Novel COVID-19

Update 17 September 2021

MIGA’s COVID-19 medico-legal and insurance Q&A covers the latest pandemic developments for our members and clients.

Categories include:


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

Insurance cover for COVID-19 vaccinations

Note - the answers in this section only apply to MIGA policies issued to doctors, Eligible Midwives and healthcare businesses which are current as at the date of publication.  Your individual cover is subject to the terms and conditions of your policy with MIGA and your chosen category of practice.  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 administration of COVID-19 vaccinations.
  • Am I covered for services related to COVID-19 vaccinations including administering the vaccines? New 1 Feb 2021

    Yes.
    • You are covered with MIGA for claims and inquiries arising from COVID-19 vaccination services you provide
    • We cover you for healthcare services provided within your category of insurance/scope of practice or healthcare business that is consistent with with your qualifications, training, experience or the healthcare services provided by your practice/business
    • You should ensure you comply with all relevant requirements and guidelines - see Q&A - What do I need to do if I’m involved in the COVID-19 vaccination program?
    • 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 guide you on potential medico-legal issues involved.
    • You should let us know as soon as possible if you become aware of any claim or potential claim arising from administering the vaccines.
  • Do I need to let MIGA know that I plan to be involved in the administration of the COVID-19 vaccines? New 1 Feb 2021

    No. 
    • Unless you are in a category of insurance that does not include cover for private practice
    • If you are considering entering into any agreement (with governments, healthcare providers or otherwise) to be involved in COVID-19 vaccination services, you should contact MIGA prior to signing any agreement to ensure that you are not assuming any responsibilities for which we are not able to provide cover
    • We can also help you understand any insurance and medico-legal implications of any agreement.
  • Am I covered if I am working outside of my usual scope of practice to administer COVID-19 vaccines? New 1 Feb 2021

    Yes, if it is permitted by your Ahpra registration, you have appropriate qualifications, training and experience and you are in the appropriate category of insurance with MIGA.
    • You should only provide healthcare you are appropriately qualified and trained for and have sufficient experience to provide
    • Ahpra has provided the following information about medical practitioners moving into new roles in responding to the COVID-19 pandemic
    • If the work you are planning to undertake is outside of your usual area of practice, you should ensure you will meet your regulatory obligations with Ahpra
    • We recommend you take the following steps before starting your new work:
      • Ensure your Ahpra registration does not restrict or prevent you from engaging in the new scope of practice
      • 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
      • Ensure your proposed practice is consistent with your hospital/facility credentialing
      • Confirm with your hospital, practice or other workplace (preferably in writing) that you will have the benefit of any indemnity you are normally entitled to as an employee or contractor (e.g. as a visiting medical officer for public patients) 
      • Ensure you do not use a specialist title unless you have the appropriate qualifications – for more information see Ahpra’s guide on health titles
      • Contact MIGA to ensure you have the right category of insurance cover with us. 
  • Will my policy provide cover if my employees administer the vaccine and there is a complaint or claim? New 1 Feb 2021

    Yes

    • You are covered for your own vicarious liability as an employer but remember that you should ensure that your employees are working under your supervision and within the scope of their duties and responsibilities as you have agreed with them.
    • If you are:
      • a doctor, remember that your policy covers some but not all kinds of employees for claims made directly against them - refer to the important note at the top of this update regarding employees who need their own insurance
      • a midwife, remember that your policy covers you personally and not any employees
      • a healthcare company, remember that your policy only covers your employed doctors if the relevant optional extension is included in your Schedule.
  • If I'm asked to administer vaccines to public patients in a public hospital, am I covered for this New 1 Feb 2021

    Generally, No
    • If you are employed in a public hospital (including if you are a medical student) you will generally be indemnified by the hospital for work you undertake
    • If you are insured as a Hospital Doctor with MIGA, cover is generally only for legal expenses for inquires and investigations for which you are not otherwise indemnified or insured and for some limited private practice you may undertake outside your public practice employment
    • If you work in the public health system and plan to undertake work in the private system to administer the COVID-19 vaccines, contact us to check the extent to which you may be covered for private work under your category of insurance
    • If in doubt, please check with your hospital’s administration to clarify your indemnity situation or call MIGA to clarify your position.
  • Is my practice or healthcare business covered by MIGA's Healthcare Policy if it contracts to be part of the COVID-19 vaccination program? New 1 Feb 2021

    Yes.

    • MIGA’s Healthcare Policy for entities will cover the business and its employees (excluding doctors and other who bill on their own right) for claims and inquiries arising from their involvement in the vaccination program
    • This is provided it is within their usual scope of practice/specified business and it is subject to them complying with all relevant requirements and guidelines (see Q&A - What do I need to do if I’m involved in the COVID-19 vaccination program?).
    • Employed medical practitioners are not covered by the policy (unless MIGA has agreed to this) and will need to be covered under an individual practitioner policy with MIGA.
  • If I am asked to sign a contract for COVID-19 vaccine administration, what should I do? New 1 Feb 2021

    If you are considering entering into any agreement (with governments, healthcare providers or otherwise) to be involved in COVID-19 vaccination services, you should contact MIGA prior to signing any agreement to ensure that you are not assuming any responsibilities we are not able to provide cover for, and to understand what insurance and medico-legal implications there may be. 

    Contracts may impose obligations on you that you would not otherwise have, or they may ask you to give up rights that you would otherwise have.  Your insurance does not cover you for these changes to your rights and responsibilities unless we first agree in writing to cover you.

  • What do I need to do if I'm involved in the COVID-19 vaccination program? New 1 Feb 2021

    It is extremely important that you are familiar with and follow all guidelines provided by the manufacturers, distributors, Federal and State Governments and your professional college/association.  Be aware these guidelines may be updated regularly as circumstances change and new information becomes available.

    MIGA is working closely with Australian Governments and professional groups on the COVID-19 vaccine program and will provide further information on guidelines and other information on this website once released. 

COVID-19 vaccinations - medico-legal Q&As

Note - the answers in this section only apply to MIGA policies issued to doctors, Eligible Midwives and healthcare businesses.

COVID-19 vaccination - availability and eligibility

  • Which COVID-19 vaccines are available? Updated 10 September 2021

    The TGA has:
    • Provisionally approved the Pfizer / BioNTech mRNA vaccine ‘Comirnaty for use in those aged 12 or over – its use for patients is subject to Government eligibility criteria  - see Q&A When are people eligible for COVID-19 vaccines?)
    • Provisionally approved the University of Oxford / AstraZeneca ‘VAXZEVRIA’ viral vector vaccine – its use for patients is subject to Government eligibility criteria  – see Q&A What are the recommended age groups for the AstraZeneca vaccine?
    • Provisionally approved of the Moderna mRNA vaccine Spikevax (Elasomeran) for use in those aged 12 and over - eligibility criteria are yet to be determined pending vaccine availability
    • Is evaluating the Novavax protein vaccine for provisional registration in Australia.

    Although the TGA has provisionally approved the Janssen / Johnson & Johnson viral vector one dose vaccine for ages 18 and over, it is not included in Australia’s COVID-19 vaccination program and is not available here. 
  • Who can be involved in delivery of COVID-19 vaccines? Updated 23 July 2021

    A range of doctors and nurses working in hospitals, approved GP clinics, Commonwealth GP vaccination / respiratory clinics, Aboriginal Controlled Community Health Services, state / territory mass / community vaccination clinics, and approved pharmacies are involved in vaccine delivery.

    Ability to authorise and administer COVID-19 vaccinations is based on:

    • Having necessary training and experience to provide immunisation
    • Completing the Commonwealth Government’s online COVID-19 vaccination training program – there may also be other required / suggested training in individual states and territories, particularly for new immunisers or those working in state immunisation clinics / hospitals – see for example Victoria, Queensland and WA
    • Being an authorised immunisation provider in your state / territory.

    Authorised immunisation providers generally include doctors, nurse practitioners and registered nurses. 

    The Commonwealth Health Department has confirmed that all health professionals involved in COVID-19 vaccine administration, including those only overseeing vaccinations, must complete the required training.

    For COVID-19 vaccination Medicare billing, activities associated with individual items can only be undertaken by suitably qualified and registered health practitioners working within their scope of practice and who have undertaken required COVID-19 vaccination training.  A range of Q&A below deal with Medicare billing requirements. 
     
  • Which COVID-19 vaccines will I be able to use? Updated 17 September 2021

    What COVID-19 vaccines can be used depends on TGA approvals and Australian Government frameworks.

    You cannot choose what vaccine you will use on patients.

    At this stage:
    • Various hospitals, Commonwealth GP vaccination / respiratory clinics, state and territory mass / community vaccination centres, Aboriginal Community Controlled Health Services and other contracted service providers are delivering both the Pfizer and AstraZeneca vaccines (see Q&A When are people eligible for COVID-19 vaccines?) 
    • Pfizer vaccines are available in some approved GP clinics, with all approved GP clinics providing AstraZeneca vaccines
    • AstraZeneca vaccination is being delivered in approved pharmacies across the country
    • At this stage the Australian Government has no intention of sourcing the Janssen / Johnson & Johnson viral vector vaccine.

    The Commonwealth Government has foreshadowed:
    • All GP practices currently involved in the COVID-19 vaccine roll-out will be eligible to deliver the Pfizer vaccine, in addition to the AstraZeneca vaccine (use of this will decrease significantly once those aged 60 and over are fully vaccinated), later this year
    • Moderna vaccine is expected to become available for delivery in some pharmacy and government clinic settings from 20 September 2021, with possible use through workplace vaccination programs too.
  • When are people eligible for COVID-19 vaccines? Updated 17 September 2021

    Although the TGA has provisionally approved use of Pfizer and Moderna vaccine in those aged 12 and over, and AstraZeneca vaccine in those aged 18 and over, these vaccines can only be given in accordance with Commonwealth, state and territory government approvals.These vary across the country and are detailed below.

    The Commonwealth Government provides an eligibility checker to assist in determining whether a person is eligible for COVID-19 vaccination at a particular time under the Commonwealth scheme, and provide further information on assessing eligibility. 

    GP clinics, Commonwealth GP vaccination / respiratory clinics, Aboriginal Controlled Community Health Services and pharmacies

    All those aged 12 and over are now eligible for Pfizer vaccination at approved GP clinics, Commonwealth GP vaccination / respiratory clinics and Aboriginal Controlled Community Health Services.

    AstraZeneca vaccination is now available to anyone aged 18 years and over at approved GP clinics, Commonwealth GP vaccination / respiratory clinics, Aboriginal Controlled Community Health Services and approved pharmacies.  For more information on using this vaccination, particularly for those under 60 years of age, see Q&A:

    • What are the recommended age groups for the AstraZeneca vaccine?
    • What steps should I take in considering whether a patient under 60 years of age should receive the AstraZeneca vaccine? 
    • How can I provide informed consent for COVID-19 vaccines? 

    State / territory clinics

    Pfizer vaccination is available to those aged 40 to 59 at state / territory vaccination clinics and is also available to additional age groups in those clinics as follows:
    • New South Wales – year 12 students and others aged 16 to 39 in high risk LGAs and suburbs
    • Victoria and ACT – ages 16 to 59
    • Queensland, South Australia, Western Australia and Northern Territory - ages 12 and over
    • Tasmania and (from 20 September 2021) ACT - ages 12-59.

    AstraZeneca vaccination is also available to all those aged 18 or over at state / territory vaccination clinics.
  • What proof do I need from a patient of COVID-19 vaccine eligibility? Updated 3 September 2021

    The Australian Government has indicated that proof of vaccination age eligibility can be based on all standard forms of identification, including drivers license or passport), which should be noted in the clinical record.

    You also need to check the patient hasn’t already received a COVID-19 vaccine elsewhere.  If in doubt, information on this may be accessible via the Australian Immunisation Register, Clinician Vaccine Integrated Platform or a patient’s My Health Record (via the new immunisation view).

    Eligibility does not need to be confirmed again for the second vaccination if the first one is already on the Australian Immunisation Register. 

COVID-19 vaccination - advertising and social media

  • Can I advertise COVID-19 vaccination to my patients or post about it on social media? Updated 3 August 2021

    Yes, you can advertise / promote COVID-19 vaccination to your patients and the community, within limits set out below.  This includes on physical signage, websites and social media.

    The TGA and Ahpra have issued a joint statement explaining the need for promotion of COVID-19 vaccinations to comply with both TGA and Health Practitioner Regulation National Law requirements. 


    TGA requirements

    Although advertising vaccinations and prescriptions medications is generally not permitted, the TGA has made an exception for COVID-19 vaccines on the Australian Register of Therapeutic Goods (namely the Pfizer and AstraZeneca vaccines) and provided detailed guidance on this issue, including examples.  It generally considers advertising to include content, such as promotional terms or language, which encourages people to seek out COVID-19 vaccines. 

    What the TGA considers acceptable advertising of COVID-19 vaccines includes:

    • Using material developed by Australian Governments (federal, state and territory) – for example the Commonwealth Government communication kit and posters
    • Self-developed materials which are consistent with Australian Government messaging,

    You cannot add / include any of the following in Government materials / to self-developed materials:
    • Tradename, sponsor name and/or active ingredient of the specific vaccine, except that Commonwealth Government materials or self-developed materials from approved COVID-19 vaccination providers referring to Pfizer and AstraZeneca vaccine being offered at the practice can be used
    • Statements to the effect that COVID-19 vaccines cannot cause harm or have no side-effects
    • Statements comparing COVID-19 vaccines, or comparing those vaccines with other treatments
    • Any statement regarding COVID-19 vaccines which is false or misleading.

    According to the TGA ‘factual and balanced’ information about COVID-19 vaccines is unlikely to be considered advertising and subject to its restrictions.  Examples it has given include:
    • Technical information relating to how the vaccines were developed and manufactured
    • Statements a clinic or pharmacy does not have stock of a particular vaccine
    • Sharing scientific reports from reputable sources (like the World Health Organization) about vaccination, without including promotional material or language
    • Re-tweeting or sharing valuable newsworthy information from reputable sources about the COVID-19 vaccines
    • Presenting comprehensive information that doesn't emphasise the benefits over, for example, the risks and limitations.


    In addition, usual preclusions on health professionals endorsing a medicine do not apply to Australian registered COVID-19 vaccinations.


    National Boards / Ahpra requirements

    Healthcare advertising, including social media, is also regulated by the National Boards / Ahpra, who have an advertising hub providing information and resources, including advertising and social media guidelines.

    For COVID-19 vaccination, the National Boards / Ahpra have indicated:

    • Accurate” information and advice should be provided about COVID-19 vaccination - including in social media and advertising
    • Health practitioners must also ensure that up to date and reputable sources of information are accessed to support the provision of advice and information about COVID-19 vaccines
    • Any promotion of anti-vaccination statements or health advice which contradicts the best available scientific evidence or seeks to actively undermine the national immunisation campaign (including via social media) is not supported by National Boards and may be in breach of the codes of conduct and subject to investigation and possible regulatory action”.

    Be aware that the National Boards / Ahpra proactively monitor advertising and social media, and may take action even if no notification / complaint has been made to them.  If you receive communications from Ahpra about your advertising / social media, contact MIGA’s lawyers. 


    Offering incentives for vaccination

    Any person / organisation can offer valuable incentives (case or other rewards) to people who have been fully vaccinated under the Commonwealth Government’s COVID-19 vaccine roll-out as follows:
    • They can only be made to people who have been fully vaccinated (ie completed their course of Pfizer or AstraZeneca vaccination)
    • The offer must include a statement to the effect that vaccination must be undertaken on the advice of a health practitioner
    • They cannot include alcohol, tobacco or medicines (other than listed medicines)
    • Offers can only be more COVID-19 vaccinations generically, not a particular brand or type of vaccination
    • Any offer must be made to all eligible people who have been vaccinated – for example it cannot be made only to those people vaccinated after the date of the offer – it must also apply retrospectively. 

    Doctors and other registered health practitioners are subject to National Board / Ahpra regulation in offering incentives, particularly the need to clearly state the terms and conditions of any gift, discount or other inducement.  Be careful to ensure that any incentives do not encourage what could be considered to directly or indirectly encourage the “indiscriminate or unnecessary use” of health services provided by doctors or other practitioners.

    Other resources

    MIGA also provides an overview of your advertising obligations generally, including recent changes. 
  • Do the COVID-19 vaccine advertising restrictions apply to consultations with patients Updated 18 June 2021

    No, they do not.

    The TGA and Ahpra have confirmed that “a practitioner providing information about treatment in a consultation is not considered to be advertising a regulated health service”. 

    The TGA has confirmed “if a patient asks their doctor what brand of vaccine they will be receiving the doctor can provide advice to the patient without risk of breaching the advertising laws”.

  • Can I offer incentives to patients to undergo COVID-19 vaccination? Updated 18 June 2021

    Any person / organisation can offer valuable incentives (case or other rewards) to people who have been fully vaccinated under the Commonwealth Government’s COVID-19 vaccine roll-out as follows:

    • They can only be made to people who have been fully vaccinated (ie completed their course of Pfizer or AstraZeneca vaccination)
    • The offer must include a statement to the effect that vaccination must be undertaken on the advice of a health practitioner
    • They cannot include alcohol, tobacco or medicines (other than listed medicines)
    • Offers can only be more COVID-19 vaccinations generically, not a particular brand or type of vaccination
    • Any offer must be made to all eligible people who have been vaccinated – for example it cannot be made only to those people vaccinated after the date of the offer – it must also apply retrospectively.


    Doctors and other registered health practitioners are subject to National Board / Ahpra regulation in offering incentives, particularly the need to clearly state the terms and conditions of any gift, discount or other inducement.  Be careful to ensure that any incentives do not encourage what could be considered to directly or indirectly encourage the “indiscriminate or unnecessary use” of health services provided by doctors or other practitioners.

    The TGA and Ahpra have issued a joint statement providing further guidance on offering rewards for COVID-19 vaccination.

  • Am I permitted to post links on social media to research about COVID-19 vaccines? New 12 March 2021

    The TGA has indicated that:

    Provided the posts and the articles themselves do not constitute advertising [see Q&A Can I advertise COVID-19 vaccination to my patients or post about it on social media?] … there is no issue with posting links to the articles on social media.

    Where written in a scientific context, the medical journal articles reporting on clinical trials and studies related to COVID-19 vaccines are unlikely to be considered advertising – especially where they are comprehensive and report not just on the study outcomes but also any adverse events identified and any limitations of the study itself.

    However, care needs to be taken in the phrasing of a social media post for the article to ensure it is not considered advertising – for example, a ‘Brand X COVID-19 vaccine shows superior efficacy to Brand Y vaccine in new clinical trial’ would be promotional; ‘outcomes of clinical trial assessing efficacy of Brand X and Brand Y COVID-19 vaccines’ would not.

    Keep in mind National Board / Ahpra requirements around social media use and advertising – see Q&A Can I advertise COVID-19 vaccination to my patients or post about it on social media?

COVID-19 vaccination - assessment, precautions / contraindications and informed consent

  • What are the recommended age groups for the AstraZeneca vaccine? Updated 28 July 2021

    ATAGI has provided separate advice for use of AstraZeneca vaccine in each of Greater Sydney, significant outbreak and non-outbreak settings. 

    Greater Sydney region
    On 24 July 2021 ATAGI issued specific advice on use of AstraZeneca vaccine in Greater Sydney during its COVID-19 outbreak, recommending all individuals aged 18 years and above in Greater Sydney, including adults under 60 years of age, should strongly consider getting vaccinated with any available vaccine, including AstraZeneca vaccine.

    Significant outbreak settings
    On 13 July 2021 ATAGI released updated advice on indications for AstraZeneca vaccine in an outbreak setting:

    • Ages 60 and over:
      • AstraZeneca vaccine benefits strongly outweigh the risks of adverse effects
      • Vaccination is essential for this group in the context of an outbreak.
    • Under 60 years of age:
      • Where Pfizer supply is constrained, adults younger than 60 years old without immediate Pfizer access should re-assess the benefits to them and their contacts from AstraZeneca vaccination, versus the rare risk of a serious side effect
      • Changing risk-benefit balance is illustrated in previously published scenarios
      • Current cumulative risk of COVID-19 for Sydney residents to 11 July 2021 is approximately 10 per 100,000 and is increasing by 2 additional cases per 100,000 per day
      • Although overall this is comparable to the Australian first wave (cumulative incidence 29 per 100,000), the ongoing risk would be considerably greater in some parts of Sydney and for specific populations – for Fairfield local government area the cumulative risk to date is >100 per 100,000 and has increased by >10 cases per 100,000 per day in the past week.

    ATAGI also provides specific advice on pre-vaccination / informed consent discussions with patients in these settings – see Q&A How can I provide informed consent for COVID-19 vaccines? 
     
    Non-outbreak settings
    On 17 June 2021 ATAGI issued recommendations (which the Federal Government “fully accepts”) on use of AstraZeneca vaccine in certain age groups in non-outbreak settings:

    • Pfizer vaccine is preferred over the AstraZeneca vaccine in people under the age of 60 years
    • AstraZeneca vaccine can still be given to adults under 60 years if:
      • Pfizer vaccine is not available
      • Benefit of AstraZeneca vaccination outweighs the risk of thrombosis with thrombocytopenia’ syndrome (TTS) in the age group
      • The patient has made an informed decision based on an understanding of the risks and benefits – see Q&A How can I provide informed consent for COVID-19 vaccines?
    • People of any age without contraindications who have had their first AstraZeneca dose without any serious adverse events should receive the second AstraZeneca dose
    • In people aged 60 years and over, the benefits of AstraZeneca vaccine outweigh the risks of TTS.


    The Commonwealth Health Department has released information for immunisation providers on TTS following COVID-19 vaccination and a patient information sheet on thrombosis with thrombocytopenia syndrome.
    THANZ has provided a multidisciplinary guideline for suspecting and treating TTS cases.

  • What steps should I take in considering whether a patient under 60 years of age should receive the AstraZeneca vaccine? Updated 23 June 2021

    For any patient under 60 being considered for a first dose of AstraZeneca vaccination, MIGA recommends:

    • Be aware what available, local options a patient may have for Pfizer vaccination (see Q&A When are people eligible for COVID-19 vaccines?) – if possible, this would be the preferred course for their COVID-19 vaccination, in line with ATAGI recommendations (which vary depending on whether you are in a significant outbreak or non-significant outbreak setting – see Q&A What are the recommended age groups for the AstraZeneca vaccine?)
    • The patient be seen by a doctor in the practice who is across the latest ATAGI advice and information on clotting risks more generally
    • Be very clear on what the patient’s underlying vulnerabilities / illnesses mean if they contracted COVID-19, and their current risk of contracting it
    • Explain to patients the Commonwealth Government information on weighing up potential benefits against risk of harm for AstraZeneca vaccine to consider whether to use this vaccine and in advising patients
    • Go through the potential benefits and risks with the patient - the Commonwealth AstraZeneca vaccine information sheet and COVID-19 vaccine consent form have been updated detailing this information, and a specific information sheet on these issues has been produced by the Commonwealth Government
    • In assessing the patient’s specific clinical and public health risks, you could consider as appropriate:
      • Liaising with your local public health unit on the suitability of using AstraZeneca vaccine at this stage of the pandemic
      • Seeking advice from treating specialists, the local immunisation service and / or local primary health network on the particular patient’s risks / benefits.
    • Invite the patient to take time to consider the information they have been given, unless there is a compelling need for vaccination soon
    • If the patient goes ahead with AstraZeneca vaccination, make sure they are clear about the possible signs and symptoms of clotting disorders to watch out for, and what to do in response
    • Document these steps and discussions in the patient’s clinical records.
  • What other advice is available on COVID-19 vaccination for certain conditions, contraindications and precautions? Updated 20 August 2021

    General contraindications

    Contraindications to both the Pfizer and AstraZeneca vaccines are:

    • Anaphylaxis / hypersensitivity to any components of the vaccine being used
    • Anaphylaxis after a previous dose of the same vaccine.   

    General advice and precautions

    Precautions for Pfizer and / or AstraZeneca vaccines are detailed in:
    The following resources provide information about specific conditions:
  • What information is available about COVID-19 vaccine adverse events? Updated 9 April 2021

    Weekly reporting on Australian COVID-19 vaccine adverse events is available from:

  • How can I provide informed consent for COVID-19 vaccines? Updated 20 August 2021

    Appropriate informed consent for COVID-19 vaccination is similar to that for other vaccinations.

    Generally you are required to disclose risks which are ‘material’ to a reasonable person in the patient’s position, or which are ‘material’ to that particular patient.  This will depend on how the patient’s condition and how much information they seek. 

    Specific considerations for AstraZeneca vaccination
    For use of AstraZeneca in significant outbreak settings, ATAGI advises pre-vaccination discussions / informed consent should include Information about common and rare but serious side effects, including the symptoms and signs of the thrombosis with thrombocytopenia syndrome (TTS) (latest TTS risk data is here).

    For the benefits and risks of the AstraZeneca vaccine in any setting:
    • ATAGI’s latest advice on AstraZeneca vaccine should be covered with patients - see Q&A What are the recommended age groups for the AstraZeneca vaccine?
    • The Commonwealth Health Department has released:
      • Information on how ATAGI assesses potential benefits and risk of harm from the AstraZeneca vaccine,
      • A patient information sheet on thrombosis with thrombocytopenia syndrome
      • A guide on talking to patients about the AstraZeneca vaccine..

    COVID-19 vaccination – informed consent generally
    ATAGI has produced a guide to obtaining informed consent for COVID-19 vaccination. It sets out a range of suggested discussion points and information (including a checklist) to assist in answering them, including:
    • Benefits and risks of vaccination
    • Continuing possibility of COVID-19 transmission
    • Need for a second dose of the same vaccine
    • Vaccine safety, possible side-effects and their management, including when to seek medical care
    • Continuation of public health measures (including physical distancing, hand washing, COVID-19 testing)
    • Mandatory reporting vaccinations on the Australian Immunisation Register.

    For more information see Q&A What are the recommended age groups for  the AstraZeneca vaccine?

    Generally you should consider:
    • Whether there are any potential contraindications / precautions which should be raised
    • Potential adverse events
    • Previous experiences with vaccinations, particularly adverse reactions
    • Personal and public health benefits of vaccination
    • Any particular concerns which the patient may have. 

    There is no requirement for written consent from the patient, but MIGA recommends:
    • Using the Australian Government Consent form for COVID-19 vaccination or similar forms developed by your hospital
    • All consent should be documented in patient records
    • For patients with precautions or who raise concerns, documenting your discussions with the patient. 

    For those involved in providing COVID-19 vaccinations in a hospital setting, your state / territory or local hospital (for example NSW or Queensland hospitals) may have particular information and consent forms to be used for patients as part of the vaccination process.

    MIGA’s resource What is informed consent provides more information about general requirements for informed consent.   

    Specific issues – pregnancy, older people or patients lacking capacity
    For women who are considering pregnancy, pregnant or considering breastfeeding, see RANZCOG  - COVID-19 Vaccination in Pregnant and Breastfeeding Women and those planning pregnancy.

    A decision guide has also been prepared by the Australian Government for frail older people, including those in residential aged care facilities.

    For situations when a patient lacks capacity to provide informed consent, see MIGA’s resources Substitute consent and Q&A How do I seek consent for vaccination if my patient is under guardianship or has no substitute decision-maker?
  • Do I need to get informed consent again before the second vaccine dose? New 25 June 2021

    If circumstances have changed between first and second doses (e.g. updated ATAGI advice, adverse events following first dose) an informed consent covering those changed circumstances should be obtained prior to the second dose. 

  • I am administering vaccinations in an aged care facility. Who is responsible for providing informed consent? Updated 6 July 2021

    The Commonwealth Government has advised the aged care facility is responsible to ensure informed consent is obtained from the resident (or their substitute decision-maker if they lack capacity) for vaccination.

    Facilities are required to have a Clinical Lead (e.g. a registered nurse) who is responsible for vaccine program management at the facility, including liaising with immunisation providers and ensuring informed consent has been obtained.   Facilities are required to consult with GPs if there are concerns about a resident’s suitability for a vaccine. 

    More information around responsibilities is available in the following Australian Government guides:


    You will need to ensure informed consent has been provided prior to vaccinating the patient.  Completion of the Australian Government Consent form for COVID-19 vaccination would generally be sufficient.   If not provided, you should ensure informed consent is provided prior to vaccination (see Q&A How can I provide informed consent for COVID-19 vaccines?). For patients who lack capacity and are either under guardianship or do not have a substitute decision-maker, see Q&A How do I seek consent for vaccination if my patient is under guardianship or has no substitute decision-maker?

    The Commonwealth Health Department has also released a decision guide for frail older people, including those in residential aged care facilities.

    The Australian Government has also advised immunisation providers should be alert to residents that have a bleeding disorder or are taking anti-coagulant medication – see Q&A What other advice is available on COVID-19 vaccination for certain conditions, contraindications and precautions? 

    You may encounter residents and family members who have questions after informed consent has been provided.  Even though consent may already have been provided, as is the case before any healthcare you need to try and answer the questions to the best of your ability and ensure they are comfortable to proceed prior to vaccination. 

    MIGA’s resource Capacity and consent in the elderly provides further information around capacity and consent issues for this age group.

  • How do I seek consent for vaccination if my patient is under guardianship or has no substitute decision-maker? Updated 25 June 2021

    Public Guardians / Public Advocates across the country have differing requirements around consent for COVID-19 vaccination for persons under their guardianship for healthcare and who are unable to provide consent to vaccination themselves.

    For example, in seeking consent for vaccination for a person under guardianship who is unable to provide consent themselves:

    • NSW – Will only accept the Australian Government COVID-19 vaccination consent form as part of an application for consent to vaccination if assessment is undertaken and the form is signed by a doctor.  Otherwise the Guardian’s usual application form must be used
    • Vic and Qld – will only accept usual applications for consent, not the Australian Government consent form, even if signed by a doctor. 

    There may also be situations where Public Guardian / Advocate consent to vaccination is required, even if they are not the person’s guardian.  These requirements differ across the country.  For example:
    • Vic – Public Advocate indicates:
      • If there is no medical treatment decision maker, a health practitioner, such as the person’s GP, needs to decide if the vaccine administration is ‘significant’ or ‘routine’ treatment.
      • If it is routine treatment, the health practitioner can make the decision but must record the details in their notes.
      • If it is significant treatment, for example if the injection will cause the person distress or there is a risk of significant side effects, the health practitioner must request the Public Advocate to make the decision (by completing the s.63 for COVID-19 vaccine online form).
    • NSW – MIGA understands that Public Guardian considers COVID-19 vaccination be ‘minor treatment’ which can be given without consent if there is no person responsible, or they cannot be located or are unwilling to give a decision – consent from the Public Guardian is not required. However the doctor providing or supervising vaccination will be required to certify in writing in the patient’s clinical record that:
      • Vaccination is necessary and is the form of treatment which will most successfully promote the patient’s health and well-being
      • The patient does not object to vaccination. 

    If you are involved in providing COVID-19 vaccinations to people who lack capacity and do not have a substitute decision-maker (guardian, person responsible or similar), and you are uncertain about local requirements where you practice, you should liaise with your state / territory Public Guardian / Advocate. 
  • What advice is available on providing COVID-19 and flu vaccines at the same time? Updated 11 June 2021

    Generally
    ATAGI advises:
    • Co-administration of COVID-19 vaccine with other vaccines is not routinely recommended. A
    • A minimum 7-day interval is advised between administration of a COVID-19 vaccine and any other vaccine, including influenza vaccine.  This interval can be shortened (including same day administration) in special circumstances, including:
      • Increased risk of COVID-19 or another vaccine-preventable disease (e.g. COVID-19 outbreak, influenza outbreak, tetanus-prone wound)
      • Logistical issues e.g. difficulty scheduling visits to maintain the 7 day interval.

    More information is contained in ATAGI advice on influenza and COVID-19 vaccines, and on seasonal influenza vaccination in 2021

COVID-19 vaccination - post-vaccine observation, reporting and second doses

COVID-19 vaccination - Medicare and billing

  • How is COVID-19 vaccination billed to Medicare? Updated 15 July 2021

    Temporary Medicare COVID-19 vaccine suitability assessment bulk billing only item numbers incorporating bulk billing incentives are available.  An additional MBS service fee is now also available for certain attendances at a residential aged care / residential disability facility or person’s home to provide COVID-19 vaccination, including for vaccinating facility staff members and  patients unable to attend the doctor’s practice.

    These items are only available for use in GP clinics selected to participate in the Australian Government COVID-19 vaccine roll-out.  They cannot be used by other doctors or practices for assessment of vaccine suitability.  They are not used in Commonwealth GP vaccination respiratory clinics, Aboriginal Controlled Community Health Services or state / territory immunisation clinics.


    You should be familiar with the following MBS COVID-19 vaccination and follow their requirements strictly:



    There are different standard items for:

    • GPs (including other medical practitioners working in general practice who are not RACGP or ACRRM fellows) and other medical practitioners (specialist medical practitioners and consultant physicians working in a general practice setting who are not vocationally registered GPs)
    • Urban and rural settings – a general practice’s Modified Monash location can be identified via DoctorConnect
    • After hours services (based on usual non-urgent MBS after-hours periods).

    There are also COVID-19 Vaccine Incentive Payments for practices enrolled in the Practice incentives program who provide both a first and second MBS vaccine assessment service to a patient. 

    The items are billed in the name of the supervising GP (or other doctor working in general practice), who must be present at the location where the assessment is being undertaken and accept “full responsibility” for the service.

    Activities associated with each item can be undertaken by a GP, other doctors working in general practice, registered nurse or other suitably qualified registered health practitioner working within their scope of practice who have undertaken required COVID-19 vaccination training.  For more information on who can undertake COVD-19 vaccination generally, see Q&A Who can be involved in delivery of COVID-19 vaccines?

    The standard assessment items can be billed at each vaccination appointment, so long as the item requirements are met.  This means they can be used when both first and second doses of a vaccine are given (there are different items for each appointment). However, the in-depth assessment items can only be billed once for each patient in association with one of the standard assessment items. 

    If a patient chooses not to go ahead with vaccination following assessment, the relevant MBS item can still be billed if its requirements are met.  If a patient decides not to receive a COVID-19 vaccination, but later chooses to receive it, the relevant standard assessment item numbers can still be billed at each consultation.
  • What limits are there on COVID-19 vaccination billing? Updated 25 June 2021

    The Commonwealth Government requires that COVID-19 vaccinations be free to the population and indicated “general practices will not be permitted to charge co-payments for vaccine administration”.

    For GP clinics delivering COVID-19 vaccinations, the only permissible COVID-19 vaccination billing are via the MBS COVID-19 vaccine suitability assessment (standard and in-depth) items bulk billed by GPs or other doctors working in an approved GP clinic or the MBS COVID-19 vaccination service fee for residential aged / disability care facilities and home visits for those unable to go to a clinic for vaccination.  These clinics cannot claim additional MBS items for pre-vaccination assessments or time spent administering a vaccination following use of the suitability assessment items. 

    As is the case for bulk billing generally, there should be no charges associated with COVID-19 vaccination, such as new patient registration or consumables charges.
  • Do I need a referral for COVID-19 vaccination to bill Medicare for it? New 19 Feb 2021

    No, a referral is not required for COVID-19 vaccination billing, or for COVID-19 vaccination generally.

    Eligibility for COVID-19 vaccination is based on eligibility criteria during each phase of the vaccine roll-out - see Q&A - When are people eligible for COVID-19 vaccines?

  • Does Medicare require the claiming doctor to see the patient personally? Updated 15 July 2021

    It depends on which type of item is being claimed. 

    For the in-depth COVID-19 vaccination patient assessment items for patients aged 50 or a personal attendance of at least 10 minutes is required, involving:

    • In-depth clinical advice on the individual risks and benefits of vaccination
    • One of both of the following, where clinically relevant
      • A detailed patient history
      • Complex examination and management. 

    For other COVID-19 vaccination assessment items:
    • The claiming doctor is not be required see or assess the patient in person in order to claim those items
    • A claiming doctor will need to be on-site during vaccination (telehealth availability is insufficient) and take ‘full’ responsibility for other team members (e.g. registered nurses) assessing patients and delivering vaccinations to them
    • Doctors need to be available to see COVID-19 vaccination patients as clinically appropriate
    • There are no limitations on doctors seeing patients for COVID-19 vaccination. 


    If you are not seeing the patients yourself for vaccination you should ensure:

    • Only appropriately qualified staff are managing the patients – see Q&A - 'Who can be involved in delivery of COVID-19 vaccines?' 
    • You have appropriate processes in place for triage, assessment and observation
    • Any issues requiring attention of a doctor are referred promptly to you as clinically appropriate.  Depending on individual circumstances, this might include patients with suspected contraindications, certain precautions or who have complex or many questions about vaccination. 
  • What assessment requirements are there to bill a Medicare COVID-19 vaccination assessment item number? Updated 25 June 2021

    The MBS COVID-19 standard vaccine assessment items include the following requirements:

    • A face-to-face attendance on the patient by a GP or other suitably qualified and registered health practitioner
    • Scope for a short patient history and limited examination / management where clinically relevant – this may include where the patient has a possible contraindication or precaution to vaccination
    • The vaccine needs to be immediately available to administer to a suitable patient
    • Post-vaccination observation is required in line with professional requirements.

    The in-depth assessment items for those aged 50 and over require:
    • Personal attendance of at least 10 minutes on the patient by the claiming doctor
    • In-depth clinical advice on the individual risks and benefits of vaccination
    • One of both of the following, where clinically relevant:
      • A detailed patient history
      • Complex examination and management. 
  • What are the Medicare COVID-19 vaccination assessment item record-keeping requirements? New 26 Feb 2021

    The MBS COVID-19 vaccination assessment record-keeping requirements include:

    • Completion at time of service or as soon as practicable afterwards
    • Clearly identifying the name of the patient
    • Reasons for the patient’s attendance
    • Outcomes of the consultation, including whether or not the patient received a COVID-19 vaccine
    • Contain a separate entry for each attendance by the patient for the vaccination suitability assessment service and the date(s) on which the service was provided
    • Record the patient’s consent to receive the vaccine
    • Provide clinical information adequate to explain the service
    • Be sufficiently comprehensible that another GP, relying on the record, can effectively undertake the patient’s ongoing care as it relates to COVID-19 vaccinations.

    In addition, the Commonwealth Health Department recommends recording the time of service for any after hours billing.
  • Does the Medicare 80/20 rule apply to COVID-19 vaccination items? New 1 April 2021

    No - Medicare COVID-19 vaccination items are exempted from the ‘80/20’ rule (the Medicare “prescribed pattern of service”), triggering a compliance process and Professional Services Review referral.

  • Can I still bill the Medicare COVID-19 vaccination assessment items if the patients chooses not to receive the vaccination? New 26 Feb 2021

    Yes. If a patient is assessed as not being suitable or doesn’t want to go ahead with vaccination, the MBS items can still be billed if the item requirements are met.

    If a patient needs more than two assessment services, only one PIP incentive payment can be paid. 

    The Commonwealth Health Department has indicated there shouldn’t be more than one claim on the same day (eg patient decides against vaccine, then changes their mind) unless there are exceptional circumstances which need to be detailed in the patient’s records.

  • Can I see a patient for other medical issues at the same time as COVID-19 vaccination and use my usual billing practices for those other issues? Updated 3 August 2021

    For standard COVID-19 vaccine assessment items, this is permitted where there is a clinical need to provide care for the other medical issue and there is no ‘cross-over’ between the COVID-19 MBS assessment item and the other MBS item/s being claimed.

    The in-depth assessment items can only be claimed together with a standard assessment item and a flag-fall item (where relevant). 

    The Commonwealth Health Department indicates:

    • Standard MBS multiple same-day attendance rules apply for co-claiming including
      • The other GP service must be unrelated to the vaccine assessment item
      • The subsequent attendances are not a continuation of the initial or earlier attendances.
    • Before billing, there is a need for informed financial consent for the patient so they understand there is no cost with the Covid vaccine component, and understands how the other service is billed – this should be recorded in the patient records
    • There should be no triage or screening for COVID-19 vaccination using existing MBS items before an MBS vaccination suitability assessment
    • No items can be claimed for time spent administering a vaccine following assessment
    • If a patient suffers a significant adverse reaction to a COVID-19 vaccine, the provider can bill another MBS item in order to provide appropriate treatment – this would include systematic reactions such as syncopal episodes, severe allergic reactions (e.g. anaphylaxis) and a strong, adverse mental / emotional reaction to vaccination – these additional services should be bulk-billed
    • COVID-19 vaccination assessment items cannot be co-claimed with certain other bulk billing incentive items.

    See the Department’s detailed fact sheet for more information, which includes a range of scenarios involving co-claiming.
  • What if a non-Medicare eligible patient presents for vaccination at an approved GP clinic? Updated 25 June 2021

    Non-Medicare eligible patients cannot be ‘privately’ billed. 

    Non-Medicare eligible patients should be referred to a GP respiratory clinic or state / territory immunisation clinic. 

  • If I am delivering COVID-19 vaccinations to patients at a location different to my practice, what is the billing location for Medicare purposes? New 5 March 2021

    Like other Medicare items, COVID-19 vaccine assessment items are billed from the practice location, not the location where the vaccine is delivered if it is different to the practice location.

    For example, if your practice is located in a Modified Monash 1 area, and you deliver the vaccine to a patient at a Modified Monash 2 area location, you would bill the relevant COVID-19 vaccine assessment item for Modified Monash 1 area

  • I / my practice is not providing COVID-19 vaccinations, but I am advising my patient on whether they should receive a vaccination. Can I bill Medicare? Updated 3 August 2021

    Relevant non-COVID-19 vaccine assessment items may be used by GPs and other specialists who are not part of the Australian Government COVID-19 vaccine roll-out and who are advising their patients about COVID-19 vaccinations, so long as the individual requirements of the MBS item number in question are met.

    There is no indication that such advice cannot be provided to the patient either face-to-face or via telehealth.

    The specific COVID-19 vaccination assessment items cannot be used by those who are not part of the COVID-19 vaccine roll-out program.

  • My patient has experienced an adverse reaction to COVID-19 vaccination. What can I bill? New 20 August 2021

    The Commonwealth Health Department indicates that if a patient suffers a significant adverse reaction to a COVID-19 vaccine, the provider can bill another MBS item in order to provide appropriate treatment.  This includes systematic reactions such as syncopal episodes, severe allergic reactions (e.g. anaphylaxis) and a strong, adverse mental / emotional reaction to vaccination.  Additional services should be bulk-billed.

COVID-19 vaccination - certificates, requiring vaccination and workplace issues

  • How can a patient get confirmation of COVID-19 vaccination? Updated 27 August 2021

    Proof of COVID-19 vaccination is available from:
    • Services Australia via an immunisation history certificate or COVID-19 digital certificate
    • From 27 August 2021, available via a My Health Record.
  • My patient seeks a certificate exempting them from COVID-19 vaccination. What should I do? Updated 27 August 2021

    There are a range of public health directions mandating COVID-19 vaccination – see Q&A What expectations are there of doctors and other healthcare practitioners around receiving COVID-19 vaccination? for those applying to healthcare workers.  There may be other circumstances where vaccination has been required by government entities or certain employers. 

    Requests for ‘exemption certificates’ might be based on medical contraindications or personal choice. 

    NSW Health has released a COVID-19 vaccine medical contraindication certificate to be used in the context of its requirement for certain healthcare workers to be vaccinated.

    In providing any certificate or other letter for a patient declining COVID-19 vaccine, you should:
    • Be up-to-date with current government, regulatory and professional guidance on COVID-19 vaccinations, contraindications and precautions – see Q&A What are the recommended age groups for the AstraZeneca vaccine? and What other advice is available on COVID-19 vaccination for certain conditions, contraindications and precautions? 
    • Limit your certificate / letter to clinical issues within your expertise
    • Avoiding being perceived to support patient decisions which are not based on clinical grounds (e.g. recognised contraindications)
    • Consider providing your patient with further information on COVID-19 vaccination from appropriate sources, or arranging appropriate specialist referral to discuss their concerns
    • Be aware that there is no requirement for you to provide a certificate / letter if you do not feel comfortable in doing so. 

    For further information, see Q&A - "A patient wants a medical clearance certificate for COVID-19.  Can I give this?"  for more information on certificates generally.
  • What mandatory COVID-19 vaccination requirements are there for healthcare workers? Updated 10 September 2021

    It is only:

    who are required to have COVID-19 vaccination (details below). 

    New South Wales – working in public and private hospitals and aged care facilities, living in certain areas

    New South Wales has issued a public health order making COVID-19 vaccination mandatory for all healthcare workers:

    • Working for or in a NSW Health entity (e.g. public hospital), private hospital or day procedure centre – this includes employees, contractors, visiting medical officers, visiting practitioners, volunteers and students undertaking clinical placements
    • Requiring a first dose by 30 September 2021 and a second dose by 30 November 2021 of a TGA approved vaccination
    • Workers will be required to give evidence of their vaccination status to their employer
    • Employers, entities contracting workers or providing healthcare facilities, and those supervising students are required to take “all reasonable steps” to ensure workers comply with this requirement.

    By public health order healthcare practitioners and students cannot enter aged care facilities after 31 October 2021 unless they have received at least one dose of a TGA approved COVID-19 vaccination.  

    Practitioners who provide services to the facility under a contract or similar arrangement will need to have the first vaccine dose by 17 September 2021.  

    The vaccination requirements do not apply to:
    • Private primary care providers, such as GPs, or private specialists working outside hospital / day surgery or aged care settings
    • Healthcare workers unable to be vaccinated due to a medical contraindication – they will need to provide a medical contraindication certificate to their employer / contracting entity / facility where they work
    • Health practitioners responding to medical emergencies. 

    In Sydney:
    • From 9 September 2021 authorised workers (which include all healthcare workers) who live in an LGA of concern but work outside it are only permitted to work if they have had their first vaccination dose or an appointment for first vaccination on or before 19 September 2021, unless they have a medical contraindication certificate
    • From 20 September 2021 these workers will need to have had at least one vaccine dose to leave an LGA of concern for work unless they have a medical contraindication certificate. 

    Victoria – working in aged care

    From 17 September 2021 those employed or engaged by facilities, including medical practitioners providing care, must have:
    • Received at least 1 dose of COVID-19 vaccination and be booked for their second dose by 15 November 2021 or
    • Booked to receive their first dose by 1 October 2021,

    unless they have evidence from certain doctors (including GPs, certain GP registrars, general, public health or infectious disease physicians, clinical immunologists, obstetricians or gynaecologists) certifying an exemption applies (based on ATAGI medical contraindications) and provided it to the facility. 

    Queensland – public healthcare workers, treating COVID-19 patients, working in aged care, students and crossing NSW / Qld border

    Queensland has foreshadowed all public health system workers will need to have their first COVID-19 vaccine by 30 September 2021, and second dose by 30 November 2021.  Further details and the public health direction are yet to be released.

    By public health direction Queensland Hospital or Health Service employees and contractors:
    • Working in COVID-19 wards at designated COVID-19 hospitals
    • Providing emergency care to COVID-19 patients or quarantined international arrivals in an emergency department
    • Providing occasional or intermittent care to COVID-19 patients (eg specialist consultations),

    must be vaccinated for COVID-19.  In certain circumstances of emergency or lack of other staff, the health service chief executive may provide exemptions to these requirements. 

    By public health direction Queensland Health employees, or doctors and allied health professionals who regularly provide on-site care to aged care facility residents, cannot enter or work in aged care facilities unless they comply with the following COVID-19 vaccination requirements:
    • By 16 September 2021, they have received at least a first dose
    • By 31 October 2021 must be fully vaccinated. 

    Accepted vaccinations include either those approved by the TGA for use, or endorsed by the WHO COVAX facility if the employee was vaccinated overseas.  Exceptions to this requirement include providing emergency care and entering the facility for personal reasons (i.e. visiting family). 

    By public health direction all students on clinical placement must be fully vaccinated (received both doses) against COVID-19 before they can enter restricted healthcare and aged care facilities.  Students who have been in a restricted local government area in the last 14 days cannot enter any Queensland hospital or aged care facility for a clinical placement unless fully vaccinated. 

    From 21 August 2021, by Queensland public health direction essential workers crossing the NSW / Qld border into Queensland (including doctors and other healthcare workers) are required to have had at least one dose of a COVID-19 vaccine. 


    South Australia – working in aged care facilities and quarantine care

    From 17 September 2021, by public health direction those working in aged care facilities, including those visiting the facility to provide healthcare, are required to have at least 1 dose of COVID-19 vaccine and has evidence of a booking for a second dose, unless a valid exemption applies or they are responding to an emergency.   

    By public health direction those providing healthcare to:
    • An overseas arrival undertaking supervised quarantine (irrespective of where it occurs, including in a public hospital), or
    • Persons undertaking supervised quarantine at a medi-hotel or quarantine facility, are required to have at least one dose of a TGA approved COVID-19 vaccination, and receive a second dose of the same TGA approved vaccination no later than 6 weeks after starting that work.  This does not apply to those entering a quarantine centre to provided non-COVID-19 related emergency care.   

    Western Australia – healthcare workers, aged care facilities and quarantine centres

    The following mandatory requirements for healthcare worker vaccination apply:
    • Entering aged care facilities - From 17 September 2021, by public health direction those working in aged care facilities, including those visiting the facility to provide healthcare, are required to have at least 1 dose of COVID-19 vaccine, unless a valid exemption applies or they are responding to an emergency
    • High risk public and private hospital areas – first dose by 1 October 2021, and fully vaccinated by 1 November 2021, to access ‘tier one’ facilities, including intensive care units, high dependency units, respiratory wards, emergency departments, COVID-19 clinics, COVID-19 vaccination clinics and hospital wards with designated respiratory beds in certain regional hospitals
    • Public and private hospitals generally – first dose by 1 November 2021 and fully vaccinated by 1 December 2021 to access ‘tier two’ facilities, including all public and private hospitals
    • Other public health or designated healthcare facilities – first dose by 1 December 2021, and fully vaccinated by 1 January 2022, to access ‘tier three’ facilities, including other public health or designated healthcare facilities
    • Quarantine centres - by public health direction those providing healthcare in quarantine centres are required to have at least one dose of COVID-19 vaccination.  This does not apply to those entering a quarantine centre to provided non-COVID-19 related emergency care. 


    Tasmania– healthcare workers and those working in aged care and quarantine facilities

    Tasmania has foreshadowed a requirement for healthcare workers to have received their first dose of COVID-19 vaccination by 31 October 2021.  The scope of healthcare workers who will fall under this requirement is yet to be finalised, but it is expected to include at least all those working in hospital, day surgery and government community health settings. 

    From 31 October 2021, by public health direction a person employed or engaged by medical or health facilities (which includes hospital and community health care services, both public and private) or undertaking clinical placements / work experience at them are not permitted to enter those facilities for work purposes, or provide healthcare services generally, unless they have:
    • Received their first dose of a COVID-19 vaccine or have made a booking for it as soon as reasonably possible, and made a booking for their second dose as soon as reasonably possible
    • Made a booking for the first dose and receives all necessary doses as soon as reasonably possible. 

    By public health direction employees or contractors of aged care facilities (and those undertaking clinical placement / work experience at them) and those entering quarantine facilities are required by 17 September 2021 to:
    • Have received their first dose of a COVID-19 vaccine or have made a booking for it as soon as reasonably possible, and made a booking for their second dose as soon as reasonably possible
    • Made a booking for the first dose and receives all necessary doses as soon as reasonably possible. 

    Under these healthcare, aged care and quarantine worker regimes, workers are excused from vaccination if they have a completed vaccine exemption form from a doctor certifying they have a medical contraindication precluding vaccination, or if they are providing healthcare in an emergency situation. If any of those exceptions apply, a fitted face covering must be work at all times when providing healthcare (unless they have a medical certificate from a doctor indicating they have a health condition or disability making a fitted face covering unsuitable)

    More information on mandatory Tasmanian healthcare worker vaccination is available here


    Northern Territory – working in aged care facilities

    The Northern Territory Government has announced that it will require healthcare workers to be vaccinated against COVID-19, with the scope of the requirement and commencement date yet to be announced. 

    In Northern Territory, by public health direction employees or contractors of aged care facilities are required to have their first dose of a COVID-19 vaccine by 17 September 2021, and their second dose by 31 October 2021, and provide evidence of this to the facility.  

    ACT – working in aged care facilities

    In the ACT registered health practitioners providing healthcare at aged care facilities are required to have received at least one dose of a COVID-19 vaccination by 17 September 2021.  Exemptions are available for those who cannot be vaccinated due to a medical contraindication, or if vaccination is not reasonably available to them. 
  • What other expectations are there of healthcare workers around receiving COVID-19 vaccination? Updated 10 September 2021

    Outside any mandatory COVID-19 vaccination requirements, the National Boards and Ahprastrongly encourage” all registered health practitioners and students to be vaccinated unless there is a medical contraindication.

    Irrespective of their own vaccination status, the National Boards and Ahpra indicate health practitioners “must ensure that there are appropriate measures in place in their practice to manage any risk of transmission” of COVID-19 to patients, colleagues and the community.

    If a practitioner has a conscientious objection to COVID-19 vaccines, the National Boards / Ahpra indicate the following is required:

    • Where necessary they must inform their employer and / or relevant colleagues of their objection as soon as reasonably practicable
    • They must inform their patient where relevant to their patient’s care and be careful not to discourage them from seeking vaccination
    • Those authorised to prescribe and/or administer the vaccine but who have a conscientious objection “must ensure appropriate referral options are provided for vaccination
    • All practitioners, including students on placement, must comply with local employer, health service or health department policies, procedures and guidelines relating to COVID-19 vaccination
  • Can I require my practice staff/can I be required by my workplace to undergo COVID-19 vaccination? Updated 13 August 2021

    Generally workplaces can take reasonable steps to ensure workplace safety – this includes both for workers and visitors. 

    Whether COVID-19 vaccination could be required depends on a variety of issues and individual circumstances, including:
    • Whether there are any public health directions / other legal requirements around COVID-19 vaccination
    • Government, workplace regulator and public health advice
    • Current risks of COVID-19 transmission in your workplace and in your local area
    • Individual workers’ roles, including degree of risk of COVID-19 transmission they pose
    • Extent to which vaccination would reduce the risk of COVID-19 transmission in your workplace, both to staff and to patients
    • Whether you / your staff member have medical condition which may make COVID-19 vaccination unsuitable
    • Current vaccine availability, based on ATAGI advice on recommended or preferred vaccines
    • Considering whether other measures, such as physical distancing, cleaning, PPE use, regular COVID-19 testing and minimising contact with others (including work from home), sufficiently reduce the risk of COVID-19 infection.

    The Fair Work Ombudsman has also provided updated guidance on workplace rights and obligations involving COVID-19 vaccinations, including:
    • Healthcare includes ‘Tier 2 work’, where employees are required to have close contact with people who are particularly vulnerable to the health impacts of COVID-19
    • An employer’s direction to employees performing Tier 1 or Tier 2 work is more likely to be reasonable, given the increased risk of employees being infected with coronavirus, or giving coronavirus to a person who is particularly vulnerable to the health impacts of coronavirus
    • Whether a direction is reasonable will always be fact dependent and needs to be assessed on a case-by-case basis. This will require taking into account all relevant factors applicable to the workplace, the employees and the nature of the work that they perform
    • Steps to take if considering mandating COVID-19 vaccinations for workers, including any necessary consultation
    • Requesting evidence of COVID-19 vaccination and dealing with employees who decline to be vaccinated.

    Absent public health or other legal requirements for COVID-19 vaccination, it would be preferable to encourage vaccination in the workplace, and consider individuals’ reluctance to do this on a case by case basis.  This might include exploring concerns, obtaining public health and / or specialist advice on the situation, and other viable ways of reducing the risks of COVID-19 transmission.  It would be prudent to make a record of discussions and steps taken. 

    The OAIC has also released guidance on the obligations that organisations have to their workers if they want to inquire about workers’ COVID-19 vaccination status or keep records of their workers’ vaccinations.
  • Could healthcare workers refuse to come to work if another worker isn’t vaccinated? Updated 13 August 2021

    The Fair Work Ombudsman indicates that “Generally, it’s unlikely that an employee could refuse to attend their workplace because a co-worker isn’t vaccinated against coronavirus.”. 

    For a worker who is reluctant to come to work if others are not vaccinated in the workplace, MIGA recommends exploring their concerns, obtaining public health and / or specialist advice on the situation, and considering whether there are other ways of reducing the risks of COVID-19 transmission.
  • Can I make COVID-19 vaccination a requirement for seeing patients face-to-face? Updated 27 August 2021

    Requiring patients to be vaccinated against COVID-19 as a condition of attending your practice is a complex issue. 

    For most people Governments have been encouraging, not mandating, vaccination. 

    It has only been required by public health direction so far for certain, high risk workers.  

    Workplace regulator advice on the possibility of mandating vaccination in higher risk workplaces deals with only the possibility of mandating vaccination for staff, not patients or other visitors (see Q&A Can I require my practice staff / can I be required by my workplace to undergo COVID-19 vaccination?)

    There are likely to be a range of professional and ethical views on requiring patient vaccination as a condition of a face-to-face consultation. 

    A wide range of issues need to be considered, including:

    • Current ATAGI, public health and peak body advice
    • Whether you are in an outbreak area
    • Local vaccine eligibility and availability
    • Whether other measures such as staff vaccination, PPE, COVID-19 testing, telehealth triaging, hygiene measures and physical distancing reduce transmission risk sufficiently
    • Other local healthcare options and continuity of care for non-vaccinated patients, discrimination law and appropriate exceptions (e.g. emergencies and medical contraindications). 


    More straightforward approaches would be:

    • Strongly encouraging vaccination
    • Exploring with individual patients their reluctance to be vaccinated
    • Telehealth triaging and pre-consultation testing.
  • Can I ask my patients and staff about their COVID-19 vaccination status? New 16 August 2021

    Whether it is appropriate to ask patients and / or staff about their COVID-19 vaccination status will depend on a range of factors, including:
    • Any state / territory public health directions mandating vaccination – see Q&A What expectations are there of doctors and other healthcare practitioners around receiving COVID-19 vaccination? 
    • Government and peak body advice
    • Whether you practice in an area with a significant outbreak
    • Vulnerability of patients and staff
    • Patient / staff vaccine eligibility
    • Local vaccine availability
    • Extent to which other protection measures, such as PPE, social distancing, hygiene measures and / or COVID-19 testing are likely to reduce the risk of COVID-19 transmission
    • For patients, the extent to which it is relevant to the healthcare you provide.    

    The OAIC advises that employers are only able to collect information about their employee’s COVID-19 vaccination status in “very limited circumstances”, namely where the employee consents and the information is “reasonably necessary” for your work / practice.   However the Fair Work Ombudsman advisesan employer may ask to view evidence of an employee's vaccination status without raising privacy obligations provided they do not collect (i.e. make a record or keep a copy of) this information”.

    If you decide to ask your patients and / or staff about COVID-19 vaccination status, MIGA recommends:
    • Explaining the reasons why you are taking such steps
    • Exploring the concerns of the patient / staff member
    • If they remain reluctant to provide the information, consider whether there are other ways to ensure protection of other patients and staff without pressing for the information. 

COVID-19 vaccination - further information

Insurance cover for other COVID-19 matters

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 Apr 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 Aug 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 our various Q&A on telehealth.

    * 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 Jul 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 Aug 2020

    Public health directions may restrict healthcare which may be provided, particularly in a COVID-19 hotspot - see Q&A on healthcare restrictions.  

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

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

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

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

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


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

Healthcare restrictions

  • What healthcare restrictions / requirements are in place in New South Wales? Updated 17 September 2021

    Lockdown orders in place across New South Wales are lifted in certain regional areas. Elsewhere they remain in place until certain COVID-19 case or vaccination thresholds have been met. They have also been reimposed in certain LGAs in response to localised cases.

    Lockdown areas - face-to-face healthcare restrictions

    Lockdown orders impose a range of restrictions on healthcare:

    • People can leave home for essential reasons, which include:
      • Medical or caring reasons – this includes getting a COVID-19 vaccination
      • For work if you cannot work from home.
    • There are no legal restrictions on the types of healthcare which can be provided face-to-face:
      • Some public hospitals are using telehealth for outpatient appointments where possible / clinically appropriate, and continuing only essential or urgent face-to-face consultations
      • Across the Greater Sydney region, the NSW Government strongly advises reducing non-essential activity and considering whether leaving the home is necessary.  The NSW Premier advised people not to leave home in the Greater Sydney region unless they “absolutely have to”. 
      • In those circumstances:
        • Consider carefully whether providing non-essential care face-to-face is appropriate, given potential for significant medico-legal and reputational risks
        • You may wish to consider using telehealth for non-urgent / non-essential clinical care.
      • In aged care settings, face-to-face healthcare should be limited to what is essential
    • Employers must require employees to work from home if reasonably practicable to do so – this is of relevance for:
      • Doctors / nurses / other healthcare workers who wish to provide telehealth from home if that is clinically appropriate
      • Administrative staff who are able to work from home.
    • Non-urgent elective surgery has been suspended in public hospitals and many private hospitals across Greater Sydney – see Q&A Are there any restrictions on surgery? 
    • Fitted face coverings must be worn when providing or receiving healthcare (and whenever outside the home in Greater Sydney), except for:
      • Under 12s
      • Providing healthcare where a mask needs to be removed, identification or communication purposes
      • Working alone in an indoor area
      • Public hospital or private health facility (private hospital or day surgery) patients, and aged care facility residents
      • Those to whom a valid exemption applies
    • Use of the Service NSW check-in system is required for staff and non-patient visitors (ie family members, suppliers).  It is not required for patients or hospitals that already have an electronic visitor registration system sufficient for contact tracing
    • You can only enter these areas for essential reasons - this includes for medical care if not reasonably available outside those areas
    • Outdoor public gathering limits of 10 people do not apply to healthcare (e.g. queuing / waiting outside for vaccination).


    Additional restrictions – Greater Sydney LGAs of concern

    Within Greater Sydney LGAs of concern, each of doctors, nurses, other registered health practitioners and those working for them or providing support services to them are ‘authorised workers’ permitted to leave LGAs of concern for work.  9pm to 5am curfews in place in LGAs of concern do not apply to providing or seeking healthcare, but the following requirements do apply.

    Certain vaccination requirements apply to authorised worker who work outside their LGA of concern – see Q&A What mandatory COVID-19 vaccination requirements are there for healthcare workers? 
    Authorised workers:
    • Leaving LGAs of concern to work and / or
    • Entering LGAs of concern to work,

    are required to register with Service NSW, which indicates “You must carry your travel registration and supporting documents with you at all times. You'll need to provide these to NSW Police if requested”.


    Regional NSW areas not in lockdown

    Those areas of regional NSW not in lockdown:
    • Continue to require masks to be worn in public indoor areas, including when providing healthcare, unless valid exceptions apply
    • Workplaces must permit workers to work from home where reasonably practicable.

    Depending on individual circumstances you may wish to consider using telehealth for non-essential care, where clinically appropriate.
  • What healthcare restrictions / requirements are in place in Victoria? Updated 17 September 2021

    Different requirements apply to metropolitan Melbourne (under lockdown) and regional Victorian areas subject to lockdown (in response to local cases).  A range of existing public health measures continue to apply across Victoria. These are detailed below. 

    Lockdown areas

    During the metropolitan Melbourne lockdown a range of restrictions apply to healthcare.

    People can leave home to provide or receive authorised healthcare (see below), which includes COVID-19 vaccination. This includes during nightly 9pm to 5am curfews in metropolitan Melbourne. 

    Authorised healthcare workers  are required to carry a permit issued by their employer. Photo ID issued by your organisation, identifying place of work, is sufficient to meet this requirement

    For authorised healthcare providers, you must be unable to work from home. 

    There are no restrictions on providing telehealth from a provider’s home. 

    Fitted face masks must be worn when leaving the home, including to provide or receive face-to-face healthcare, unless specific exceptions apply. 

    No cosmetic surgery or other procedures not addressing significant medical conditions are permitted. 
    Permitted face-to-face healthcare includes:

    • Emergency surgery, procedures and medical consulting for investigation, diagnosis and management of conditions where failure to do so expediently and safely will lead to:
      • loss of life or
      • loss of limb or
      • permanent disability.
    • Non-emergency but urgent surgery, procedures and medical consulting for the investigation, diagnosis and management of conditions where failure to do so in a clinically appropriate timeframe will lead to a predictable and evidence based outcome as follows:
      • loss of life where appropriate health intervention would otherwise have prevented this or
      • permanent disability where appropriate health intervention would otherwise have prevented this or
      • where clinical evidence supports an increased risk of loss of life or permanent disability should appropriate health intervention be significantly delayed.
    • Any health services provided under the auspices of a hospital, urgent care centre or similar service – this includes bush nursing centres
    • Any GP, nursing or midwifery care
    • Immunisation and vaccination services
    • Hospital radiology service, except for routine screening services
    • IVF treatment a patient has commenced before the restrictions, or required for the preservation of eggs for future IVF where required health treatment will render eggs non-viable
    • Surgical termination of pregnancy
    • Maternal and child health workers providing essential care to newborns or at-risk babies and children
    • Drug and alcohol services
    • Mental health services involving:
      • hospital emergency or inpatient psychiatric services (including from allied health professionals in hospital)
      • urgent care in private consultant psychiatry practice or by allied health professionals in community settings, but only where telehealth is not clinically appropriate.
    • Human medical research trials
    • Medical, nursing, midwifery and allied health students on placement providing essential care in hospitals or in residential care facilities, or through telehealth
    • Health practitioners and medical, nursing, midwifery and allied health students on placement, when undertaking critical training and examinations
    • Allied health services:
      • in hospitals or in residential care facilities providing critical clinical care or as directed by the hospital
      • private or public community services, whether clinic-based or home-based, providing essential clinical care where telehealth services are not clinically appropriate.
    • Certain urgent dental oral services. 



    Regional Victoria non-lockdown areas

    For regional Victoria not subject to lockdown:

    • Restrictions on face-to-face healthcare have been removed (but depending on individual circumstances you may wish to consider using telehealth for non-essential care, where clinically appropriate)
    • Fitted face masks must be worn when leaving the home, including to provide or receive face-to-face healthcare, unless specific exceptions apply
    • Travel to or from metropolitan Melbourne for healthcare it is restricted face-to-face healthcare permitted in Melbourne.


    Across Victoria

    Ongoing Victorian healthcare requirements include:

    • Businesses must continue to have a COVID Safe Plan, which must cover appropriate level of personal protective equipment to be worn and response to suspected / confirmed COVID-19 cases
    • A workplace attendance register of all persons at the premises for longer than 15 minutes is required where confidentiality obligations do not apply (ie it is not required to be kept for patients) – outside of a hospital / day surgery setting, use of the Victorian Government QR code service is now required
    • Regular cleaning of premises using disinfectant
    • Hospitals and day surgeries have additional obligations around daily comprehensive cleaning and worker declarations before starting shifts, and further obligations for high-risk services (i.e. treating confirmed COVID-19 cases or if in areas of community transmission).
    • For any COVID-19 cases amongst staff, notify both WorkSafe Victoria and the Victorian Health Department, which has further information on notification and other necessary responses, including isolation, risk assessment and management.
  • What healthcare restrictions are in place in the ACT? Updated 17 September 2021

    Under the ACT lockdown permitted healthcare includes:

    • Any health services provided in a private or public hospital or in a community health facility, including immunisation and vaccination services (NB – arguably this would permit surgical procedures in hospitals, but perhaps not day surgeries)
    • Any health services provided by a private or public specialist
    • Any health services provided by a general practitioner
    • Any health services provided by nursing professionals or midwifes
    • Mental health services involving hospital emergency or inpatient psychiatric services, allied health professionals providing mental health services in hospital, private consultant psychiatry practice and allied health professionals providing mental health services in community settings
    • Appointments with ‘prescribed’ health practitioners, confirmed in writing by them, including Ahpra registered specialties, allied health providers and registered NDIS providers
    • IVF procedures to complete any cycle of IVF treatment that a patient has commenced before the lockdown, or required for the preservation of eggs for future IVF where required health treatment will render eggs non-viable
    • Termination of pregnancy
    • Drug and alcohol services
    • Emergency and licensed non-emergency patient transport
    • An appointment at an Aboriginal or Torres Strait Islander Health Service
    • Any dental services provided to patients with urgent needs, or where failure to provide care in a clinically appropriate timeframe will lead to adverse outcomes
    • Allied health services provided by allied health professionals in hospitals, in residential care facilities providing critical clinical care or working in private practice or community services
    • Students, medical/nursing/midwifery/allied health on placement providing essential care in hospitals or in residential care facilities
    • Conduct of human medical research trials.


    Telehealth or other virtual care options should be considered wherever possible and where clinically appropriate.It is a requirement to work from home where reasonably practicable.

    Masks must worn at all times for face-to-face healthcare, subject to valid exemptions.

    Requirements for COVID-19 safety plans, density limits and collecting visitor information (via QR code or otherwise) do not apply to healthcare.

  • What healthcare restrictions are in place in Queensland? Updated 27 August 2021

    Post lockdown requirements - South East Queensland

    Following the end of lockdowns in South East Queensland (Brisbane City, Gold Coast City, Ipswich City, Lockyer Valley Regional, Logan City, Moreton Bay Regional, Noosa Shire, Redland City, Scenic Rim Regional, Somerset Regional and Sunshine Coast LGAs) mask requirements continue.    

    When leaving the home in those areas, people must wear masks indoors , subject to valid exceptions, and practice physical distancing.  Masks are not required where unsafe or if you can stay 1.5 m away from others. 

    Gathering restrictions do not apply to healthcare, except for cosmetic injections where 1 person per 4 square metre rule applies. 


    Across Queensland - Treating COVID-19 patients

    Queensland has public health requirements around where COVID-19 patients can be treated, COVID-19 vaccination for certain healthcare workers treating these patients and personal protective equipment (PPE) to be used in these situations. 

    By public health direction:

    • COVID-19 cases must be transferred (once safe to do so) to a designated COVID-19 hospital
    • Other hospitals can only treat COVID-19 patients in an emergency or other urgent situations, or otherwise on Chief Health Officer exemption
    • Once aware of a COVID-19 diagnosis, other hospitals must contact their local public health unit and follow its directions
    • Designated COVID-19 hospitals must have specific COVID-19 wards which meet certain requirements
    • A range of other requirements apply around the management of COVID-19 patients, including preclusion of students from entering COVID-19 wards, rostering, surveillance testing, PPE, COVID-19 vaccination and record-keeping.

    Across Queensland – aged care
    • Health care workers who wear appropriate PPE (in accordance with the Residential Aged Care Facility and Disability Accommodation PPE Guidance) and follow recommended infection control precautions are not considered ‘known contacts’ of confirmed COVID-19 cases for the purposes of entry to a residential aged care facility
    • In all facilities, must remain at least 1.5 m away from other person where possible, and limit contact with other persons at the facility
    • All visitors to aged care facilities must check in using the Check in Qld app.

    Across Queensland – cosmetic injections

    Outside Queensland lockdown areas cosmetic injections are permitted so long as your practice:
    • Operates in compliance with a COVID SAFE framework (including a COVID Safe checklist)
    • Has ‘public health controls’ to reduce risks, which may include “environmental cleaning, hygiene measures, regular washing of hands, availability of hand sanitiser and avoiding handshaking
    • Collect and keep contact information about all visitors (information separate to usual healthcare or financial records should be deleted after 30 days) – use of the Check In Qld app is compulsory
    • For public areas, has no more than 1 person per 2 square metres
    • Practice physical distancing (1.5 metres) where reasonably practicable.


    More information is available here.

  • What healthcare restrictions are in place in the Northern TerritoryUpdated 20 August 2021

    Following the end of the lockdowns in Greater Darwin and Katherine regions masks must be required when providing face-to-face healthcare unless physical distancing of 1.5m can be maintained. 

    Across the Northern Territory, hospitals and other premises where healthcare is provided must continue to:
    • Lodge a COVID-19 safety plan online and review it 6 monthly
    • Appoint a COVID-19 safety supervisor
    • Collect contact information (including time of entry) from visitors using the Territory Check In app
    • Provide hand sanitiser or handwashing facilities
    • Conspicuously display signage encouraging people to consider COVID-19 safety principles and practices.

    More information is available here.
  • What healthcare restrictions / requirements are in place in SA, WA and Tasmania? Updated 17 September 2021

    South Australia

    Masks are required face-to-face healthcare, subject to valid exceptions.  They are not required for hospital / day surgery inpatients. They are also recommended for use in workplaces, including non-public facing healthcare facilities. 

    For face-to-face care South Australian healthcare providers must:

    • Have a completed COVID Safe Plan – once completed and lodged you will receive a unique QR code for patients and visitors to use for your premises
    • Use an approved contact tracing system (including COVIDSAfeCheckIn via the mySA GOV app) to capture the contact details of patients and other visitors
    • Use “best endeavours” to ensure contact details are recorded
    • Use a paper recording log if a patient or visitor lacks a smartphone – these should be kept for 28 days then disposed of securely
    • Ensure total number of persons in ‘public’ (i.e. patient accessible areas) areas of your premises (excluding staff members and anyone else providing healthcare), and within a single room or other enclosed area, does not exceed 1 person per 2 sq m
    • Use best endeavours to keep a distance of 1.5m between people, unless required for healthcare (e.g. physical examination).



    Western Australia
     
    Western Australia public and private hospitals are required to collect contact information from visitors (patients are excluded from this requirement), but this requirement does not extend to community healthcare settings.
     
    In aged care facilities across Western Australia, healthcare must be provided by telehealth, or by attending an external facility, where reasonably practicable or in the resident’s best interests.
     

    Tasmania

    By public health direction masks are required to be work in hospitals and day procedure centres unless a valid exemption applies. 

    From 31 October 2021, they will also be required to be worn by unvaccinated healthcare workers unless a valid exemption applies – see Q&A What mandatory COVID-19 vaccination requirements are there for healthcare workers?

    Requirements for COVID-19 safety plans, density limits and collecting visitor information (via QR code or otherwise) do not apply to healthcare.


    Northern Territory
     
    Across the Northern Territory, hospitals and other premises where healthcare is provided must continue to:

    • Lodge a COVID-19 safety plan online and review it 6 monthly
    • Appoint a COVID-19 safety supervisor
    • Collect contact information (including time of entry) from visitors present for more than 15 minutes – the Territory Check In app  or paper system can be used for this
    • Provide hand sanitiser or handwashing facilities
    • Conspicuously display signage encouraging people to consider COVID-19 safety principles and practices.

     
    More information is available here.

  • Are there any restrictions on surgery? Updated 3 September 2021

    New South Wales

    Although no public health orders limit elective surgery, non-urgent elective surgery (non-urgent category 2 and any category 3 surgery) has been suspended in public hospitals and a range of private hospitals across Greater Sydney. At affected private hospitals, elective surgery can continue “if the patient’s clinical condition indicates that an emergency admission may eventuate if the condition is not treated within 30 days”. 

    The NSW Government has also recommended limiting non-essential activity and movement, with the NSW Premier asking people not to leave their homes unless they “absolutely have to”. 

    In those circumstances, consider carefully whether undertaking any non-urgent elective surgery in settings where it has not already been suspended is appropriate, given potential medico-legal and reputational risks, and whether it would be clinically appropriate to delay surgery.

    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.


    ACT

    The ACT lockdown has not placed restrictions on elective surgery.

    Given public health risks, medico-legal risks and reputational considerations you may wish to consider whether to delay non-urgent surgery, depending on the patient’s clinical situation and how long the lockdown lasts. 


    Victoria

    During  Melbourne’s lockdown and localised lockdowns in regional Victoria:
    • No cosmetic surgery or other procedures not addressing significant medical conditions are permitted
    • Permitted surgery / procedures include:
      • Emergency surgery, procedures and medical consulting for investigation, diagnosis and management of conditions where failure to do so expediently and safely will lead to:
        • loss of life or
        • loss of limb or
        • permanent disability.
      • Non-emergency but urgent surgery, procedures and medical consulting for the investigation, diagnosis and management of conditions where failure to do so in a clinically appropriate timeframe will lead to a predictable and evidence based outcome as follows:
        • loss of life where appropriate health intervention would otherwise have prevented this or
        • permanent disability where appropriate health intervention would otherwise have prevented this or
        • where clinical evidence supports an increased risk of loss of life or permanent disability should appropriate health intervention be significantly delayed.


    Elsewhere in Australia

    Elsewhere in Australia there are no restrictions on elective surgery. 


    Surgery following COVID-19 infection

    For timing of surgery following COVID-19 infection the National COVID-19 Clinical Evidence Taskforce recommends:
     
    Do not routinely perform elective surgery within eight weeks of recovery from acute illness, following a diagnosis of SARS-CoV-2 infection, unless outweighed by the risk of deferring surgery, such as disease progression or clinical priority.

    Informed consent and, where deemed necessary, shared decision-making with a valid substitute decision-maker, should include discussion about the potential increased risk of surgery following a diagnosis of COVID-19 and in the presence of post-acute COVID-19 symptoms.

Mask / COVID-19 testing requirements and exemptions

  • Can I ask my patients to wear masks when attending our practice? Updated 3 August 2021

    MIGA considers it is reasonable for you to request patients aged 12 or over to wear a face mask when attending your practice, subject to any medical or other valid reasons, where:
    • Face masks are required by public health direction or advised by authorities / peak bodies - see  above Q&A - on healthcare requirements / restrictions across the country
    • There are high risks / significant levels of community transmission
    • You, your colleagues or your staff are vulnerable to COVID-19.

    If you are asking patients to wear masks in your practice, it would be appropriate to have stocks available for those patients who do not have one. 
     
    Where a patient is reluctant to wear a face mask, you should consider:
    • Whether there is an appropriate alternative way to provide care to your patient, eg via telehealth where clinically appropriate – see Q&A below on telehealth
    • Whether use by yourself and your staff of appropriate PPE would reduce the risk involved, in liaison with your local public health unit
    • How to ensure necessary continuity of care for your patient.

    The Australian Human Rights Commission provides information on whether requiring people to wear masks would constitute discrimination.  Adapted for the healthcare context, it indicates:
    • A strict rule preventing patients without face masks from accessing healthcare at your practice, even patients who are lawfully exempt from public health requirements and cannot wear masks for medical reasons, could constitute unlawful discrimination
    • The onus would be on you to show a strict rule is reasonable in the circumstances, which may include:
      • Scope of public health directions and exemptions
      • Urgency of healthcare being sought
      • Risks of transmission in your practice, e.g. scope for physical distancing
      • How long the patient would remain in the practice
      • Whether there are other patients / staff who are most vulnerable to severe COVID-19
      • Government, regulator and peak body advice on medical and work health and safety risks
      • Whether you can provide healthcare in another way (e.g. via telehealth)
      • Local incidence, severity and distribution of COVID-19
      • Alternative methods for reducing risk without strict mask wearing requirements, such as testing regimes, physical distancing or PPE.
    • You are also required to make “reasonable adjustments” for people with disability, which are those which do not impose an “unjustifiable hardship” on your business – this might include providing healthcare without need for a mask at certain times / with certain providers or telehealth
    • You may be able to use the ‘infectious disease’ exemption to justify strict mask wearing requirements if “reasonably necessary”, but it is unlikely to be enough that a mask requirement is “merely helpful, desirable or convenient in protecting public health”.
  • My patient seeks an exemption to a requirement to wear a mask - What can I do? Updated 23 July 2021

    You may be approached by your patients to provide a certificate or written support for them not wearing a mask.

    Context of the request

    Usually requests for exemptions come in the context of public health directions requiring the wearing of masks. Those directions detail circumstances where people are exempted from wearing a mask.  Generally this includes a physical or mental health condition or disability that makes wearing a mask unsuitable.  More information on current mask requirements is in the Q&A above on healthcare restrictions.

    If an employer has asked your patient to wear a mask, it is important to explore the reasons for the employer’s request with the patient.

    In New South Wales if a person seeks exemption from wearing a mask on grounds of physical or mental health conditions or disability, they must have:
    • A medical certificate or other written evidence signed by a registered health practitioner or registered NDIS provider confirming they have the physical or mental health condition or disability, and that it makes wearing a fitted face covering unsuitable; or
    • A statutory declaration from them confirming they have the physical or mental health condition or disability, and that it makes wearing a fitted face covering unsuitable.


    Assessing requests for mask exemptions

    You can only provide an opinion within the limits of your expertise, and which you feel comfortable and confident in expressing from a clinical perspective. 

    In assessing requests for mask exemptions, consider:
    • Whether the patient’s individual circumstances (risks to them / others from not wearing a mask) and broader public health imperatives outweigh any clinical issues for them in wearing a mask.  
    • Exploring with the patient alternative options to a mask exemption, such as working from home, minimising time they are required to be wearing a mask, or whether certain masks / face coverings are more acceptable to the patient than others  
    • Seeking specialist advice and / or liaising with your local public health unit as appropriate.

    Unless the patient clearly warrants an exemption consider advising them about the public health benefits of using masks, particularly if they work in higher risk settings (such as health or aged care).

    It is appropriate to decline the patient’s request for a mask exemption if you do not feel their condition or disability justifies an exclusion from wearing a mask on clinical grounds, when balanced against public health imperatives and risks the patient may face or pose to others from not wearing a mask.

    In some circumstances, it may be appropriate to offer to provide the patient with a certificate / letter stating that they have a certain medical condition or disability if you don’t feel comfortable in saying they should be exempted from wearing a mask.
  • Can I ask my patients to undergo a COVID-19 test prior to undergoing surgery or seeing them face-to-face? Updated 27 August 2021

    If considering whether to require patients to have a COVID-19 test before they undergo surgery or attend your practice and / or to require your staff to undergo regular testing, the following factors are relevant:
    • Current state / territory public health directions for testing – see Q&A on healthcare restrictions for current healthcare worker testing requirements
    • Government and peak body advice – see for example RACS elective surgery recommendations
    • Approaches taken by local public hospitals - MIGA is aware testing is being utilised by public hospitals in the context of outbreaks
    • Whether you practice in an area with a significant outbreak
    • Whether they have recently suffered from COVID-19 symptoms
    • Vulnerability of patients and staff
    • Local testing capacity, including ability to obtain a result before coming to your practice
    • Extent to which other protection measures, such as PPE and hygiene measures are likely to reduce the risk of COVID-19 transmission.

    If a patient / staff member is reluctant to undergo testing, or a result is delayed, MIGA recommends exploring with the patient / staff member whether there are ways to ensure appropriate protection of other patients / staff without a current test result.  As relevant this may include whether attending the practice / surgery can be delayed until this has taken place, or whether a consultation via telehealth is clinically appropriate.

Protecting yourself, your colleagues and your patients

  • Where can I find guidance on PPE to use? Updated 11 June 2021

    Government advice on PPE to use is available from the Commonwealth (Health Department, CDNA, ICEG (latest guidance developed by a joint ICEG National COVID-19 Clinical Evidence Taskforce) and ACSQHC), ACT, NSW, Qld, SA, Tasmania, Victoria and WA.   
     
    A range of peak bodies have prepared guidance on PPE use. 

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

    In supporting healthcare workers who are vulnerable to COVID-19, consider: ASCIA information on COVID-19 and immunosuppression.
  • What services are there to support the profession during this time? Updated 8 Dec 2020

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

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

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

    Midwives can access Nurse & Midwife Support, a 24/7 telephone and online service – contact details are here.
     
    Other resources and support include: The Black Dog Institute TEN – The Essential Network app for healthcare workers and further COVID-19 resources here.
  • My patient seeks an exemption to a requirement to wear a mask - What can I do? Updated 23 July 2021

    You may be approached by your patients to provide a certificate or written support for them not wearing a mask.

    Context of the request

    Usually requests for exemptions come in the context of public health directions requiring the wearing of masks. Those directions detail circumstances where people are exempted from wearing a mask.  Generally this includes a physical or mental health condition or disability that makes wearing a mask unsuitable.  More information on current mask requirements is in the Q&A above on healthcare restrictions.

    If an employer has asked your patient to wear a mask, it is important to explore the reasons for the employer’s request with the patient.

    In New South Wales if a person seeks exemption from wearing a mask on grounds of physical or mental health conditions or disability, they must have:
    • A medical certificate or other written evidence signed by a registered health practitioner or registered NDIS provider confirming they have the physical or mental health condition or disability, and that it makes wearing a fitted face covering unsuitable; or
    • A statutory declaration from them confirming they have the physical or mental health condition or disability, and that it makes wearing a fitted face covering unsuitable.


    Assessing requests for mask exemptions

    You can only provide an opinion within the limits of your expertise, and which you feel comfortable and confident in expressing from a clinical perspective. 

    In assessing requests for mask exemptions, consider:
    • Whether the patient’s individual circumstances (risks to them / others from not wearing a mask) and broader public health imperatives outweigh any clinical issues for them in wearing a mask.  
    • Exploring with the patient alternative options to a mask exemption, such as working from home, minimising time they are required to be wearing a mask, or whether certain masks / face coverings are more acceptable to the patient than others  
    • Seeking specialist advice and / or liaising with your local public health unit as appropriate.

    Unless the patient clearly warrants an exemption consider advising them about the public health benefits of using masks, particularly if they work in higher risk settings (such as health or aged care).

    It is appropriate to decline the patient’s request for a mask exemption if you do not feel their condition or disability justifies an exclusion from wearing a mask on clinical grounds, when balanced against public health imperatives and risks the patient may face or pose to others from not wearing a mask.

    In some circumstances, it may be appropriate to offer to provide the patient with a certificate / letter stating that they have a certain medical condition or disability if you don’t feel comfortable in saying they should be exempted from wearing a mask.

Managing COVID-19 - testing, certificates, privacy and medications

  • Where can I find information on rapid antigen testing? New 3 September 2021

    The TGA providers FAQ on use of rapid antigen testing and details of approved testing kits. 

    Conditions on their use include that they can only be used by trained health practitioners (and staff under their supervision).The TGA indicates “Failure to appropriately supervise testing may amount to professional misconduct. The practitioner remains liable at all times for the conduct of the testing.”

    Various state / territory specific restrictions / advice also apply on use of these tests.For example:
    • They cannot be used in Western Australia, or outside SA Health / SA Pathology settings in South Australia
    • The Victorian Health Department advises against their use outside research settings or unless specifically advised by the Department
    • Information is also available about their use in NSW.

    We encourage you to liaise with your local health department before considering their use in your practice. 
  • My patient doesn't fit the criteria for COVID-19 testing, but they are demanding a test. Updated 10 Sept 2020

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

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

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

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

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

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

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

    Release from isolation

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

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

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


    Vulnerability to COVID-19

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


    Medical certificates generally

    For medical certificates 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.
  • Are there restrictions on medications for managing COVID-19? Updated 17 September 2021

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

  • What are the Victorian notification and response requirements if there is a COVID-19 case in my staff? Updated 15 Dec 2020

    There are requirements to notify both WorkSafe and the Victorian Health Department of COVID-19 cases in your workforce.

    Details on how to notify WorkSafe Victoria are available here.

    Other necessary steps

    The Victorian Department of Health has further information on notification and other necessary responses, including isolation, risk assessment and management.

Telehealth and Medicare requirements

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

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

    Telehealth can still be used if it does not qualify for a Medicare item where clinically appropriate to do so. 
    Your fees for this should be disclosed to the patient prior to consultation.
     
    For telehealth guidance see:
  • What platforms can I use for telehealth? Updated 3 September 2021

    A range of commonly used video platforms and landline / mobile telephone services can be suitable for telehealth.  
     
    Be aware free versions of telehealth platforms may not meet privacy and security requirements. 
     
    To assist in choosing suitable video conferencing platforms, the Australian Digital Health Agency provides:
    Telehealth video conference platform interpreting is available via TIS National
  • What are the changes to the general practice COVID-19 Medicare Telehealth framework from July 2021? Updated 20 July 2021

    A range of temporary COVID-19 Medicare telehealth items are in place until 31 December 2021.   

    Outside COVID-19 hotspots, the range of telephone MBS items for GPs were narrowed from 1 July 2021.  However in Commonwealth Government declared COVID-19 hotspots, the Commonwealth Government has announced that two new longer telephone MBS items (Level C) consultations can be used. 
     

    Non-COVID-19 hotspots

    From 1 July 2021, the number of telephone items for general practice have been reduced, but video consultation items will remain unchanged.  The following telephone items will continue:
    • Items 91890 / 91892 - telephone attendance less than 6 minutes for an obvious problem / straightforward care, requiring a short patient history and, if required, limited management
    • Items 91891 / 91893 – telephone attendance greater than 6 minutes item for more complex care that includes any of the following that are clinically relevant:
      • taking a short patient history
      • arranging any necessary investigation
      • implementing a management plan
      • providing appropriate preventative health care.
    • Certain mental health treatment services, including for longer consultations.


    COVID-19 hotspots / patients under isolation or quarantine

    From 16 July 2021, two new Medicare telephone items (92746 and 92747) are available for GPs and other doctors in general practice for patients in Commonwealth Government declared COVID-19 hotspots, or those in other locations who are required to quarantine or isolate under a public health order, including Australians who may have travelled through or from a hotspot location.   

    They enable doctors to provide telephone consultations lasting 20 minutes or more and require any of the following that are clinically relevant:
    • taking a detailed patient history
    • arranging any necessary investigation
    • implementing a management plan
    • providing appropriate preventative health care.

    These two items are exempt from the requirement of a face-to-face consultation with the providing doctor or another doctor at the same practice in the last 12 months.   

    For more information, see the MBS fact sheet on these new items.  
  • When can I use the COVID-19 Medicare Telehealth framework? Updated 20 August 2021

    The current items extend to all Medicare eligible Australians, so long as the requirements for individual item numbers are met. 
     
    Both you and your patient must be in Australia to use Medicare telehealth items (as is the case for Medicare items generally). 
    You do not need to be within your regular practice to provide telehealth.  It can be provided from home. 
    You should use your provider number for your primary practice location. 
     
    Your Medicare provider number should only be used for telehealth consultations you undertake yourself.  
    It cannot be used by other practitioners you work with for their consultations. 
     
    For each service / consultation, the full requirements of a telehealth item must be met.  They cannot be used solely for triaging.  There are also restrictions around when you can initiative a service, and when they need to be patient initiated – see Q&A - Can I initiate Medicare telehealth services with patients, or should they come to me first? 
     
    In determining whether telehealth is appropriate, Medicare requires the practitioner must:
    • Have the capacity to provide the full service through this means safely and in accordance with professional standards; and
    • Be satisfied that it is clinically appropriate to provide the service to the patient; and
    • Maintain a visual and audio link (or audio only for telephone) with the patient; and
    • Be satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy – see Q&A What platforms can I use for telehealth? 
    • Only use telephone if video cannot be used.
     
    Online chat, messaging and email cannot be used for Medicare telehealth items.
     
    Before using the new items, you should familarise yourself with the requirements for telehealth use generally and each individual item.   This is very important.  This includes:
    • Obtaining informed financial consent before providing telehealth where you are not bulk-billing (the AMA’s Informed Consent guide is here)
    • Documentation – there are the same record-keeping requirements as for face-to-face consultations – this includes referrals where required
    • Assignment of benefit:
      • For the new telehealth items only, documentation in clinical notes of a patient’s agreement to assign their benefit as full payment for the service is sufficient
      • Other options include posting the completed assignment of benefit form to the patient for their signature and return, or email agreement between the practitioner and patient
      • The agreement can be provided by a patient’s carer or family member if the patient is unable to provide it
      • The Department of Health has indicated it does not intend to undertake compliance activities “directly focused on whether the assignment of benefit process aligned with the usual requirements”, but may investigate potentially fraudulent claims by seeking to verify that the service was provided to a patient
    • Multiple attendances on the same day (co-claiming is precluded) – see Q&A 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. 
     
    The Commonwealth Health Department has released the following Medicare telehealth guidance:
    COVID-19 telehealth item news – detailing changes to the items as made.
  • Can I only use Medicare COVID-19 telehealth items for existing patients? Updated 20 July 2021

    Subject to a range of exceptions (see below), GPs and other doctors working in general practice can only claim COVID-19 telehealth items if they have an existing and continuous relationship with a patient. Similar restrictions have not been imposed on specialists or other healthcare providers.
     
    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. 

    For GPs and other doctors working in general practice, Medicare has confirmed that “Only a face-to-face attendance with the patient in the 12 months prior to the date of service of the proposed telehealth consultation satisfies this new requirement.”  This means that you must have seen the patient face-to-face in the last 12 months for each and every COVID-19 MBS telehealth claim.  If this requirement was met for past telehealth claims, but you have not now since the patient face-to-face for more than 12 months, you cannot claim MBS COVID-19 telehealth items. 
     
    There are a number of exceptions, which are:
    • Patients living under COVID-19 movement restrictions imposed by state or territory public health requirements, including local quarantine and isolation or Commonwealth Government declared COVID-19 hotspots at the time of the telehealth service
    • Use of certain long telephone items in Commonwealth declared COVID-19 hotspots - see Q&A "What are the changes to the general practice COVID-19 Medicare telehealth framework from July 2021?"
    • Those awaiting a COVID-19 test result
    • Children under 12 months of age
    • Homeless patients – this includes people who live in an inadequate dwelling, have no tenure or a short and non-extendable tenure, or live somewhere where they do not have control of, and access to, space for social relations
    • Patients receiving an urgent after-hours (unsociable hours) service
    • Doctors located at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service
    • Doctors participating in the Approved Medical Deputising Service (AMDS) program if the AMDS provider has a formal agreement in place with a medical practice to provide services to its patients, and that practice has provided, or arranged, at least one personal attendance for the patient in the past 12 months.
     
    Medicare provides an AskMBS Advisory - existing relationship clarification

    Details of GP COVID-19 telehealth claiming requirements are here
  • Can I initiate Medicare telehealth services with patients, or should they come to me first? New 10 Sept 2020

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

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

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

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

    More information is available here (Provider FAQs). 

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

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

    More information is available here.

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

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

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

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

     

Electronic prescribing

  • How can I use digital image prescribing? Updated 16 April 2021

    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 digital image prescribing end? Updated 10 September 2021

    With the introduction of electronic prescribing across the country, permission for digital image prescribing will cease in Australian states on the following dates:
    • 27 September 2021 in Victoria (this is expected to be extended to 31 December 2021)
    • 29 September 2021 in NSW
    • 30 September 2021 in Western Australia
    • 30 December 2021 in South Australia, Queensland and Tasmania.

    Digital image prescribing has no expiry date in the ACT and the Northern Territory. However the Commonwealth Pharmaceutical Benefits Scheme will cease permission for digital image prescription on 30 December 2021, which will then limit any use of digital image prescribing to non-PBS prescriptions.

    MIGA recommends you and your practice take steps prior to 30 December 2021 to offer electronic prescribing.
  • Where can electronic prescribing be used? Updated 12 March 2021

    Subject to local pharmacy readiness, electronic prescribing, including for Schedule 4D and 8 medications, is now available across Australia.

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

  • What does electronic prescribing involve? Updated 19 May 2021

    Token model – available now across the country
     
    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 – now available in Tasmania

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

    To use electronic prescribing:

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

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

Registration and training issues

  • Are there exemptions for the usual intern clinical term requirements during the COVID-19 pandemic? Updated 3 September 2021

    The Medical Board has reduced clinical term requirements for certain 2021 interns (including those who started in late 2020) who had their rotations interrupted because of the pandemic.

    Those who have taken “genuine COVID-related leave” have their clinical term requirements reduced by up to 7 weeks (from the usual 47 weeks)

    The Board also providers further information for interns who are redeployed.

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

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

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

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

    You should:

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


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

  • I have returned to practice as part of Ahpra's pandemic sub-register. Are there limitations on what I can and cannot do? Updated 10 September 2021

    The pandemic sub-register for doctors, nurses and midwives has been extended to April 2022.

    Ahpra has provided information for practitioners on the sub-register.

    Ability to practice is limited to working in any area that supports the COVID-19 response, if fit and suitable to do so.This includes the COVID-19 vaccination roll-out.

    Whilst on the sub-register, and 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. 
     
     
  • I have only returned to work in the public sector. Do I need cover from MIGA? New 3 Apr 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? Updated 19 Feb 2021

    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, which presently has been declared to run until 17 March 2021, and may be extended further.  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.

  • I have ceased practice and am not currently working, do I still have to have insurance? Doctors and Midwives Updated 22 Apr 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.

Commonwealth, state and territory advice and contacts


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

State / Territory Vaccine Information Health advice Public health unit
ACT ACT Government Health advice 02 5124 9213
02 9962 4155 (A/H)
New South Wales NSW Health Health advice 1300 066 055
Northern Territory Northern Territory PHN Health advice Local unit numbers
Queensland Qld Health Health advice Local unit numbers
South Australia SA Health Health advice 1300 232 272
Tasmania Tasmania Government Health advice 1800 671 738
Victoria Victorian Health Department Health advice 1800 675 398
Western Australia WA Health Health advice Local unit numbers

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.