The COVID-19 pandemic has given rise to new and increased demands for the treatment and care of South Africans infected and affected by the virus. Health practitioners are operating under conditions that the current regulatory framework has not anticipated. The healthcare system will need more practitioners for an effective response against the pandemic. This may lead to practitioners being called upon to practise outside the usual scope of their profession and for longer periods of time. And yet, practitioners are already caring for sick and anxious patients, and are themselves exposed to infection. They are, at the same time, required to care for their infected and affected family members and loved ones.
The guidelines below fall under the Health Professions Act and are aimed at assisting practitioners in the performance of their duties during the outbreak. Further changes may be made when needed based on developments around the pandemic and the response to it.
1. Performance of Professional Acts (Ethical Rule 21)
The HPCSA considers the current state of disaster as an emergency that warrants some adjustments in the application of Ethical Rule 21. In particular, practitioners may be called upon to perform professional acts which are outside the scope of their professions or specialities and in doing so consideration should be made by individual practitioners as to their ability to perform such professional acts with reasonable skills and safety based on their education, training and experience.
2. Essential Services
An ‘essential service’ is defined in regulation 11A, based on section 213 of Protecting the public and guiding the professions the Labour Relations Act, 1995 as “a service, the interruption of which endangers the life, personal safety or health of the whole or any part of the population”.
Practitioners are expected to observe or comply with the lockdown regulations and utilise their professional/clinical judgement in determining what constitutes an essential service in accordance with the scope of their profession.
Further details in this regard may be provided by the Professional Boards concerned, when and where necessary. Practitioners are also advised to use the provisions of the recently amended Telemedicine Guidelines where services can be rendered remotely.
3. Continuing Professional Development (CPD)
Practitioners are encouraged to continue to participate in CPD activities that are relevant to the scope of their professions during the current COVID-19 pandemic. However, the HPCSA understands that practitioners may have difficulty meeting CPD requirements due to, among other things, the cancellation of conferences, CPD activities and changed priorities.
The HPCSA will therefore not act against practitioners who fail to submit their CPD portfolio and/or meet expected requirements while the pandemic persists. Further guidance in this regard will be provided to practitioners after the COVID-19 outbreak once has been brought under control.
4. Undergraduate Training
With the closure of institutions of higher learning, the HPCSA recognises that students’ educational programmes will be negatively affected. Council, therefore, expects that faculties of Health Sciences in consultations with relevant Professional Boards should put measures in place to compensate for lost training time.
5. Requirements for Internship and Postgraduate Training
Institutions accredited to provide internship and postgraduate training are encouraged to provide trainees with reasonable clinical exposure, as well as support during this time of national disaster. Interns who have completed their period of internship should be released for public service (community service). Internship duty certificates should not be unreasonably withheld due to service delivery needs.
The HPCSA will also provide additional guidance and support on this, through its structures, including the respective Professional Boards.
6. Colleges of Medicine of South Africa Examinations
The HPCSA has noted the decision of the Colleges of Medicine of South Africa Examinations (CMSA) Senate to postpone the first semester examinations to the second half of the year, and the possibility that examinations may not be held at all this year. Registrars and Senior Registrars, ordinarily employed on a contractual basis, will be deeply affected by the postponement of examinations, which will not only negatively impact their employment, but the production of specialists so desperately needed in the country as well.
In view of this challenging situation, the HPCSA recommends that Provincial Departments of Health mobilise additional financial resources to ensure the retention of Registrars/Senior Registrars in their posts until examinations are held.
7. New Registrations
Council considers all activities related to registration as essential services and practitioners should continue to submit their applications for registration and/or restoration, electronically to: registrationgroup@hpcsa.co.za. Registrations processed during the lockdown period will be for a limited or temporary period from the date of registration to 31 March 2021 and applicants will be required to provide original documents after the lockdown and once verified, the registrations will be converted to permanent registration.
Applications for registrations from persons who hold qualifications not prescribed for registration and those that are required to undergo an assessment as prescribed by the relevant Professional Boards will only be attended to after the lockdown period. All applications will be processed within 72 hours and should practitioners not receive registration certificates within this period, they should send their enquiries to this email: servicedelivery@hpcsa.co.za and copy Doreenm@hpcsa.co.za.
8. Annual Renewal of Registrations
The due date for annual renewals of registrations has been extended from 1 April 2020 to 1 July 2020* and practitioners should ensure that their annual fees are paid by the 30 June 2020*. Practitioners should utilise the online portal for the renewal of their registration where they will also access their annual practising certificate. All annual practising certificates which expired on 31 March 2020 should be considered as valid until 30 June 2020*. Practitioners may also access their profile using the HPCSA mobile app that is available on this link: https://hpcsamobileapp.co.za/
9. Practitioners’ Wellbeing
Practitioners are at the forefront in the response against the COVID-19 pandemic. As a result, they have an elevated risk of infection and should always, therefore, be cautious as they carry out their responsibilities. In this regard, the HPCSA encourages practitioners to refer to the NICD guidelines for COVID-19 and seek help from available supportive structures whenever the need arises.
The South African Depression and Anxiety Group (SADAG) may also be of assistance and can be contacted on their 24-hour helpline: 0800 456 789.
10. Restoration of practitioners to the Clinical Register
Practitioners who have been on the non-clinical register and/or applied for voluntary erasure for a subsequent period not exceeding five years (from the date of registration), will be considered for restoration to the clinical register without the need to meet further requirements. This measure is put in place to ensure that the healthcare system has enough resources to respond to the pandemic.
11. Personal Protective Equipment
The HPCSA expects employers to take all necessary steps to ensure that health practitioners are always suitably equipped and afforded personal protective equipment to minimise the risk of infection.
12. Telemedicine/Telehealth
On the 26th March 2020, the HPCSA published the Guidance on the use of Telemedicine Guidelines during the COVID-19 pandemic in terms of which, the following provisions were amended: Clause (b) which stated that “Telehealth is only permissible in circumstances where there is an already established practitioner-patient relationship, except where Telepsychology and/or Telepsychiatry is involved, in which case telehealth is permissible even without an established practitioner-patient relationship” was amended as follows: “Telehealth should preferably be practised in circumstances where there is an already established practitioner-patient relationship, and where such a relationship does not exist, practitioners may still consult using Telehealth provided such consultations are done in the best clinical interest of patients”. Clause (c) which stated that “Practitioners may charge a fee for services rendered through a telehealth platform” was amended as follows: “Although practitioners may charge fees for consultations undertaken through Telehealth platforms, the Council strongly cautions against practices that may amount to over-servicing and perverse incentives”.
Practitioners are reminded that, notwithstanding amendments as described hereabove, the Ethical Rules of Conduct for Health Practitioners registered under the Health Professions Act remain in force even when practising Telehealth. The guidance provided herein is only applicable during the COVID-19 pandemic and Council believes that it will assist practitioners to continue servicing their patients while observing the Regulations made in terms of Section 27 of the Disaster Management Act, especially regulation 11B. (1) (b) which states as follows: “During the lockdown, all businesses and other entities shall cease operations, except for any business or entity involved in the manufacturing, supply, or provision of essential goods or services, save where operations are provided from outside of the Republic or can be provided remotely by a person from their normal place of residence.”
The HPCSA will soon after the end of the pandemic inform practitioners about the continued use, or otherwise, of this guidance.
13. Complaints
The HPCSA will continue to process all complaints received from members of the public and/or patients against practitioners registered under the Act. The extraordinary conditions under which practitioners are working as a result of COVID19 will be considered when complaints are handled. All professional conduct inquiries and contact mediations have been suspended until the nation-wide lockdown is lifted.
14. Meetings of Council and Professional Boards
Although members of the Council and Professional Boards are at the front-line dealing with the COVID-19 pandemic, the HPCSA’s governance structures are continuing to function and conduct meetings using virtual platforms of communication during the lockdown period. This, unfortunately, is not a usual way of conducting the business of Council and the Professional Boards under its ambit, and there may, therefore, be delays in processing some of the matters.
15. Conclusion
The HPCSA believes that all practitioners registered with the Professional Boards under its ambit are committed to their patients and society in general and will use their knowledge and professional skills to assist the government and other stakeholders to ensure that the COVID-19 pandemic is effectively dealt with. The HPCSA will monitor developments around the pandemic and provide additional or updated guidance to practitioners as and when needed. Practitioners requiring additional guidance from Council can submit their queries to Professionalpractice@hpcsa.co.za.
Issued by Health Professions Council of South Africa