We understand that in the current situation doctors may have to consult with patients remotely more frequently than normal.

Although a face-to-face consultation is usually preferred, a remote consultation with their regular doctor may, for the time being, be preferable for some patients.

The practitioner should inform the patient why, on that particular occasion, they are proceeding with a remote consultation. In making the decision to consult remotely, the practitioner must balance the risks and benefits in how they consult with their patients and how they advise them. They must also be satisfied that they can adequately and clinically assess the patient remotely.

Regardless of the unique circumstances, we would recommend doctors makes a record of the reasoning behind any decisions made, and the information given to patients, in case it is necessary to explain the approach taken later.

Please be reassured that should you need to do a remote consultation with a patient whom you would ordinarily see face-to-face, your membership with Medical Protection will enable you to request assistance for matters that could arise from such consultations during this time.
 

The World Health Organization’s (WHO) advice in relation to infection prevention and control measures for healthcare workers states that contact and droplet precautions are recommended for all healthcare workers caring for a patient with suspected or confirmed COVID-19. The WHO advise that provision of appropriate personal protective equipment supplies (PPE) should be a national and institutional priority.
Members are always advised to follow the guidance in your country in relation to what PPE must be worn and when.

It is clear that employers should be providing adequate PPE to allow health professionals to do their jobs safely.  If you are concerned that such equipment is not being supplied, or is in short supply and likely to run out, you should raise concerns in line with the local process for raising concerns within your organisation in the first instance.

There may be occasions when you believe that it is justifiable not to see a patient without adequate PPE.  Ultimately there is a limit to the risk that you would be expected to put yourself at in order to provide treatment to a patient. 

If you are asked to see a patient without the appropriate PPE, each situation will need to be considered on a case by case basis.  You are urged to consider the government’s guidance on this matter in making any decision.  You should of course be prepared to justify any decision you make in the event that this decision becomes subject of a complaint or investigation at a later time.  You should also ensure that any reasoning for any decisions that you make is carefully documented.

Medical Protection members who do find themselves subject to regulatory or disciplinary proceedings as a consequence of not seeing a patient because there was a lack of appropriate Personal Protective Equipment can contact Medical Protection to seek advice, support and representation.

So long as you are in an appropriate indemnity grade and have received specific COVID vaccination training – including storage and administration – prior to administering any COVID vaccines on a private practice basis, then you would have the right to request assistance with all non-claims, and also claims arising from alleged acts of negligence in relation to the storage, use or administration of the vaccine from Medical Protection if needed.

If the administrating of vaccinations is within your normal scope of practice, and you are in a membership category which already provides claims indemnity for this, then you will not be required to pay an additional subscription for this work, and you do not need to inform us of your intention to do so.

If you are unsure if it is within your normal scope of practice, then you should contact Medical Protection in the first instance to ensure you are appropriately indemnified.

If you are a retired member (registered medical healthcare practitioner) returning solely to undertake COVID vaccinations within a private facility, then you will need to contact Medical Protection to be placed on an appropriate indemnity grade. You will also need to hold an active regulatory registration.

If a doctor is asked to perform a duty that they would not normally undertake, regardless of the circumstances they need to assess whether they have the skills and competency to proceed.

This will include considering what is in the best interests of the patient. If they do not feel it is safe to proceed and that to do so would place the patient at greater risk of harm than not undertaking the duty that has been requested, then they should advise whoever has asked them to do so and explain their concerns.

It would be wise to record the details of this deliberation in case it becomes necessary to explain the reasoning behind the decision to act or not to act.

If Medical Protection members have any concerns about the duties they are currently performing to help manage Covid-19 (in a state role or in a private capacity), they should contact us for advice.

In response to the work that healthcare workers are undertaking in public practice during the COVID-19 crisis, all retired or deferred members of Medical Protection will have their indemnity membership with us automatically reinstated completely free of charge.

This means that whilst the state will indemnify your for any claims that could arise as a result of you undertaking this work in public hospitals, Medical Protection can offer assistance with other matters such as medicolegal advice and regulatory representation, support with complaints, disciplinary proceedings, inquests and criminal investigations arising from clinical practice.

To qualify, you must:
• comply with any local rules of being regulated and licenced
• be working fully in a state-indemnified facility during this period.

If you will be treating private patients in private hospitals, you will need to reinstate your Medical Protection membership. Please contact us to arrange this.

We actively encourage members to contact us for advice to provide peace of mind and to help prevent a concern or problem escalating.
Medical Protection does not use the number of requests for advice as part of its risk assessment of a member. This includes determining their membership subscription.
In exceptional cases, where a request for advice involves facts or circumstances of a highly unusual or unique nature it might trigger a general review of an individual’s risk profile. However, we stress that this would be very unusual.
So, if you want to discuss a medico-legal issue or need advice on how to prevent a concern or problem escalating, please do let us know - we are only a phone call away.

Our expectation is that the state will indemnify members treating public patients, even if private hospitals are being utilised to provide the care. Medical Protection will of course provide advice and representation for non-claims matters (e.g. regulatory matters, inquests, complaints, reports etc.) arising from this work.

Doctors will face enormous challenges in the months ahead and we will work with the Government to ensure there is clarity on indemnity arrangements which will allow doctors to focus on treating patients.

South Africa

 
If the State co-opts private hospitals –

Our expectation is that the state will indemnify members treating public patients, even if private hospitals are being utilised to provide the care. Medical Protection will of course provide advice and representation for non-claims matters (e.g. regulatory matters, inquests, complaints, reports etc.) arising from this work.

Doctors will face enormous challenges in the months ahead and we will work with the Government to ensure there is clarity on indemnity arrangements which will allow doctors to focus on treating patients.

Should the State decline to cover such claims we will assist in bringing pressure on to the State to meet their obligations. 

If the State negotiates a fixed fee arrangement with private hospitals –

Private specialists would be covered by their normal private practise cover as these patients are now no different to private patients where the State is now the third party payer as opposed to a medical aid, or the patient paying privately.

Before starting it is vital you seek written confirmation from the ambulance service as to your duties; whether they expect you to hold registration and a License to Practice or international equivalent; and to confirm that the service will provide you with an indemnity in the event of a claim of clinical negligence made.
If you are due to work in a medical capacity and the ambulance service is not providing you with indemnity, you should speak to our membership department before undertaking the role.

Yes, you will be placed on a student grade to support the COVID-19 effort and will be provided with non-claims benefits (e.g. support with regulatory matters, inquests, complaints, reports etc.) arising from this work.. We would urge members to work within their competence and skill set.

We will then move you formally onto our FY1 membership in July, following our standard process for graduating medical students.

Please be reassured that should you need to do a remote consultation with a patient whom you would ordinarily see face-to-face, your membership with Medical Protection will enable you to request assistance for matters that could arise from such consultations during this time and you do not need to inform us of these changes.

We understand that in the current situation doctors may be required to consult with patients remotely in situations where their normal practice would have been a face-to-face consultation. Not all situations are appropriate for a remote consultation, but for the time being, it will be preferable for some patients.
 
A practitioner should inform the patient why, on that particular occasion, they are proceeding with a remote consultation. In making the decision to consult remotely, the practitioner must balance the risks and benefits in how they consult with their patients and how they advise them. They must also be satisfied that they can adequately and clinically assess the patient remotely.

Regardless of the unique circumstances, we would recommend doctors make a record of the reasoning behind any decisions made, and the information given to patients, in case it is necessary to explain the approach taken later.

Members who have increased their working hours to support the COVID-19 efforts should update their practice details to reflect this and be on the relevant grade for the amount of work they do. This can be done by either calling Member Services or logging onto the Portal.