The SAPPF has sent out a communication to members to update them on deliberations with the Department of Health on the many critical outstanding issues relating to private healthcare professionals’ role in treating and managing COVID-19 patients. Below is an extract from the letter.

We write to you at a time when the anticipated COVID – 19 surge has started. Tygerberg and Groote Schuur hospitals in the Western Cape are already straining under the number of COVID -19 patients. The private sector has had many COVID positive patients admitted and more than 400 HCWs are infected with the virus. The coming days, weeks and months are going to test our healthcare resources and our national resolve. Recognising this, SAPPF in the very early stages of the outbreak, before the declaration of a National Disaster and the commencement of the lockdown, wrote to the Minister of Health offering our support in combating this pandemic. Unfortunately this offer of solidarity and all subsequent attempts at reaching out to the NDOH have failed to elicit an adequate response from the Department of Health. There are a number of unresolved concerns:

· Scope of Practice. In order to utilise all available capacity many doctors will be asked to work outside their scope of practice or area of specialisation. We have requested from the Minister some type of blanket indemnity from prosecution for medical negligence should claims for medical negligence arise as a consequence of working outside one’s scope of practice in treating a COVID – 19 patient. No such indemnity has been offered. However, through Business for South Africa (B4SA) there is a legal team working pro-deo to achieve this on behalf of all healthcare workers.

· A joint letter signed by representatives of all private sector associations using the platform of the Progressive Health Forum (PHF) offering the assistance and cooperation of the private sector in creating an integrated response to the pandemic has likewise gone unanswered.

· All efforts to unlock potential sources of funding to finance the care of COVID -19 patients in the private sector and to ensure the survival of doctors’ practices through and post the pandemic, such as utilising medical scheme reserves (R60 Billion), and payments owed to doctors by COID, have also fallen on stony ground.

 · At the request of the NDOH for a fully loaded per diem to be developed for the care of state responsibility patients in private facilities, very extensive work was done and shared with the Minister, in principle on the 1st May, and in detail with the department’s Dr Nicholas Crisp.

· We calculated a per diem fee as requested by the NDoH. In this calculation we used a fee for service billing method and applied this to a team approach and costed it at GEMS 130%. The per diem was calculated over 10 days for ICU and over 5 days for High Care and wards and these are the VAT inclusive per diem fees we presented to NDoH for consideration:

a. ICU R5572 per patient per day

b. High Care R2428 per patient per day

c. General ward R1203 per patient per day

· Dr Crisp on behalf of the NDOH has presented a non-negotiable per diem schedule of fees to the hospital groups that included a professional component. This professional component is a blended fee for high care and ICU. The expectation is that only those patients requiring high care and ICU will be referred from state. A triage system will be applied before transfer and this system is heavily weighted towards restricting invasive ventilation. The assumption therefore is that the majority of patients will be classified as high care patients. The fee offered by NDoH is: R2493 VAT Inclusive per patient per day.

While this figure may seem to compare with our high care per patient per day per diem, there are many exclusions and variables that need consideration. The final remuneration is very dependent on patient acuity and the ICU/High Care ratio and how the carve outs such as patients needing dialysis, echocardiography and surgical interventions will be funded? 

SAPPF has up until now chosen to work alongside the NDOH, in a spirit of cooperation and solidarity, and we have understood the State’s insistence on equity in the treatment of COVID -19 patients, but to date we have seen little in return from the state. This lack of engagement suggests that the intention is to exclude the private sector, as far as possible, from an integrated national response, except when absolutely necessary. In cases of necessity where the public sector is overwhelmed and help is required from the private sector, it appears that the relationship will be a one sided take it or leave it affair, with no negotiation and no consideration given to the realities of costs experienced by private practitioners or facilities. It may be that politicians see this crisis as an opportunity to fast track NHI rather than serve the country during a period of crisis.

· Having failed to elicit an adequate response from the NDOH, SAPPF has turned to the Provincial Departments of Health, namely the Western Cape (WCDoH) where it was understood a Service Level Agreement (SLA) between the province and the private hospitals was in its 23 iteration. Extraordinarily, despite the reality that private doctors would be involved in treating state patients in these private sector facilities, no negotiations or discussions had been had with clinicians concerning their involvement!

The pandemic will ask much and take much from us all. By the time this disease has run its course, it will have exhausted us physically, emotionally and financially, and some of us will have paid the ultimate price. Despite this, our humanity, and whatever it is that drives our desire to serve our fellow travellers, will prevail for many, but it must be remembered that participation in this is voluntary and each one of us have responsibilities to self, to our spouses and our children. No one should be judged by their willingness or lack thereof to participate. We will shortly be sharing with you the terms of the WC SLA which will incorporate the per diem on offer from the state, and which we will use in drafting similar SLA’s for the other provinces.

We will be asking for your feed-back. Will you be prepared to serve in the frontline on the terms set out in this SLA?

Dr Chris Archer, SAPPF CEO

Dr Simon Strachan SAPPF Deputy CEO