Providing In-person Community Care During COVID-19: Guidance for Registrants

The following guidance has been developed by the College with expertise and direction provided by the provincial health officer (PHO), the BC Centre for Disease Control (BCCDC) and WorkSafeBC. It is intended for all registrants in community practice. It is applicable for the duration of the COVID-19 pandemic.

Note: This guidance reflects the best evidence available at this time and it will change as required to reflect updates in our understanding of the virus and its transmission. Please continue to check for updates and new resources on the College website, the BCCDC website and the WorkSafeBC website.

Overview

During COVID-19, registrants were required to reduce all non-essential and elective services involving direct physical contact with patients to minimal levels, with some exceptions allowed for time-sensitive circumstances, and emergent, urgent, and/or essential care to avert or avoid negative patient outcomes, or to avert or avoid a situation that would have a direct impact on the safety of patients.

With recent announcements from Premier John Horgan and Dr. Bonnie Henry, registrants can begin to resume in-person practice in a way that provides safe care to patients and continues to prevent the spread of the virus. As this new normal is being defined, registrants will have to adjust how they deliver care, conduct business, and attend to physical environments. In some cases, the ongoing use of digital technology to provide care may still be a very good option. Resuming in-person practice should be a thoughtful and planned process to ensure all necessary measures are in place.

This guidance to registrants will assist in determining which services are reasonable to resume in the coming weeks. The College recognizes that registrants would like very clear and specific direction on what is considered reasonable; however, it is not possible to address all scenarios.

As professionals, the College expects registrants to collaborate with colleagues in similar practices when making these decisions and to use professional judgement to determine what is in the patient’s best interest. The BC Centre for Disease Control (BCCDC) has developed guidance titled COVID-19: Infection Prevention and Control Guidance for Community-Based Physicians, Nursing Professionals and Midwives in Clinic Settings. The College expects registrants to read this guidance and follow the expectations for infection prevention and control as they resume work in a private office.

The College acknowledges and thanks all registrants for making practice accommodations to ensure patients receive safe and timely care during the COVID-19 pandemic.

Guiding principles and assumptions

The following guiding principles and assumptions have been identified as foundational by the PHO for reintroducing health-care services in the context of COVID-19. This guidance pertains to the delivery of care in community-based practices.

  • All registrants must follow the guidance, expectations, and direction provided by the PHO, BCCDC, and WorkSafeBC.
  • Some services can continue to be safely and effectively provided virtually. Other services require in-person visits including direct patient care. College practice standards apply, regardless of whether services are provided virtually or in-person.  
  • Wherever possible, physical distancing must be maintained during the delivery of care.
  • In-person services must only proceed when the anticipated benefits of such services outweigh the risks to the patient and the physician or surgeon.
  • Registrants are accountable and are best positioned to determine the need for, urgency and appropriateness of in-person services.
  • Appropriate personal protective equipment (PPE) must be used for the safe delivery of in-person services; however, all health professionals must also act to conserve PPE through its judicious use. 
  • Registrants must not recommend unproven therapies for treating COVID-19.
  • Registrants are accountable to provide clear, honest, transparent communication regarding their policies and procedures related to COVID-19.

Prioritization of patient care services

When services resume, registrants may face difficult decisions regarding which patients to see and the prioritization of service provision. Registrants must prioritize access to in-person services based on their own clinical judgement and with consideration given to the patient perspective and the referral source. 

When determining priority for in-person care, registrants should reflect upon the following considerations: 

  • What is the acuity of the patient’s condition?
  • What is the functional impairment or impact of the condition on health-related quality of life? 
  • What is the impact of not receiving services (i.e. will further delay result in a worse outcome for the patient)? 
  • Is it appropriate to provide the service via virtual care?
  • Is the service one which can only be provided in person (e.g. assessment of chronic disease, breast or pelvic examination)?
  • How long has a patient waited for care?

Ongoing pandemic best practices

Public health officials have indicated that COVID-19 is expected to continue to circulate in the general population for an extended period. As such, ongoing measures to control the spread of the virus are anticipated, including requirements to practise physical distancing of at least two metres (six feet) and increased screening for signs, symptoms, and risk factors for COVID-19. 

  1. First and foremost, registrants must adhere to the BCCDC’s guidance on infection prevention and control measures applicable to the practice environment, including PPE use and environmental cleaning best practices to enable safe practice.
  2. Adherence to all BCCDC and WorkSafeBC guidance regarding occupational health and safety exposure control plans is also required to ensure a safe work environment for staff. This includes robust policies, procedures and organizational cultures that ensure no employees associated with the practice attend work when they have symptoms of illness.  
  3. Registrants are reminded that if they are exhibiting signs of COVID-19 or respiratory illness, including cough, runny nose or fever, they must not provide in-person care and should not be in attendance at clinics or other practice settings where other staff and patients are present.
  4. Registrants must follow BCCDC and WorkSafeBC guidance for self-isolation when an employee is sick with any respiratory illness, support access to primary care provider assessment and testing, and provide sick leave support where possible until symptoms have resolved and it is safe to return to work.
  5. Registrants must screen patients for risk factors and symptoms of COVID-19 prior to attendance at the practice environment. Patients should also be encouraged to make use of COVID-19 resources by calling 811 or visiting healthlinkbc.ca
  6. If patient screening reveals the patient may be at risk of COVID-19, registrants must either refer the patient to a COVID-19 testing centre or take appropriate steps to assess the patient in their office, including use of PPE and ensuring that staff or other patients in the office are not put at risk.
  7. The College does not expect any registrant to provide treatment unless, in their professional opinion, it is safe to do so for both patients and staff.

Personal protective equipment

Recommendations regarding use of PPE in community practice should follow the directives and recommendations provided by the BCCDC and WorkSafeBC. 

Resources

BCCDC

WorkSafeBC

Practice standards and guidelines