAM, ACM and ANMF

Peak clinical groups, with the support of Australian Governments, have put together the National COVID-19 Clinical Evidence Taskforce.  The NSW Health COVID-19 Critical Intelligence Unit also provides daily updates on new evidence and reports.

Our government health departments are important sources of information and advice to the profession, updated regularly - Commonwealth (advice and resources), South Australia, NSW, Victoria, Qld, WA, Tasmania, ACT and NT.

NPS MedicineWise has resources on medication prescribing during COVID-19. 
 
The Therapeutic Goods Administration also has Covid-19 information for medicines and medical devices here.
Ahpra is also providing information around a range of registration and other regulatory issues here.

We encourage you to regularly check information from health departments and professional bodies as it is updated frequently.

Contact details for State and Territory Public Health Units are as follows:
 

ACT

02 5124 9213 or 02 9962 4155 after hours

NSW

1300 066 055

NT

08 8922 8044

QLD

13HEALTH (13 43 25 84)

SA

1300 232 272

TAS

1800 671 738

VIC

1300 651 160

WA

08 9328 0553


For workplace issues relating to COVID-19, the Fair Work Ombudsman and Safe Work Australia provide a range of information.

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.