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COVID-19: Working outside your scope of practice

29 March 2021

The COVID-19 pandemic has forced many clinicians to work outside their normal scope of practice. But what does this mean for your Medical Protection membership and what is the HPCSA’s view? Kirsty van Rhyn, Case Manager at Medical Protection, has the answers

 

On 15 March 2020, the President of the Republic of South Africa declared the COVID-19 pandemic a national disaster in terms of the Disaster Management Act 57 of 2002. An influx of patients to healthcare facilities due to the effects of the coronavirus outbreak caused healthcare practitioners to operate under unprecedented conditions.

These extraordinary demands called on practitioners to support the strained healthcare system by working outside their usual scope of practice. Practitioners were redeployed to assist with managing patients with limited health resources. Practitioners themselves have fallen ill, which put the health system under further strain. 

The number of COVID-19 cases has increased substantially, meaning that practitioners who normally practise in a specialised field such as orthopaedic surgery or ophthalmology, are being tasked with working in emergency medicine and critical care.

Medical practitioners have written to Medical Protection to assist with the unique challenges that the pandemic presents, with many practitioners enquiring how practising under these conditions affects their membership, whether practising without the necessary skills and training is permitted, and for details on their indemnity should something go wrong. 

The HPCSA has relaxed its scope of practice rule

Ethical rule 21 states that a practitioner shall only perform a professional act, unless in an emergency, for which he or she is adequately trained, educated and sufficiently experienced and under proper and appropriate conditions or surroundings. The HPCSA regards the COVID-19 pandemic and state of disaster as an emergency for the application of this ethical rule, according to the guidelines posted on the HPCSA website on 7 April 2020.

The guidelines state that when practitioners are requested to perform professional acts that are outside the scope of practice of their profession, they should give consideration to their ability to perform such professional acts with reasonable skills and safety based on their education, training and experience.

The HPCSA refers to dentists and medical practitioners who hold registration as specialists specifically, as the relaxation of rule 21 mostly applies to them in a practical sense, and states that these practitioners are allowed to not confine their practice to the specialty in which they are registered.

It is also noteworthy that the guidelines further point out that, although encouraged, the HPCSA will not act against practitioners who fail to submit or fail to meet the expected Continuous Professional Development (CPD) requirements due to the pandemic and changing priorities.

How will practising out of scope affect Medical Protection membership?

It is not mandatory for a member to contact Medical Protection to advise of a change to their hours or scope of practice due to COVID-19 requirements. If they do, however, an appropriate note will be made on their membership record. For members on a private practice indemnity grade, no change in grade will be required.

Members who are on a non-clinical grade and who have to begin work in a clinical setting due to COVID-19 requirements are also not required to change their current grade, but they may wish to notify Medical Protection of the temporary change from clinical to non-clinical work.

If a member will be making permanent changes to their clinical practice, they should follow the usual process and notify the change to the international membership team via 0800 225 677 or mps@samedical.org.  

What happens if something goes wrong while working outside scope of practice?

If a medical practitioner is asked to perform a duty they would not normally undertake, it is expected that they assess whether they have the skills and competency to proceed and act with reasonable skill and care.

If there is an adverse event flowing from practising under these unusual circumstances, the HPCSA has acknowledged that any complaints from the public will be considered in the extraordinary circumstances in which the practitioner is working.

There is no official communication regarding the standards of reasonableness in relation to working outside scope of practice for specialists or non-clinical practitioners. Taking the HPCSA’s recognition of the heavy demands placed on medical practitioners into account, rules should not be enforced in the same manner as they were before the pandemic. This will be determined on a case-by-case basis.

Members are encouraged to contact Medical Protection for advice at any time, and to prevent any problem escalating. Medical Protection’s only goal is to look after the professional interests of our members and during the current crisis we once again encourage all members to contact us for assistance and peace of mind. We are here to support and protect you and be the strength by your side.

Useful links

Visit Medical Protection’s online Coronavirus FAQ.

The HPCSA’s guidelines and announcements are available at:

HPCSA Response to Covid-19 Pandemic

HPCSA guidelines for healthcare practitioners

References