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General Practice Emergency/ Business Continuity Plan (with thanks to Hampshire LMC)
The …………..Practice
General Practice
Emergency/Business Continuity
Plan
Author(s)
Date of issue
Date tested
Date of review
Date of next review
Version No
Name, Practice Manager
Month, year
Month, year
One
We acknowledgement the contribution of the RCGP, BMA & Wessex
LMCs in the development of this plan
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Contents
1.
INTRODUCTION………………………………………………………………. 4
1.1
Aim of the Plan……………………………………………………….….4
1.2
Method………………………………………………………….………..4
1.3
Implementation………………………………………………………….4
1.4
Overview of the management of an incident………………...………4
2.
DOCUMENT REVIEW ARRANGEMENTS…………..……………………5
3.
ALERTING PROCESS…………………………………………………...........5
3.1
Preventing Escalation of the Incident…………………………..........5
4.
ISOLATION………………………………………………………………………5
5.
EVACUATION OF THE PREMISES……………………………………..……5-6
6.
COMMUNICATION………………………………………………………………6
7.
RESTORATION OF NORMALITY……………………………………………..6
8.
IDENTIFICATION OF STAFF…………………………………………………..6
9.
TRAINING AND EXERCISING…………………………………………………6
10.
ACTIVATION OF THE BUSINESS CONTINUITY PLAN…………………..7
11.
SPECIFIC SITUATIONS, INCIDENTS & PROBLEMS………………..…….7
11.1 Emergency response to Major Incidents………………………………7
11.2 Medical Support at Rest, Evacuation & Survivor Centres……………7
11.3 Vulnerable People………………………………………………………..7-8
11.4 Mass Vaccination/Prophylaxis Issue…………………………………..8
11.5 Pandemic Flu or other Epidemic……………………………………….8
11.6 Chemical Biological, Radiological & Nuclear Incidents………………8-9
12.
BUSINESS CONTINUITY………………………………………………………..9
12.1 Priority order of services provided………………………………………9
13.
IMMEDIATE RESPONSE FOLLOWING SIGNIFICANT EVENT…………9-10
13.1 Surgery Building - long term or short term loss of access………..10-11
13.2 Evacuation of Buildings & Emergency Services…………………..11
13.3 Establishing an Emergency Control Centre………………………..11
13.4 Immediate Communication Issues………………………………….11-12
13.5 Communication with Patients and Clients………………………….12
13.6 Damage Assessment…………………………………………………12
14.
FAILURE OF IT SYSTEMS…………………………………………………..12-13
14.1 Computers……………………………………………………………..12
14.2 File Server……………………………………………………………..12
14.3 Protection of Servers…………………………………………………12
14.4 Hardware & Software Specifications………………………………..13
15.
SHORT TERM LOSS………………………………………………………….13
16.
LONG TERM LOSS…………………………………………………………...13-15
16.1 Back-up Tapes………………………………………………………...13
16.2 Prescriptions……………………………………………………………13
16.3 Loss of Access to Paper Medical Records…………………………13-14
16.4 Emergency Security of Information relating to non patient,
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17.
procedural records, protocols, clinical guidelines etc………………14
16.5 Essential Forms List…………………………………………………..14-15
FAILURE/LOSS OF TELEPHONE SYSTEMS……………………………15
17.1 Short Term Loss……………………………………………………...15
17.2 Long Term Loss……………………………………………………....15
18.
FAILURE/LOSS OF ELECTRICITY SUPPLY……………………………..15-17
18.1 Appointment Sheets………………………………………………….15
18.2 Clinical Refrigerators…………………………………………………16
18.3 Computers……………………………………………………………..16
18.4 Heating…………………………………………………………………16-17
19.
BREAKDOWN OF STERILIZER…………………………………………….17
20.
FAILURE/LOSS OF GAS SUPPLY…………………………………………17-18
20.1 Hot Water Heaters…………………………………………………….18
21.
FAILURE/LOSS OF WATER SUPPLY……………………………………...18
21.1 Treatment Room……………………………………………………….18
21.2 Toilets……………………………………………………………………18
21.3 Hand Hygiene…………………………………………………………..18
21.4 Drinking Water………………………………………………………….18
22.
FLOOD………………………………………………………………………….18-19
22.1 Internal Flood………………………………………………………….18-19
22.2 External Flood…………………………………………………………19
23.
FUEL SHORTAGES…………..………………………………………………19
24.
DISRUPTION TO SUPPLIES………………………………………………...19-20
25.
FIRE………………………………………………………………………………20
26.
PARTNER/STAFF SHORTAGES…………………………………………...20-21
26.1 Incapacity of GPs……………………………………………………..20-21
26.2 Incapacity of employed Staff…………………………………………21
27.
MUTUAL AID ARRANGEMENTS WITH OTHER PRACTICES………….21
28.
ARRANGMENTS FOR REPLACEMENT MEDICAL STAFF……………..21
29.
ARRANGEMENTS FOR REPLACEMENT NURSING STAFF……………21
30.
ARRANGEMENTS FOR REPLACEMENT ADMIN AND MGT STAFF….21
APPENDICES
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(A)
CONTACTS LIST……………………………………………………………...22-24
(B)
CONTINGENCY PLAN FOR PANDEMIC FLU…………………………….25-30
(C)
INFECTIOUS PATIENTS……………………………………………………..31
(D)
CONTAMINATED PATIENTS………………………………………………..32
(E)
CONTENTS OF EMERGENCY BOX………………………………………...33
(F)
ACTION CARDS FOR EVACUATION OF PREMISES FOR FIRE………34
DISTRIBUTION LIST…………………………………………………………………...35
REFERENCES…………………………………………………………………………...36
1.
INTRODUCTION OF THE BUSINESS CONTINUITY PLAN
Emergencies within practices are rare occurrences, which have the potential for
serious impact on both the service provided and the business of the practice. It is
recognised that pre-planning for such emergencies can reduce the impact of the
emergency on both aspects. This plan is part of that process. It aims to cover all risks
for any and all foreseeable emergencies and threats. The plan seeks to incorporate
the roles of all members of staff and the responsibilities of the practice to the wider
health community. The range of incidents can vary from a very local practice
emergency such as a telephone system failure, to a wide incident such as extensive
flooding of severe weather, to a national or international threat such a disease
outbreak, pandemic or terrorism. The degree to which we plan to manage any
emergency is usually a balance of the risk of the event occurring and the impact on
practice operations and those of the wider health community such an event would
have.
1.1
Aim of Plan:
To bring together existing plans for emergencies into a single document capable of
dealing with “All risks”, therefore reducing the impact on the business and service
delivery of this practice.
1.2
Method:
 To build on existing procedures and command structures within the practice for
“common” emergencies to ensure that they are robust enough to deal with more
significant emergency events.
 To identify and plan appropriate contingencies
1.3
Implementation:
All staff will be aware of the contents of the plan. Parts of this Plan will be exercised
annually and a review undertaken where the said parts identify gaps and further
action.
1.4
Overview of the Management of an Incident:
The process of managing an incident is much the same, irrespective of the cause of
the incident:
o
Identify the problem
o
Alert wider team
o
Prevent escalation of incident
o
Seek outside assistance as appropriate
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2.
o
Communicate widely
o
Institute process to return to normality
DOCUMENT REVIEW ARRANGEMENTS
This document will be reviewed on an annual basis or when there is a change in the
working systems of the practice or changes to the contact arrangements of staff or
suppliers that affect the content. The date of the review will be recorded on the front
of the document along with the date of the next review. This will be the responsibility
of the Practice Manager.
3.
ALERTING PROCESS
On recognition of a potential or actual hazard there needs to be widespread alerting
as to the nature of the problem and these will follow the usual lines of responsibility
within the practice. This would normally be by the means of wider alerting below but
when appropriate by activation of the fire alarm. Occasionally incidents affecting the
wider health community will be notified to us by the PCT but it will be the
responsibility of the staff member receiving such notification to alert the practice
using the model below:
Staff Member
Office Manager/Practice
Manager/Duty Doctor
Relevant staff
3.1
Partners
Wider Health Community
Preventing escalation of the Incident
It is necessary to identify early in the process what is required to protect staff,
unaffected patients, the practice and finally any directly affected patients from further
harm. Depending on the nature of the problem this may require isolation of a patient,
evacuation of the practice, or controlling access to the practice i.e. closing.
4.
ISOLATION
All patients with high temperature, rash, or severe breathing problems will be isolated
in a dedicated examination room, the door labelled and the duty doctor informed of
the location of the patient(s) and apparent condition.
Any patient presenting in a contaminated state will be placed outside of the building
on a chair, if possible, Where this is not possible (i.e. patient unable to stand,
inclement weather etc.) the patient will be placed in a dedicated examination room.
5.
EVACUATION OF THE PREMISES
Evacuation of the premises, will be considered if there is a threat to safe working
within the practice. This may be immediate as in the case of fire and chemical
contamination situations or delayed as in situations such as loss of power and flood.
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Ideally we should be able to verify who was in the building at the time of evacuation
and that all people are accounted for. Given the large number of members of the
public who visit the building, often only for a few minutes, this may prove difficult. It is
therefore important that all areas are cleared and checked and staff groups will be
allocated areas of the building to check when such situations arise.
Evacuation may be required as an emergency when the fire alarm is sounded, or as
an urgent procedure on instruction of clinical staff due to contamination with
chemicals etc. or a suspicion that a highly contagious patient having presented.
On the sounding of the fire alarm or a decision to evacuate, the areas will be cleared
and checked by the staff groups as follows:
Staff Group/Person
Area to check - actions
Reception Staff
Waiting room, Health Visitors Room,
and District Nurses treatment area
Secretarial Staff
All consulting rooms and treatment
rooms.
Nursing Staff and Doctors to assist
any persons with special needs
 Assist any persons with special
needs
 Pick up the Major Emergency Box
and resuscitation equipment from the
building.
Practice Manager and Office
Manager
First Floor
Duty Doctor
Co-ordinate evacuation and a list of
persons in the building.
Where possible the names of all people will be collected as they are evacuated.
6.
COMMUNICATION
Depending upon the nature of the situation, consideration should be given to the
communicating of the incident to the following persons/organisations:
o
o
o
o
o
o
o
o
7.
Partners
Practice Managers
Ambulance Service
Out of Hours Service
PCT
Secondary Care
Health Protection Agency
Consultant in Communicable Disease Control
RESTORATION OF NORMALITY
Procedures will be included that include arrangements for the resumption of normal
service, particularly in the communication with patients and personnel of the practice.
8.
IDENTIFICATION OF STAFF
It is not current policy to provide staff with photographic ID documents.
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9.
TRAINING AND EXERCISING
The emergency and business continuity response arrangements within this plan will
not be effective if the staff that are expected to implement them at the time of an
emergency are unaware of them. To this end all staff will be made aware of the plan
as part of their induction and on-going training. If there are any significant changes to
the plan that affect the way in which staff respond these will be communicated to
them. The arrangements within this plan will be exercised at least once a year and
this will help to validate their effectiveness and highlight any gaps in the procedures
which can then be addressed.
10.
ACTIVATION OF THE BUSINESS CONTINUITY PLAN
The nominated person for this surgery to decide whether the plan or any part of it is
activated is the Practice Manager. The deputy in case of the Practice Manager’s
absence or unavailability will be the Senior Partner. Names and contact details of
these persons are:
Practice Manager, ?????????????
Senior Partner, Dr ???????????????
The decision to activate all or part of this plan will be done using the cascade
procedure – see Appendix ?
11.
SPECIFIC SITUATIONS/INCIDENTS & PROBLEMS
11.1
Emergency Response to Major Incidents
This response will be coordinated by the Hampshire Primary Care Trust to prevent
duplication and maximise the overall response. To assist in this the NHS will set up
its command and control structure. This comprises an emergency control centre
(ECC) being established within each PCT affected, and where there is more than one
NHS organisation involved the Lead PCT (Hampshire PCT) will establish an
overarching ECC for Hampshire and the IOW. This ECC will be responsible for
“coordination of health and social care economy, operational and public health
response” 4
Where support is offered or requested from GPs and Primary Care Teams this needs
to be coordinated through the PCT responsible for the area in which the practice is
situated.
For The ??????? Practice the PCT coordinating the response is Hampshire
PCT. In the event of a Major Incident to offer support, the contact is: 07017
031451 (Director on Call) or 07017 031107 (Service manager on call).
11.2
Medical Support at Rest, Evacuation and Survivor Centres
In the NHS Guidance on Major Incidents4, Primary Care Trusts have a responsibility
to provide medical support to rest, evacuation and survivor centres, on request.
Within Hampshire the South Central Ambulance NHS Trust will initially assess the
medical needs at either of the above centres and, if it is deemed necessary, the PCT
will be asked to provide a team.
It has been recognised that when people are caught up in a major incident, whether
directly involved in the incident or as a secondary impact of being evacuated, that
they will arrive at the centre without their medication. In these instances a local
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practice may receive a request for GP support to assist in the process of prescribing
and supplying medications.
11.3
Vulnerable People
In the event that there is reason to evacuate part of the community for any reason,
the Healthcare sector has a responsibility to work with the other agencies to assist in
any way possible. This may be by identifying vulnerable people who are known to the
practice, so this can be highlighted with the teams evacuating the residents and also
so that their needs can be taken into consideration. One of the sources of this
information will be the GP Practices serving the community.
The practice will hold a list of vulnerable people that they are aware of in the
community, which in the event that an evacuation is required can be shared with the
PCT, so this can be considered in planning for the evacuation.
Any practice staff who become aware of a vulnerable client registered with the
practice will inform the on call service manager (contact no above) who will be
responsible for maintaining the list. The list will be kept at the ECC. NB patients must
be made aware that they are on the list and for what purpose.
11.4
Mass Vaccination / prophylaxis issue
In the event of a major outbreak of infectious disease, the NHS via the PCTs may be
required to organise the mass vaccination or issue of prophylaxis to part or the whole
of the community; for example, in the case of a smallpox outbreak the DoH have
issued a framework6 that proposes that the entire eligible population of the UK will be
vaccinated within three days. In these cases the GP practices may receive a request
for assistance in the implementation of such a process.
11.5
Pandemic Flu or other Epidemic
In the event of a Pandemic Flu situation being notified by the DH/PCT please see
Appendix B
11.6
Chemical Biological Radiological and Nuclear (CBRN) Incidents
As general practices are considered one of the first ports of call into the health
system along with minor injury units, walk in centres and A&Es, it is not inconceivable
that if there was ever a CBRN incident within our area, general practices would have
self-presenting patients to surgeries.
In the event of an overt release of contaminated material at an identified site, the
emergency services have plans in place that will establish cordons to contain the
contamination and contaminated casualties, but there is always the possibility that
casualties will have left the scene before the emergency services arrive. If there is a
covert release of CBRN contamination, then it may be some hours or days later that
those contaminated, as well as those they have been in contact with since the
release, start experiencing signs and symptoms. It is at this time that the first
presentation at a GP practice is possible.
As soon as the authorities are aware of an incident involving CBRN release and
possible self-presentation of contaminated casualties at any entry to the health
system, all responding agencies will be informed as set out In the Hampshire and Isle
of Wight Multi Agency Generic CBRN Response Memorandum of Understanding.7
In the event that a contaminated casualty presents at the practice the following steps
should be taken.
1
Contain the casualty away from others and keep all staff at a distance.
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2
3
4
5
6
Consider containment for those who have already come into contact with the
casualty.
Call the Ambulance Service, stating that you have a contaminated casualty at
the practice.
Ask the casualty to remove their clothing, as this has been shown to reduce
the contamination by up to 80% of contaminant. Provide a plastic bag for the
casualty to place the clothes in.
Provide the casualty a 10Lt bucket of warm water containing 10ml of washing
up liquid and a sponge, encourage the casualty to wash their whole body.
Eyes should be washed with plain water. The casualty should also blow their
nose and wash their mouth out with water.
Provide a blanket once decontamination is complete and await the
ambulance service.
Remember all efforts must be taken to prevent further contamination of others.
12.
BUSINESS CONTINUITY
As stated in the introduction of this document, ensuring that General Practices are
able to maintain business continuity in the event of an emergency or business
interruption is essential.
In this section, the plan will cover the main areas where the practice could potentially
be required to implement business continuity arrangements.
Business Continuity Management (BCM) is not simply about having a plan. The
Business Continuity Institute describes five stages as follows: 




understanding your business,
business continuity strategies,
developing and implementing a BCM response,
developing a BCM culture and
exercising and maintenance and audit5.
This same approach has been recommended in the Civil Contingencies Act
guidance2 .
12.1
Priority order of services provided
General Practices offer a wide range of services to their patients and a list of services
that this surgery provides is provided below in order of priority.
Table 1
Patient consultations
Home visits
Specialist Clinics
(Add all the core and enhanced services provided in priority to patient need)
In the event of an emergency or business interruption this practice will endeavour to
maintain services to usual or as close to the usual standard, but it may be evident
that this is not possible. The Practice Manager will, at this point decide which are the
priority services that the practice must continue and which will be reduced or
stopped.
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Any decisions made to reduce or stop services must be communicated to the Head
of Primary Care at Hampshire PCT or out of hours, to the On Call Director (details
provided in the Useful Contacts List)
13.
IMMEDIATE RESPONSE FOLLOWING A SIGNIFICANT EVENT
The nominated person to lead / co-ordinate will normally be:
(1) Practice Manager
(2) Senior Partner
The first responsibility is to assess the situation and follow suitable course of action
as defined below.
13.1 Surgery Building – Long Term or Short Term Loss of Access
If the building becomes unavailable for use for any reason, a suitable alternative
accommodation has been identified which is an alternative general practice that is
local, has rooms and facilities which are available for temporary surgeries:
Accommodation
Another practice/school
Telephone No
In the short term patients will be requested to telephone the surgery number (enter
surgery number) and either listen to the recorded message or speak to a member of
staff who will provide up-to-date clear instructions to patients. This number may, in
due course, be transferred to the OOH service, at which time the OOH service will be
fully informed of the situation in order to update patients. In the longer term patients
will be requested to watch for notices placed within local chemists or outside the
surgery premises. These will be updated on a regular basis by nominated staff.
Immediate action that will be taken or considered by the lead person:















Evacuation of building if situation arises during working hours – staff to take
personal belongings including house keys, mobile phones, essential records
i.e. last back-up tapes, practice diaries and emergency procedure manual
which contains essential contact information.
Setting the telephone message system or transference of the telephones to a
mobile via BT 0800 154902
Locking of medical record cabinets. Remove keys and take away from site.
Remove back-up tapes and take away from site
Asking staff to remove their cars from the car park.
Asking patients to remove their cars from the car park.
Closing off the car park permanently with cones or vehicles.
Notification of house holders located behind the surgery
Staff to be instructed to contact the Practice Manager/Office
Manager/Reception Manager on a regular basis for up-to-date information if
sent home and provided with contact details of such persons.
Staff to provide Practice Manager with up-to-date contact telephone numbers
Advising staff that the Cascade communication system may/has be initiated.
Contacting the Police and/or Fire services as/if appropriate.
Contacting the Gas and Electricity Boards as/if appropriate (safety).
Contacting the PCT to inform a senior staff member of the current situation
(see contact list at annex ?, page ??? of this document).
Contacting Clinical IT Supplier (name of clinical system) (see contact list at
annex ?, page ??? of this document). Ensure clinical data is available
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










Contacting telephone service provider (SWT and BT, see contact list at annex
?, page ??? of this document).
Confirmation that the surgery telephone number is available with a suitably
recorded message. Re-record special message if appropriate.
Contacting Healthcare Computing who, in turn, will liaise with the PCT for
future computer requirements
Contacting of the alarm company see contact list at annex ?, page ??? of this
document).
Contacting of the Cleaners (see contact list at annex ?, page ??? of this
document)
Preparing and posting of signs on the doors if appropriate.
Turning off the gas, electricity and water. (NB: Electrical shut-down will effect
the telephones and alarms – see section ???, page ?? of this document).
Ensuring that the building is locked and set alarms if electricity still available.
Allocation of two senior staff members to remain close to the site, if
appropriate, to guide and deal with emergency vehicles. Provide them with a
mobile phone and give each the telephone number of the other and also note
this for the Lead personnel.
Organise the assembly of personnel at the remote “Emergency Control
Centre” location (see page ???? below)
Instructing the Royal Mail to hold all mail for the practice at the sorting office
until this can be collected by a staff member.
A contact list is included in appendix ??? at the end of this document including our
normal contractors.
13.2 Evacuation of Building and the Emergency Services
This is in accordance with our Fire Policy (see appendix ???). A nominated senior
member of staff or partner will direct actions for the removal of staff, patients,
equipment, non-medical and medical records depending on the nature of the
emergency. Staff will normally be instructed to return home and await for further
information and be provided with an emergency contact number so that they can
remain in touch regarding the situation. In the event of a bomb alert, the fire bell will
not be sounded, to avoid panic and evacuation will take place by word of mouth.
13.3 Establishing an Emergency Control Centre
It is a practice decision that in the event of an incident occurring, all available
partners, the Practice Manager, Office Manager and Reception Manager will attend
an emergency meeting as soon as possible following the event. This will be at a
designated command centre (which will be located ?????????) until suitable
alternative accommodation has been arranged. A laptop or other suitable computer,
printer, telephone(s) and fax machine will be available at that location. The address
and telephone number is contained in the Contacts List provided at annex ? of this
document. Any outstanding action from the evacuation points above may be taken at
this time.
Following instruction from the IT clinical supplier, the back-up tapes, where available,
will be used to immediately restore management data to the computer systems
available at the alternative site and the Contacts List made available to access
insurance, staff, suppliers, PCTs, Ambulance Trusts etc. (contained at annex ????)
13.4 Immediate Communication Issues
Staff will be instructed that they should not make comments to the media and that all
enquiries be referred to the nominated Partner or Practice Manager in the first
instance, who may decide to issue a basic and standard statement to prevent
misrepresentation of facts.
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Once a Control Centre has been established the following should be advised of the
emergency, as appropriate, if not previously informed together with the telephone
number of the Control Centre:












The emergency services (Police, Fire, Ambulance etc.)
The Out of Hours service
The PCT
The PPSA
The PCT Risk Manager
Staff and Partners not involved in the initial incident
All local surgeries
All local hospitals
All local pharmacies
The Practice insurers
Health Protection Agency
Consultant in Communicable Disease Control
Contact details of the above are provided in appendix ???.
13.5 Communication with Patients/Clients
It is important to maintain communication with clients during any period of business
interruption and the aim of this practice will be to reassure patients and clients by
providing them with regular information on the progress made in returning to
normality.
In the event that a business interruption is so severe that alternative arrangements
for the provision of care need to be communicated to the clients of the practice, this
will be done in collaboration with the PCT.
In the event that support from the PCT is required in publicising alternative
arrangements, the Lead person of the incident will contact Hampshire PCT Head of
Primary Care at the earliest possible moment to allow as much time as possible to
achieve communication with patients and clients. In the event of a major
communication requirement, the Practice Manager will liaise with the PCT to request
they contact the local media in order to advise patients within the locality of the
nature of the incident and where to find out up-to-date information together with
contact telephone numbers. (This may also involve requesting the PCT to write to
patients).
Where it is believed that it would be useful in clients knowing of contingency plans in
advance in helping to mitigate the effects of business interruption in such situations,
the appropriate arrangements within this plan will be shared with them in patient
information leaflets/newsletters regarding practice arrangements.
13.6 Damage Assessment
The Partners / Practice Manager will liaise with the emergency services to conduct
an immediate assessment of the situation and determine the extent and likely
duration of the emergency. A decision will then be taken set against the likely
duration of the event and emergency steps put into action. Staff will then be advised
using the cascade system (this is appendix ??? within this document).
The Practice Manager will liaise with the practice insurers and other agencies to
ensure that a swift and correct recovery is supported and achieved; including contact
with possible sources of alternative accommodation provision.
14.
FAILURE OF IT SYSTEMS
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Also refer to the Information Governance Policy which is located………….
14.1 Computers
All computers including those in consulting rooms and other parts of the building
should be switched off at the sockets to prevent damage when the power is restored.
14.2 File Server
The file server has a UPS attached and should not be switched off (the UPS will
automatically power down the server if the UPS’s power reserve is close to
exhaustion). Full procedures for this are held in the Emergency Procedures File
located ?????
NB – check that this auto-power down facility is configured correctly, if it is not
it will be necessary to check the length of time the UPS will provide power, and
ensure that the server is powered down before the UPS power reserve runs
out.
14.3 Protection of servers
During periods of extreme heat it is important to ensure that the server is maintained
at a temperature that will not cause overheating and subsequent failure.
14.4 Hardware and Software Specifications
Full specifications of all IT equipment on the practice premises including system
details and installed software are held by Healthcare Computing who can be
contacted on 01425 470888. The practice also has a basic equipment list as part of
the asset register and this is kept ?????????????????
15.
SHORT TERM LOSS
For short-term loss reception staff will need to revert to a paper-based call system
and a paper record of appointments will be maintained. See protocol for printing lists
in the Emergency Procedures Manual which is located ………….. Clinicians will use
Resilience, (present on each pc work station and hand held devices) and follow the
directed protocols within Resilience regarding paper, accessing letters, referrals,
dictation etc.
Loss of hardware is covered by Hampshire PCT who should be consulted about any
replacements. The Practice will need to contact the PCT IT Manager, insert name to
arrange for any replacements on enter tel no. Replacement computers are held offsite by Healthcare Computing and or at the PCT. For the Server, a replacement may
take longer but usually within 24 hours if the equipment is in stock. If the equipment
required is out of stock a response time of within 36 hours is normal. The Practice
Clinical Supplier has confirmed that their response time to provide a loan server
would be as soon as reasonably possible. Loan servers are offered for a period of 2
weeks free of charge and after this period, the practice would have to rent the loan
server from them. (An adequate back-up tape is required and this is always taken off
site for protection).
16.
LONG TERM LOSS
16.1 Back-up Tapes
A back-up tape of the computer is undertaken on a daily basis and is stored in the
practice fire proof safe (which is located …………..) A weekly back-up tape is also
undertaken and taken home by the Practice Manager each Monday, who returns the
previous week’s tapes each Tuesday. The back-up tapes are renewed regularly and
rotated. Care is taken to ensure that the named tapes run on the previous night are
used in a back-up restoration.
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In the event of long term system loss, the back-up tapes will be used to recreate the
practice database at a new location or on a new computer system. The Practice
Manager/IT Administrator will liaise with the Practice IT Clinical System Supplier, the
PCT IT Manager and Healthcare Computing.
16.2 Prescriptions
These will need to be hand written whilst the computer system is out of action. If
there are insufficient numbers of prescriptions, the PPSA should be contacted on
01962 853361, who will arrange an urgent supply of replacement pads. See protocol
contained within the Emergency Procedures Manual which is located ……………..
16.3 Loss of Access to Paper Medical Records
The paper medical records of patients are stored in the medical record filing system
within the reception office area and are not fully protected from an untoward event
such as fire (i.e. they are not contained in a fireproof cabinet)
If they are destroyed or damaged in any way, records can be constructed from data
held on the computer system but this would only apply to notes that have been
summarised onto the computer. Past information could therefore be lost but this
would be minimal.
The stationery required to re-construct the medical records can be obtained from the
PPSA who are also able to produce address labels with the name, address DOB and
NHS number for each individual patient. They are also able to supply a printout of all
patients registered at the Practice and should be contacted on 01962 853361 to
request this, if necessary.
16.4
Emergency Security of Information relating to Non-Patient Procedural
Records, Protocols, Clinical Guidelines
Wherever possible in an emergency situation, the following documents should be
removed off-site so that they can be accessed in an alternative location to ensure
continuity of service:










All back-up tapes from the practice fireproof safe (located within the general
office on the first floor) which contain both clinical and non-clinical information
Tape verification back-up CD (this is already kept off site at the Practice
Managers home)
Paper based medical records, where possible. It would be difficult to remove
all due to the vast volume of such
Letters and correspondence from today and also letters awaiting scanning or
filing as these will not be included within the previous evening’s tape back-up
Printed patient lists for today’s or tomorrow’s appointments
Mobile computing devices as these contain patient details
Printed prescriptions and referral letters awaiting collection
Blank prescription forms
Doctors bag from site and given to duty doctor
Controlled drugs from site – (only if site is not fully secure as these are
already kept in safe storage on the premises as per CD regulations). Store
with other practice or agree with a local chemist to provide safe storage until
you are organised. (??????chemist located ??????? have agreed to cover
the practice for this).
Procedural records, protocols and clinical guidelines are maintained on the practice
intranet. A back-up copy of the intranet is maintained on the normal back-up tapes.
16.5
Essential Forms List
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In order to effectively manage the loss of normal business, a supply of the following
forms will need to be ordered. These can be borrowed on a temporary basis from
NMHCP. An Emergency Stationery Box containing the most commonly used forms
including prescriptions, appointment cards and FP8s etc. is held in the
………………………..for use in the case of an emergency.
FORM
Prescription pads
Temporary Resident and New
Registration Forms
Current day’s un-scanned
correspondence
Prescriptions awaiting
collection and prescription
requests
Drug Register ?
Controlled Drugs Book
Domicillary Blood Referral
X-Ray Cards and blood
Forms
Contacts List – Telephone
Numbers
Locum Lists
Generic Referral Form
17.
DESCRIPTION
For each GP
LOCATION
Back Reception/ Cupboard on
the ground floor
Back Reception
All letters, test results,
General Office on the first floor
Prescriptions boxes on reception
desk in front reception area
Reception?????
Library on the first floor
Reception ????
Reception on reception desk in
front reception area
General Office on the first floor
General Office on the first floor
????????
FAILURE/LOSS OF TELEPHONE SYSTEMS
17.1
Short Term Loss
Ring your telecommunications provider to ask for the fault to be investigated on
01??????????????. If it is a major problem notify nearest surgeries (name the
surgeries and provide tel nos for each) on 014?????? just in case our patients try to
contact them.
17.2
Long Term Loss
The OOH service must be informed of the situation on ????????????????? as this
may have an impact on their workload during the night. They must be kept advised of
any significant changes to our circumstances and also provided with a telephone or
mobile number of a practice contact should they need to contact the surgery.
Ring BT on ??????????????? and request that they divert our telephone numbers to
the OOH service or a mobile telephone number of the practice named contact
depending on the time of day.
Contact the practice telephone system provider immediately a problem arises and
asked to attend the practice if the premises remain accessible. The telephone system
can be accessed remotely by computer link (if this is still available) and they can
arrange remote reprogramming to divert to the OOH service or another named site as
appropriate.
Arrange for BT to intercept the practice’s ex-directory number and have this also
diverted to the OOH service or another named site. Arrange also for the fax number to
be temporarily suspended to prevent faxes from being received in the surgery
premises which will not be able to be actioned.
A request may be required for the practice telephone lines to be diverted to temporary
accommodation until the telephone system is repaired or replaced. The Practice
Manager will assess whether this action is required and make the appropriate
arrangements.
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The telephone system is dependent upon an electricity supply. When the electricity
supply is interrupted, a back-up telephone (located in the front reception area???) must
be plugged into the landline socket located ????????????. This will receive incoming
calls only on enter telephone number.
If the land line fails, redirect all calls into the surgery to (insert designated mobile
phone).
18.
FAILURE/LOSS OF ELECTRICITY SUPPLY
In the event of a power failure within the building, the first thing to check are the trip
switches the main fuse box, which are situated enter location. If the problem is not the
trip switches, contact our electricity supplier to report the failure (insert supplier). The
emergency contact number is (insert emergency contact). Ask if they are able to give
an estimated length of time that the power will be off for planning purposes.
A decision should be made by the Practice Manager/Lead Partner as to whether
surgery business can be continued safely, or if relocation to an alternative site is
required to maintain business.
Torches are located in the tower room (located ????) and next to the key cupboard in
the front/back reception area. Spare batteries are located ???????????????. Wind-up
lamps are kept (enter where if appropriate)
Contact the PCT to inform them that you have a power failure affecting the practice
and what business continuity measures you are putting into place to maintain service.
If it is an electrical fault within the practice, contact (insert name and contact your
chosen electrician or if the premises are rented this may be the landlord or owner).
The Practice is reliant on electricity to power the building and in the event of a power
failure, the following systems will not work:











IT Systems
Telephone systems (internal system, voicemail etc)
Heating
Fire Alarm system
Security Alarm system
Refrigerators (these should remain closed to retain the cold status)
Lighting (except emergency lights)
ECG machines
Nebulizers
Emergency/Diagnostic equipment
Sterilizers
Each of the above will require consideration so you should follow the procedures
outlined in the section specific to the system problem.
18.1
Appointment Sheets (also refer to Emergency Procedure Manual)
If the electricity power does fail, it will not be possible to print out the appointment
sheets containing future booked appointments. Appointments therefore should only be
booked for same day urgent problems, after having informed the patient that not all
aspects of their clinical care may be addressed during the consultation because of the
system shut down. Patients should be asked to ring back where appropriate. If it is
not safe or possible to run any surgeries cancel all surgeries until such time as the
power is restored and the problems resolved and inform patients where contact details
are available. The building should be secured at this point and patient information
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displayed on the external doors of the practice. Full procedures for this are held in the
Emergency Procedures File located ?????
18.2
Clinical refrigerators
If failure is for a significant period, which will be detrimental to the contents, the
contents will be assessed and any temperature critical drugs will be relocated to (insert
contingency arrangements) to maintain them at optimum temperature (this could be to
another site or a local chemist for safe storage).
18.3
Computers
See section 14, pages 12-15 of this document
18.4
Heating
If heating is lost, assess the effect of the loss of heating related to the time of year and
general temperature, including forecast temperature. Electric heaters can be used and
are located ????????. Check first that they have an in-date pat testing sticker on the
plug or lead.
If it is felt that the practice business will be affected by loss of heating and the electrical
heaters cannot be used then if the premises are rented the landlord / owner should be
requested to provide alternative heating. The landlord’s contact details are
????????????
18.5
Loss of Burglar Alarm
This is covered by a service contract with Central Southern Security : enter tel no…… .
For a 24 hour call out service, with a response time of 4 hours, call enter tel no.
18.6
Loss of Fire Alarm
A service agreement exists with ………………….. for a 24 hour call out service with a
response time of “as soon as they can possibly get here”. Where the alarms cannot be
repaired within a 24 hour period, the building may be closed due to Health and Safety
reasons. Consider the actions associated with evacuation of the building in Section
??? of this document.
18.7
Emergency/Diagnostic Equipment
The implications, where such equipment does not have internal re-chargeable
batteries, requires consideration. If equipment does have internal re-chargeable
batteries, ensure you know the length of time the equipment can be used. See Table 2
below:
Table 2 (insert equipment)
Equipment
Internal Batteries Yes/No
If Yes duration/times it can
be used
Defibrillators
ECG Machine
19.
BREAKDOWN OF STERILIZER
This is covered by a contract with enter name of provider- tel: ???????????
The practice holds adequate supplies of disposable instruments and if necessary,
further orders should be placed for additional supplies through ???? to avoid
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exhausting stock. Used instruments should be disposed of in the clinical waste boxes
situated in the treatment rooms and these are transported off site by ???? and
disposed of as hazardous waste under the practice contract.
20.
FAILURE/LOSS OF GAS SUPPLY
In the event of a gas leak in the building, the gas-shut off valve should be deployed.
This is located in the meter room which is located on the outside of the building at
?????????. Do not use any electrical switches.
Open all windows and evacuate the building immediately.
British Gas should be called to report the failure on 0800111999 quoting reference
number: enter reference number. Request whether they are able to give an estimate
of the length it will be off for planning purposes.
If the boiler or pumps fail call ????????????? who hold a maintenance contract with
the practice.
20.1
Hot Water Heaters
All rooms have their own water heaters under the sinks. Should these fail then the
practice should call in the local plumber or electrical contractor to sort out any
problems (see Emergency Procedures File located ?????) for contact details.
Loss of hot water will pose a problem for hand washing and the cleaning of surgical
instruments – in an emergency you can use the kettle as a one off, but a plumber
needs to be called out urgently.
21.
FAILURE/LOSS OF WATER SUPPLY
See Emergency Procedures File located ????? The mains water shut off valve is
located enter location. The mains water stopcock external to the practice is located
(insert location).
The water supplier for this practice is ??? and their contact details are ????????? see
contacts list in appendix ??..
For internal plumbing emergencies contact ???(if the premises are rented this may be
the landlord or owner and not the name and contact of your designated plumber. NB
make sure they can respond to emergencies or have cover when they are away)
In the event that the water supply fails, assess the impact on the practice and consider:




Treatment Room
Toilets
Hand Hygiene
Drinking water
21.1
Treatment room
Sessions should be cancelled if the water supply is out of action and a member of staff
nominated to contact patients as soon as is reasonably possible.
21.2
Toilets
If toilets will be unavailable for a significant length of time arrange for porta-loos to be
hired from (insert name and contacts of hire companies). Notices should be placed on
the outside doors of the toilets to say that they are out of action and locked.
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21.3
Hand Hygiene
Follow advice from HPA infection control nurse specialist – to be inserted
21.4
Drinking Water
The practice has drinking water machines located in insert where….. Reception staff
are responsible for monitoring expiry dates of such and replenishing stocks.
22.
FLOOD
Depending on the extent of the flood it may be necessary to evacuate the building as
per Section ??? of this document. Check if the surgery is in the Environment Agency
predicted flood plane by going to the website http://www.environment-agency.gov.uk/
Enter the postcode of the surgery.
22.1
Internal Flood
In the event of an internal flood or burst pipe, turn off the water supply enter location.
The effected section of the building should be closed off using signing and hazard
warning equipment (which is located in ????????????????).
Essential surgeries will be held in available rooms that are unaffected. The situation
will be assessed by the Practice Manager and the following activities cancelled if
considered necessary:





Meetings
Minor surgery
Treatment room procedures
Internal Training Courses and presentations
Clinical Appointments
A member of staff should be nominated to contact patients/clients as soon as is
reasonably possible to inform them of the situation.
While the water supply is off, water should be conserved. Toilet flushing should be
reduced and disinfectant used rather than flushing where possible. Anti-bacterial soap,
which clean hands without the need for water, should be placed beside all washbasins.
Bottled water should be available for drinking if necessary and a member of staff will
be designated to source bottled water and to place notices around the practice to
inform patients/clients of the situation.
Contact our insurers on ?????????????? (see contact list at appendix ?????)
Contact details of the local plumber are ??????? and are also held on the contact list
at appendix ???. If the leakage is part of the central heating system then this is
covered by a maintenance contract with the gas servicing company which should be
called as a priority (contact details: ??????????????? see contact list at appendix ?).
22.2
External Flood
In the event of an external flood the building would normally be part of a wider
externally flooded area and will be closed. The procedures relating to Evacuation of
Building should be followed (page ???? of this document). In addition it will be
necessary to liaise with the Environmental Agency to ensure that the building is
hygienically clean (overflow of drains and sewer system etc. ) prior to the building
being re-opened.
The telephone number for the Environmental Agency is
?????????????? see contact list at appendix ??
23.
FUEL SHORTAGES
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In the event of a fuel shortage, the ability to maintain services may be affected either
by doctors and staff being unable to carry out services such as home visits or to get to
the surgery.
Each PCT has a fuel crisis contingency plan and you should contact the PCT
Headquarters of the PCT for arrangements for obtaining fuel.
24.
DISRUPTION TO SUPPLIES
During a major emergency there may be interruptions to the supply of consumables
and equipment required by the practice. This may be due to a cause of an incident,
i.e. a supplier factory fire or by a disruption to the transport network such as in a fuel
crisis.
In such an event, the Practice Manager will be responsible for assessing the impact on
the business of the practice.
If there is a need to obtain supplies from another source the options are:

Mutual aid from another practice or the PCT (insert any mutual aid arrangements
with other practices / PCT)
Contact another supplier. (List all your suppliers and alternative suppliers in a
separate annex)

Alternative suppliers are detailed on the contact list at appendix ?. Where only a single
supplier exists (e.g. Yellow Fever Vaccines) and the supplier is unable to deliver the
required supplies as expected, then arrangements should be made for patients to be
directed to other stockholders in the area. These are????????
25.
FIRE
See the Practice Fire Policy in the Emergency Procedures File located ?????
26.
PARTNER/STAFF SHORTAGES
There may be occasions when individual GPs and/or staff are incapacitated for a
variety of reasons. Their absence will have a varying effect depending on the role they
are responsible for. In some cases roles can be covered by others that have required
and appropriate knowledge and skills. Other roles may be highly specialised and
cover will need more thought and planning, especially if a service depends on that
person alone.
There may also be the scenario when a number of staff are incapacitated at the same
time such as in an influenza pandemic situation.
On discovering there is going to be a shortage of staff, the Practice Manager will be
responsible for assessing the impact on the business of the practice and the
contingency to be initiated to maintain continuity of service.
Options available:



The absence of staff for a short period does not have a significant impact on the
business of the practice – monitor the situation only.
The absence of staff will have direct impact on the front line services/ business of
the practice - divert workload to or between other staff that are capable of covering.
The absence of staff will have a direct impact on the front line services/ business
where there is no other employee who is able to cover the role(s). Seek
appropriate bank/agency staff to cover/cancel service.
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
The impact of one or a number of staff being incapacitated is such that the practice
is unable to continue services – the Practice Manager will be responsible for
assessing the capabilities of the practice and possibly which services will be
reduced (see list of priority services in table 1 on page ??? of this document) or
through mutual aid arrangements be diverted to other practices. (If you are going to
invoke mutual aid arrangements with other practices these will need to be prearranged, insert these arrangements)
If there is any reduction in patient services, the Practice Manager will contact the PCT
to inform them of this and the details as soon as possible.
26.1
Incapacity of GPs
If for any reason a GP(s) is unable to provide medical services due to incapacity or
death, the PCT should be informed as soon as possible.
Absence management is dealt with under the terms of the Partnership Agreement. If a
partner is incapacitated through ill health from providing medical services to patients,
the remaining partners will cover or employ locums for an agreed period. Locum
insurance is in existence and the company will be consulted at the outset if the
sickness or absence is for a long term period. Short term cover may be provided
internally by the partners or associates.
A list of current locum doctors with full GMC / Defence / PCT certification is held by the
Practice Manager.
In the event of the death of one of the partners, the PCT should be informed as a
matter of urgency.
No prescriptions should be printed or written on prescription pads containing the
computer code for that GP. Any prescription pads, Med3s etc. in that partners name
should be removed from use and kept in a secure place until arrangements can be
made to destroy them.
Arrangements must also be taken to suspend the prescribing details of that partner on
the computer.
An application should be made to the PCT for financial assistance as soon as possible
where locum cover is required to reduce financial impact on the practice and services.
26.2
Incapacity of Employed Staff
In the event of a member of staff being incapacitated through ill health, no formal
arrangements exist, except that other members of staff will cover for the absent staff
member. The Practice Manager and ???? hold contact details for every staff member
and will make the necessary arrangements.
If necessary, relief staff should be contacted for locum work and this should be
discussed with the Practice Manager in the first instance.
All clerical procedures are fully documented and can be found in the practice manual
27.
MUTUAL AID ARRANGEMENTS WITH OTHER PRACTICES
(Insert arrangements with other practices, including contacts)
28.
ARRANGEMENTS FOR REPLACEMENT MEDICAL STAFF
(Insert your arrangements)
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29.
ARRANGEMENTS FOR REPLACEMENT NURSING STAFF
(Insert your arrangements)
30.
ARRANGEMENTS
FOR
MANAGEMENT STAFF
REPLACEMENT
ADMIN
AND
(Insert your arrangements)
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Appendix A
Contacts List
Responsibility for activation & co-ordination of the Business Continuity
Plan:
Primary Lead
Deputy Lead
Practice Manager?
Senior Partner?
(Contact Details)
(Contact Details)_
Home
Mobile
Home
Mobile
Home
Mobile
Home
Mobile
Home
Mobile
Home
Enter details
Name
Position
Contacts
Enter names
Enter details
Enter details
Doctor Contact details:
Dr Enter names
Dr
Dr
Dr
Dr
Dr
Staff Contacts:
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PCT Contacts :
Reason for contact
Department
Contacts
Emergencies
Reduction in practice
Enter details
Enter details
Utilities / Services Contacts:
Service
Provider
Contacts
IT systems
Enter details
Enter details
Trade
Provider
Contacts
Electrician
Plumber
Heating Engineer
Builder
Enter details
Enter details
Telecommunications
Electricity
Gas
Water
Burglar Alarm
Tradesmen:
Other Health Care providers
Ambulance Service
OOH Service
Local Pharmacy
Local Hospitals
Ambulance control switch Enter details
board
Out of Hours Service
private line
Office Hours
Home
Switchboard
Switchboard
Health Protection Unit –
(Public Health)
Social Services Out of
Hours
Neighbouring Surgery
Hospital (1) switchboard
Hospital (2)
Hospital (3)
Main Line
Direct Line
Health Protection Agency
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emergency division
Other Practices with whom we have mutual aid arrangements:
Mutual aid available
Practice
Contacts
Premises
Enter details
Enter details
Suppliers of products / drugs etc:
Product
Supplier
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Appendix B
Contingency Plan for Pandemic Flu
Introduction
The Practice is required to produce a plan detailing its actions in the event of an
influenza pandemic. This section details those plans.
Aim
The aim is to provide essential General Practitioner services to registered patients during
an influenza pandemic.
Objectives
To:
 provide life saving services for every registered patient of the ?????? Practice who
requires it.
 prevent patients’ conditions becoming life threatening.
 set up a system for a flexible response to unpredictable events.
 preserve and protect the good health of all practice staff, both clinical and nonclinical.
Rationale for planning
Communication with and knowledge of our patients is at the heart of this plan. A
successful plan must offer the best possible care whilst minimising any compromises
necessary to meet demand.
The PCT has proposed an option of joint collaboration with neighbouring practices in
order to meet additional demand. The main advantages and disadvantages of this
approach over non-collaboration are as follows:
Advantages:
 Demand can be spread across a wider supply base, thereby affording a greater
probability of meeting demand.
 All patients in the collaborating practices will receive the same service level.
Disadvantages:
 Attending doctors will not have access to clinical notes of other practice’s patients.
 Continuity of care will be broken.
 Communication with patients regarding the collaborative system will be difficult and
will be unlikely to reach all who need to know in an efficient and timely manner. This
will result in confusion amongst patients which will be expressed as frustration to the
patients’ own practice, resulting in unnecessary additional pressure on an already
pressurised surgery.
 Collaboration will require high levels of co-ordination and administration between
practices and is likely to be less efficient and responsive than a practice based plan
where the practice is in full control and is in a position to respond quickly to changing
circumstances.
The disadvantages of a collaborative approach outnumber the advantages in both
number and weight and the case is not proven for collaborative working in this case.
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Therefore, it is the Practice’s view that our plan should stand independently of other
practices.
Threats






Transmission of Flu to staff and doctors
Absenteesism and extended duration of such
Increased workload
Family commitments
Wider Health Community needs
Loss of utilities
Transmission of Flu to staff and Doctors
There is a risk of transmission of Flu from patients to Doctors and staff, as there is from
anyone that we meet who is unwell. Eventually at least 75% of the population will have
been exposed sufficiently to the virus. Due to the nature of our work, we are likely to be
exposed in large quantities to the virus. Spread of the virus is likely to be due to airborne
particles and expelled particles that have landed on surfaces with which we have
contact. Spread of the disease within the practice can be reduced by infection control
methods, although it is unlikely to be a complete process.
Plans will change as the risk and workloads alter but will include measures as follows:






Segregation of Flu patients using different waiting areas and dedicated consulting
rooms
Segregation of doctors and staff managing flu patients, one doctor and receptionist
dedicated to flu patients, running an `open-house’ surgery
Wearing of appropriate Personal Protection Equipment by staff dealing with Flu
patients according to the guidance contained within this section
Prophylactic antiviral medication may be appropriate for some staff (this will follow
Guidance from the Health Protection Agency, PCT or DoH at the time of the
pandemic)
Staff who become sick will not be expected to attend work
Use of recovered (i.e. immune) staff to deal with flu patients
Absenteeism and extended duration
It is anticipated that the first wave of the pandemic will last 3-4 months with a peak of
activity lasting at least 8 weeks. It is also likely that absenteeism within health workers
will be in the region of 50% at any one time and possibly higher. Plans to deal with this
will vary through the course of the pandemic and we have considered the following:









Cancellation of outside activities, (meetings, teaching etc.)
Definition of minimum safe staffing levels
Suspension of Chronic Disease management
Suspension of new routine referrals
Increase repeat medication requests to 90 days for most drugs
Suspension of minor surgery, coil fitting, cervical smears etc.
Emergency Only `open-house’ surgeries
Team working with neighbouring practices
Identification of retired or non-practising colleagues who may be utilised
Assumptions
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





50% of doctors and staff will incapacitated and unable to work.
Minimum doctor and staff cover required will be ??????? (based on the initial week’s
activity of the pandemic i.e. we will see ??? patients with influenza seeking
treatment, rising to ???? at its peak which will be taken from national predictions and
applied to the Practice list size.
There will be no vaccine available for the specific flu outbreak at the initiation of this
plan (avian or otherwise). Should a vaccine become available, separate plans will be
developed to administer the vaccine to the approved cohort (following guidance from
the HPU, DOH or PCT) in the time frame to be agreed.
Out of Hours Services and Accident & Emergency Departments will continue to
provide a core service for hours outside normal day-time hours.
This plan is sustainable for a maximum of 8 weeks, after which a full review of
procedures will be required.
This plan will apply to The ???????? Practice patients.
Execution
General Outline.
Once the plan is initiated, and this will be via notification from either the HPU, PCT or
DOH, the Lead Partner and Practice Manager will form an Emergency Planning Team
(EPT) who will assume command of all services and procedures on behalf of the
Practice. The Practice will cease all routine treatment and re-align its services to provide
care to those with life threatening conditions. This will necessitate a change to normal
treatment priorities as provided in guidance from the initiating agency (some exampled
are provided below) If there is sufficient capacity left over, lower priority care will be
delivered at the discretion of the EPT. Anti-viral treatment will begin within 48 hours to
those patients displaying the appropriate symptoms and authorised by doctors. In line
with PCT guidance, anti-virals will not be administered as a blanket program of
protection in advance of symptoms or diagnosis.
Doctors will telephone and triage patients with flu symptoms and approve those
considered appropriate for anti-viral treatment. They will also man in-house surgeries for
the essential treatment of non-flu patients.
District Nurses will focus support on avoiding admissions to hospital.
Health Visitors will monitor the children in the at-risk cohort and provide advice to
patients and doctors as necessary.
Organisation and Tasks.
The Emergency Planning Team (EPT).
The EPT’s task is to administer this plan on behalf of the partners when so authorised,
initiate its cessation and pass control back to the Partners on its conclusion. Whilst this
plan is in place, they will make decisions as an authorised delegated body of the
Partnership and assume overall control in accordance with this document.
The EPT will consist of:
 The Managing Partner (or nominated deputy).
 The Clinical Governance Partner (or nominated deputy).
 The Practice Manager (or nominated deputy).
The EPT may co-opt any other clinical or non-clinical personnel as they see fit.
On receipt of notification from the PCT, the Partners may initiate the plan and once
initiated, will immediately hand over daily control to the EPT. In liaison with the PCT, the
Partners will decide when the plan is to cease and on receipt of such direction, the EPT
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is to close down the plan in an agreed timescale and hand back daily control to the
Partnership.
Doctors
The doctors’ task is to administer to registered patients at home and in the surgery
according to the following clinical priority (H = High, M = Medium = Low):







Patients in a life threatening condition. (H)
Patients in an imminent life threatening condition. (H)
Patients in pain. (M)
Patients not in a life threatening condition but by virtue of clinical necessity should be
seen. (M)
Routine treatment. (L)
Screening. (L)
Health promotion. (L)
Doctors are to:
Man a telephone triage service with the objective of:




Screening out those patients who do not require anti-viral treatment and approve
those who do
Approving those patients who should be given an appointment in surgery.
Man daily surgeries for those patients to be seen in surgery.
Provide a house call service for those patients who require treatment but cannot
or should not attend the surgery.
Referrals to hospital are to be minimised and avoided where possible.
Practice Nursing Team
The Practice Nursing Team’s tasks are to:



run a surgery based treatment room for High and Medium clinical priorities.
Nurses may accept Low clinical priorities into their Treatment Rooms if so
approved by the EPT but not until.
identify and administer a centralised area for holding contaminated clinical waste
until collection by the contractor.
monitor infection and contamination control procedures and facilities and give
daily reports to the EPT.
District Nurses (DN)
The DN Team will deliver services as per the PCT plan. This plan requires DNs to
concentrate on keeping patients out of hospital in accordance with their clinical priorities.
They will not be involved in the Practice anti-viral program or any subsequent
immunisation service unless so agreed with the PCT.
Health Visitors (HV)
Subject to the PCT plan, HVs will:



Postpone routine non-essential activity as directed by the PCT.
Provide a home anti-viral delivery and advice service to registered children
approved by doctors.
Administer routine childhood immunisations which would normally be done by the
Practice Nursing Team, subject to capacity.
Non-Clinical Support Team
Under the direction of the Practice Manager, the non-clinical support team will:
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

Establish an antiviral drug home delivery service.
Re-configure the telephone system to:
- facilitate a doctor telephone triage service.
- advise patients that we have become an emergency service only.


Cancel routine activity and notify patients affected.
Be prepared to reorganise into different groupings to support re-structured clinical
activity, should the EPT so direct.
Coordinating Instructions
Timings
The sequence and timing of events is unknown. Therefore, the following timings
represents the ideal sequencing and interval of events:
<D-14
<D -7
<D -3
<D -2
<D -2
D Day
DD+56
Warning received from PCT of imminent need for implementation of plan.
Internal briefings and preparations.
Delivery of anti-viral drugs.
Confirmation from PCT that implementation of plan still anticipated.
Cancellation of all Routine Appointments from D Day onwards.
Initiation of Practice Contingency Plan.
Cessation of plan and revert back to normal operation.
Normal surgery opening and closing hours will apply.
Leave & Half Days
We would not expect planned holidays i.e. leave and half days to be altered, as breaks
for hard working staff are accepted as necessary, during an extended incident.
However, staff and partners will be prepared to have their leave cancelled to return to
work in the event of a prolonged incident. This will only be actioned as a last resort.
Infection Control
The Practice Infection Control Policy (see ????????) is to be adhered to. In addition:


all masks are to be disposed of as clinical waste.
if gowns are disposable, they are to be disposed of as clinical waste. If not, used
gowns are to be collected centrally via the nurse–led infection control area.
Alteration of workload
This may be altered by patient concerns and behaviour, the need for anti-viral therapy,
capacity issues etc. It is anticipated that the practice will need to alter some of its work
patterns to provide extra capacity.
Staff Sickness
All members of the Practice will be briefed not to come to work if they believe they may
have contracted flu.
Family Commitments
In recognising that General Practice staff and doctors have a high level of dedication to
their patients, sometimes it will be necessary to put family in front of service to others. At
the time of the pandemic, there may be issues for doctors and members of staff in
dealing with sick family members or where normal child care arrangements cause
problems (i.e. schools closed etc.) We will try to support and accommodate this where
possible by flexible shift working, crèche/babysitting facilities at work and if unavoidable,
unscheduled leave of absence.
Emergency Babysitting arrangements to be considered as follows:
 Health children only
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




Use of common room
Video/DVD player
Computer with access to games and internet
Games, music, paper, comics, crayons, colouring books etc.
Babysitter to be employed as required
PCT Liaison
Prior to D Day, the Lead Partner/Practice will have discussed with the PCT the financial
consequences of implementing this plan. Specifically, these discussions should
address:



Compensation / dispensation in the event that QOF targets are not met.
Increases in prescribing expenditure in the event that the Practice exceeds their
prescribing budget at year end.
Compensation for additional operating costs (locums, consumables, nurse mileage
allowance, overtime etc).
Pharmacy Liaison.
It will not be possible to liaise with all pharmacies but close liaison is to be established
with ???? Pharmacy and ???? Pharmacy regarding the delivery of anti-viral medication
and other prescription medicines.
Loss of Utilities
It is not expected that there will be extended periods of power loss during a pandemic,
but fuel and food supplies may be difficult at times. This may need special arrangements
to be made such as authorisation and issue ID passes. This will be arranged via
Hampshire PCT
Wider Health Community Needs
It is possible that we will be asked to contribute towards the support of the wider health
community. This may include the following:





Support of neighbouring practices and single handed practice
Support of the Out of Hours service
Mass treatment distribution centres
Mass vaccination strategies
Support and advice to Pandemic Management Teams
These will be considered, according to the threat and available manpower which will be
notified via either the HPU, PCT or DOH. The practice will adapt staffing levels within
the practice, as reasonably safe to do so, to accommodate this.
Service Support
Equipment
Gowns & Masks. Requirement to be quantified and supplies obtained.
Sharps Boxes and Clinical Waste.
revised frequency of collection.
Continue to use existing contractor but consider
Locums. The EPT will consider the use of Locums and decide whether to use them
based on need and availability.
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Command and Liaison





The Partners will be the executive authority to initiate this plan.
EPT will command all activity whilst the plan is in place.
The Partners will resume command on cessation of this plan.
Liaison with the PCT will be maintained before, during and after the plan by the
Practice Manager.
Liaison with ???? Pharmacy & ???? Pharmacy regarding integrated home delivery of
medication.
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Appendix C
Infectious Patients
The infectious patient presents a threat to staff and patients in the surgery at the
same time, therefore the earlier any isolation takes place the less the exposure and
associated risk. The problem is identifying the patient as contagious is difficult for all
staff and doctors alike.
Identifying the problem may be by
o
o
o
o
Patients suspicion (“ I think my child has chicken pox”)
Symptoms (“High temperature and cough”)
Signs (“Unusual rash”)
Intelligence (“There is a new threat about”)
Consider
o Arranging a home visit if appropriate
o If in surgery consider isolation in Doctor ? side room and inform the doctor
due to see them or duty doctor.
Doctor actions
If diagnosis is of a serious infectious disease consider
o
o
o
o
Do I need to continue to isolate?
Do I need to wear mask, gown, gloves, eye protection or coverall?
Do I need to treat this patient urgently?
Do I need to discuss hospital admission with public health, health protection
agency, consultant in communicable disease, or infectious disease
consultant?
Remember it is important to protect the ambulance and hospital staff
Aide Memoire: New Diseases New Threats is in emergency box with protective
clothing and masks
Depending on potential diagnosis may require surgery to close, take details of those
in the surgery at the time, advice on this will be obtained from your Local Heath
Protection Unit
This will allow post exposure prophylaxis or immunisation to be carried out.
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Appendix D
Contaminated Patients
The contaminated patient may arise as a result of accident or deliberate intent; the
contamination may be on the clothing skin or hair of the patient. In rare
circumstances it may have been inhaled or ingested. There management is not to
that dissimilar from that of an infectious patient. Ideally the contamination will be
recognised early to prevent contamination of other people and of the practice.
Identifying the problem may be by
Patient suspicion
Nature of the incident
Symptoms
Signs
Intelligence
(“I think I have been covered in something”)
(explosion, covered in dust)
(Difficulty in breathing, eye irritation)
(Unconscious, burn marks)
(Prior warning from another source)
Consider



Contacting emergency services
Isolate the patient, preferably outside until an assessment can be made of the
risks presented.
Initiation of Evacuation Plan
Doctor actions
Assess the threat presented from history and symptoms. If a hazard is identified
contact the ambulance service giving as much information about patient and your
concerns so that appropriately protected staff can further assess and if required
decontaminate your patient.
It may be appropriate to ask the patient to remove their outer clothing whilst outside
the building so as to reduce the patients continuing exposure to the contaminant.
(Please note that the protective clothing in the emergency box is intended for use
against infection and although it will offer some limited protection against dusts and
splash it is not sufficient to protect you adequately against an unknown contaminant.
It would provide a degree of modesty protection for an ambulant casualty who has
removed their own clothing)
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Appendix E
Contents of Emergency Box:
o
o
o
o
o
o
o
o
Torch
Spare Batteries
Standard phone for use with emergency line
Re-charger adaptor for Mobile Phone (Nokia)
Space Blanket
Copy of emergency Plan
New diseases, New threats
Prepared signs for surgery
Protective equipment
Respirator type masks level FFP3D
Coveralls with hood
Reorder details
Small/ medium
3
Arco: 3M mask 8835 S/M
Medium/ large
3
Arco: 3M mask 8835 M/L
Small
2
Arco Microgard 2500 small
Medium
2
Large
2
Arco
Microgard
2500
medium
Arco: Microgard 2500 large
3
Arco
Eye Goggles
Rubber Gloves, standard
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Various sizes
Stock item
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Appendix F
Action Cards for Evacuation/Fire
Main Office Receptionists
On hearing the Fire alarm or the decision to evacuate being made
You will contact the relevant emergency services if not already informed
giving the :
 Nature of the incident
Fire, Contamination, etc
 Location of the incident,
Enter Full Address
 Number of people involved
Leave the building and assemble at the Muster Point which is ????
o
o
Secretarial Staff/Back Office
On hearing the Fire alarm or the decision to evacuate being made
o
o
o
You will ensure that all clinical rooms and common rooms are cleared
Assemble with all staff and patients at the muster point which is ????
Assist reception staff in taking names of staff and patients involved
Front Receptionist
On hearing the Fire alarm or the decision to evacuate being made
o
o
You will ask those in the waiting room to clear the building and assemble in
the muster point which is????
or as people leave the surgery take a brief note of peoples names
Clinical Staff including Doctors and Nurses
On hearing the Fire alarm or the decision to evacuate being made
o
o
o
You will assist patients to clear the building and assemble at the muster point
which is ?????
If time permits collect the resuscitation equipment and the emergency box if
not already in use.
Assemble with patients and staff at the muster point which is ???? giving any
first aid treatment required
Duty Doctor,
Will delegate a member of staff to prepare a definitive list of people involved, and
liaise with emergency services and practice manager as required
Practice/Office Manager
On hearing the Fire alarm or the decision to evacuate being made
o
o
o
You will ensure that the rest of the building is informed and evacuating as
appropriate
Assemble with staff and patients at the muster point which is ????
Liaise with the Duty Doctor
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Any questions regarding this plan should be referred to the Practice Manager.
Name of Practice Manager
Distribution List:
PCT
All Practice doctors
Practice Heads of Department
OOHS
All Local Hospital Management Teams
Ambulance Trusts
Practice Health Visitors
Practice District Nurses
References:
References
1
Royal College of General Practitioners (2004) Major Incidents and Disasters –
the role of the GP and Primary care team. RCGP
http://www.rcgp.org.uk/corporate/position/majorincidents.pdf
2
NM Government (2005) Emergency Preparedness – guidance on Part 1 of the
Civil Contingencies act 2004 its associated regulations and non-statutory
arrangements.
http://www.ukresilience.info/ccbill/index.htm
3
Department of Health (2003) Handling Major Incidents: An Operational
Doctrine. DOH.
http://www.dh.gov.uk/PolicyAndGuidance/EmergencyPlanning/fs/en
4
Department of Health Planning for Major Incidents: the NHS guidance –
Primary care Trusts, Version 10-24 September 2002.
http://www.dh.gov.uk/PolicyAndGuidance/EmergencyPlanning/fs/en
5
Business Continuity Institute (2005) Business Continuity management, Good
Practice Guidelines.
http://www.thebci.org/BCIGPG2005.htm
6
Department of Health (2005) Smallpox Mass Vaccination- an operational
planning Framework.
http://www.dh.gov.uk/policyandguidance/healthandsocialcaretopics/smallpox/f
s/en
7
Sussex Emergency Planning Steering Group (2005) Sussex Multi-Agency
CBRN Response – Memorandum of Understanding.
8
DOH UK Influenza Pandemic Contingency Plan dated October 2005
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