Buckland Medical Centre

Tara Surgery

Introduction

The purpose of this Continuity Plan is to provide both a first response and a framework under which the Practice may be managed and continue to operate under exceptional and adverse circumstances.

Source Documentation

A copy of this document is kept off the premises in hard copy by the Practice Manager and at least one of the partners, who will also hold a hard copy off the premises where it is easily accessible in the event of an emergency. The document is also available online at practice website.

General Responsibilities

Practice Manager

Responsible for

• Preparing the initial draft of the plan
• Reviewing the plan annually or at agreed intervals
• Updating the plan as changes occur (e.g. in personnel)
• Distributing the plan to all staff by the agreed means below at each update
• Holding a hard-copy and an electronic copy of the plan at work and at home
• Ensuring that the patients receive up to date information regarding the situation by the designated means (see below)
• Liaising with NHS England and other health bodies / services

 

Partners

Responsible for:

• Holding a hard-copy of the plan at work and at home
• Contributing to the plan content
• Initiating response / recovery action as detailed below
• Liaising with the press / media if appropriate

 

Staff

Responsible for:

• Holding a hard copy or an electronic copy of the plan accessible from home
• Contributing to the plan content
• Advising Sue Thatcher of changes to personal circumstances to allow the plan to be updated.
• Dealing with patient enquiries and informing other health service personnel as directed.

This plan will be distributed to the partners and staff to hold at each update, and contributions or comments will be invited from everyone.

The Partners and the Practice Manager as a collective body will be responsible for implementing the plan in the event of a recovery situation.

IMMEDIATE RESPONSES FOLLOWING A SIGNIFICANT EVENT

Surgery Building – Long Term or Short Term Loss of Access

Many of the sections below will refer to the procedures outlined in this section relating to adverse effect on the building or part of it.

If the building becomes unavailable for use for any reason, suitable alternative accommodation must be identified. The following have been identified locally and may have rooms and facilities available which are suitable for temporary surgeries.

Accommodation	Telephone	Accommodation	Telephone
PETER STREET SURGERY	01304 219890

 

In the event of an incident, the practice will ensure that patients and staff are notified of any service changes.  If services are affected, patients will be notified of any changes in a number of ways:

• Notice on the Surgery door
• Calling patients who have appointments
• Changing voicemail message
• Providing information on the Practice website.

SKCCCE/NHSE will be able to provide advice and support.

 In the longer term patients will be requested to watch the practice website www.bucklandmedicalpractice.co.uk  which will be updated on a regular basis.

Immediate Action to be taken or considered:

• Evacuation of building if in working hours – staff to take personal belongings including house keys, mobile phones, the surgery mobile phones, essential records and contact information.
• Set the telephone system to the evacuation message
• Lock records cabinets. Remove keys from site.
• Staff to be instructed to access practice website on a regular basis for up to date information if sent home.
• Ring the police and fire service if appropriate
• Ring the gas board and the electricity board if appropriate (safety).
• Ring NHS England /South Kent Coast CCG and speak to a senior staff member
• Ring Clinical Supplier
• Ring telephone service provider. Ensure surgery number is still available with the suitably recorded message. Re-record special message if appropriate.
• Ring alarm company.
• Post signs on the doors if appropriate.
• Turn off the gas, electricity and water. (Electrical shut-down will effect the telephones and alarms)
• Ensure building locked. Close security shutters if appropriate. Set alarms if electricity still available.
• Allocate a senior staff member to remain close to the site if appropriate to guide and deal with emergency vehicles. Provide with a mobile phone.
• Re-convene at remote “Emergency Control Centre” location
• Instruct the Royal Mail to hold all mail at the sorting office until this can be collected by a staff member.

A contact list is at the end of this document including our normal contractors

Evacuation of Building and the Emergency Services.

This is in accordance with published fire orders. A senior member of staff or partner will direct operations and the removal of equipment or records depending on the nature of the emergency. Staff will normally be instructed to return home and await further information. In the event of a bomb alert telephones and the fire bell will not be sounded and evacuation will be by word of mouth.

Establishing an Emergency Control Centre

For purposes of an emergency meeting and planning the partners and the practice manager will convene at the Peter Street Surgery as soon as possible following the event. This will be the command centre until suitable alternative accommodation has been arranged. An IPad or other suitable computer, printer and a telephone(s) and fax machine will be available at that location. The address and telephone number is in the Contacts List attached.   Any outstanding action from the evacuation points above may be taken at this time.

Immediate Communication Issues

Staff should not make comments to the media and all enquiries should 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.

Once the Control Centre has been established the following should be advised of the emergency, if not previously informed:

• The emergency services
• The Out of Hours service
• NHS England emergency planning officer-
• Staff not involved in the initial incident
• All local surgeries
• All local hospitals
• All local pharmacies
• Our insurers

And the phone number of the Control Centre should be given out to each.

Damage Assessment

The partners and the 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 as to the duration of the event and the emergency steps to be taken. Staff will then be advised.

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 the possible sources of alternative accommodation.

Communication with Patients

In the event of a major communication need liaise with the CCG and ask them to request the Health Authority to write to all patients on the list, advising them of the nature of the incident and to watch the website for up to date information.

Loss of Computer system

Short Term Loss

For short-term loss reception will revert to a paper-based call system and a paper record of appointments will be maintained. Clinicians will revert to paper records if available, and will implement paper notes recording individual consultations if not.

Loss of hardware is covered by the Practice insurance policy. Note that the NHS England/South Kent Coast CCG should be consulted about replacement. The Practice will need to contact the South Kent Coast CCG ICT Manager to arrange replacements

Long Term Loss

The Practice is run from a Hosted Server (VES).  InPs are responsible for the backing up of all computer data on a daily basis.

We also run and manage Peter Street Surgery, Dover.  Patients could also be seen at Peter Street as the clinical system is the same as at Buckland Medical Centre and there is full access to all patient records available at all 3 sites (i.e. all records, appointments, audits etc can be seen and information recorded as necessary).

Loss of Access to Paper Medical Records

All paper medical records are stored in fireproof cabinets.

Emergency Security of Non-Patient Procedural Records, Protocols, and Clinical Guidelines and Information.

Where time allows the following documents should be removed off-site for possible use elsewhere:

• Paper based medical records
• Letters and correspondence from today
• Printed patient lists for today’s appointments
• Printed prescriptions and referral letters awaiting collection
• Blank prescription forms

Essential Forms List

In order to effectively recover total loss of facilities the following forms will need to be ordered. These can be borrowed on a temporary basis from Peter Street Surgery.

FORM	DESCRIPTION	LOCATION
Prescriptions		Reception Cupboard (locked)
Temporary Resident Forms		Reception Cupboard
Current day’s unscanned correspondence	All letters, test results,	Scanning desk (BMC) Reception (TARA)
Prescriptions awaiting collection		Prescriptions box  reception (BMC) Medication shelves and Cabinets (Tara) any paper prescriptions kept in prescription box on reception
Pharmacy Book		Reception Cupboard
Clinical Consultation Forms		Reception Cupboard

 

Hardware and Software Specifications

A full specification of all IT equipment on the premises including system details and installed software is documented.

Essential Equipment

Where time allows the following equipment should be removed off site for possible use elsewhere:

ITEM OF EQUIPMENT	LOCATION	NOTES
Emergency response kit including oxygen (be aware of gas safety issues, especially in the event of fire)	Corridor (BMC) Nurse Room Reception	Oxygen and defib. (BMC) Oxygen (Tara) Defib. (Tara)
Doctor’s bags	With Doctors
All personal mobile phones
Emergency Drugs	Nurses room
Vaccines from the refrigerators	Within vaccine fridge	Nurses Room (BMC) Nurses Room and Dispensary (TARA)
Nebulisers	Nurses office
Photocopier	Reception/Kitchen Reception	BMC Tara

 

Loss of Telephone System

Short Term Loss

Ring British Telecom on 154 for the fault to be investigated. Ring the other local surgeries and advise them that we have a fault and they may receive some of our calls. Use the mobile phones if extra outgoing lines are needed.

Long Term Loss

SCS maintain the telephone system under contract, and should be consulted immediately a problem arises and asked to attend if the property is still accessible. Arrange also for the fax number to be temporarily suspended to prevent unactioned faxes from being received in the surgery premises. 

The telephone system is dependent upon the electricity supply, and there should be a battery back up, however if power is lost for a long period telephone functionality on the premises will also be lost, and any long-standing changes will need to be effected at the Exchange.

If the power fails for any reason, there should be “power fail” telephone sockets in the reception office and handsets to be used if the power does fail.

Loss of Electricity Supply

In the event of a power failure within the building, the first thing to check is the main fuse box, which is situated in the cupboard at the bottom of the stairs.

If the fuse box is not the cause of the problem, the electricity supply company should be contacted. They need to be told that we have a phased supply into the building.

The Practice is reliant on electricity to power the building.  In the event of a power failure, the following systems will not work:

• Computer (the UPS system will supply very short-term power)
• Heating
• Clinical Refrigerators ( these should remain closed to retain the cold status)
• Lighting (except emergency lights)

If the power does fail, cancel all surgeries until such time as the power is restored. Building should be secured, and deal with resultant issues as under Section 2.1 above.

If the power is not going to be restored for some period of time, arrange to transfer vaccines from the cold stores to Peter Street Surgery.

The computers in the consulting rooms and other parts of the building should be switched off at the sockets, to prevent damage when the power is restored.

Loss of Gas Supply

In the event of a gas leak in the building, the shut off valve can be found in the box on the front of the building at both Buckland Medical Centre and Tara.

Open windows and the building should normally be evacuated.

The gas company E.ON should be called.  If the boiler or pumps fail call Worcester Bosch who has the maintenance contract.  The boiler supplies all the hot water as well as heating.

In the event of the heating failing, electric heaters can be used. Loss of hot water will pose a problem for hand washing and cleaning of surgical instruments – use the kettle

Incapacity of GPs

If for any reason the GP(s) is unable to provide medical services due to incapacity or death, NHS England should be informed as soon as possible.

Absences are dealt with under the terms of the Partnership Agreement.  If a partner is incapacitated through ill health from providing medical services to the patients, the remaining partners will cover for a period of weeks to be agreed, after which time the partners will make a decision whether to employ a locum.  Short term cover is provided internally by the partners or locums.  In the event of the death of one of the partners, NHS England should be informed as a matter of urgency.

No prescriptions should be printed or written on prescription pads/ Computer code for that GP. Any prescription pads, Med3s etc. in that partners name should be kept in a secure place until arrangements can be made to destroy them.

Arrangements must also be made to suspend the prescribing details of that partner on the computer and then they should be deleted.

Incapacity of Staff

In the event of a member of staff being incapacitated through ill health, no formal arrangements exist, except that other members of staff cover for the absent staff member.

Loss of Burglar Alarm

This is covered by a service contract with Javes Security and can be telephoned on 01843 590363

Loss of Fire Alarm

A service agreement exists with Javes Security and can be telephoned on 01843 590363

Loss of Water Supply

The stop valve for the water can be found in cleaners cupboard under the stairs at Buckland Medical Centre and in the waiting area at Tara.  Any problems contact Affinity Water (03453572424)/Business Stream(03301232000)

Fire

This will be dealt with in accordance with standard fire orders.

Flood/loss of water supply

Buckland Medical Centre is situated near a river which has never been known to flood.  In the unlikely case of flooding there are two rooms upstairs which could be used for consultations in an emergency. 

Tara, the surgery at St Margaret’s Bay is on high ground so would be prone to flooding. 

There are no overhead tanks, should internal water pipes burst a mopping-up operation would be put into place and electricity supplies turned off until it was considered safe to restore them.

Epidemic / Pandemic

In the event of an official alert the Practice Manager will liaise with the Emergency Planning Officer at NHS England to ensure that the practice conforms and co-operates with the joint efforts being made across the region to respond to the emergency. The practice manager or a nominated person will secure immediate delivery of extra clinical supplies to include masks, gloves, and gowns as appropriate.

The senior partner will liaise with Public Health to ensure a co-ordinated clinical response to the emergency and to initiate or confirm the arrangements by which patients will be informed, either directly from the Practice or via a central mailing.

The partners will consider short-term measures to ensure that as far as possible the risk of cross-infection is contained locally, and this may include a general communication to patients who suspect that they may be infected to stay at home and request a home visit, rather than attend a surgery. Notices may be placed on the surgery doors to this effect.

The partners will consider the risk to front-line staff and may instruct the issue and wearing of protective clothes and masks. Open surgeries may be suspended and appointment surgeries may be staggered, with lengthened appointment slots to reduce the incidence of patients sitting in the waiting areas together. An isolation room will be nominated-waiting room where symptomatic patients can wait – this will be subject to special cleaning / infection control arrangements.

Consideration will be given, in liaison with NHS England Emergency Planning Officer, to the setting up of special reception centres remote from GP surgeries to deal exclusively with patients reporting symptoms.

Subject to the above, the following specific actions will be taken:

• The practice will suspend routine appointments, clinics, and peripheral activities and plan activities such that they may still be maintained with 25% of both administration and clinical staff absent through illness (25% is the expected impact during a pandemic)
• The Practice will approach other practices in the area with a view to merging operations for the duration in order to share the remaining available staff and clinicians and resources to deal with the situation. Where this occurs one of the practice premises may become dedicated to the Pandemic symptomatic patients.
• A separate waiting area will be allocated to symptomatic patients. This will be the waiting room
• All door handles (which are a one of the most common sources of contamination) are to be disinfected hourly.
• Patient information will be provided constantly in the waiting room displays, website and on the front door.
• All staff will be issued with Filter Masks.
• All patients ringing the surgery to arrange to be seen will be asked if they have flu-like symptoms. Patients will be directed according to protocols established via the PCT
• Patients with symptoms will be advised that a friend or relation should collect the prescription.
• Doctors visiting symptomatic patients will adopt disposable respiratory protection.

Response to Major Incident – Accident / Terrorism

In the event of a major incident the Practice Manager will liaise with the Emergency Planning Officer at NHS England to ensure that the practice conforms and co-operates with the joint efforts being made across the region to respond to the emergency. The practice manager or a nominated person will secure immediate delivery of extra clinical supplies to include masks, gloves, gowns, vaccines as appropriate.

The practice manager will arrange for the cancellation of all routine appointments and clinics and arrange, if appropriate, for the OOH service to provide immediate cover. Consideration will be given to the securing of locum services by contacting the locums available within the current locum list to be on-site in the event that they are needed.

Useful Contact Numbers:

Gas – EON – 0345 055 0065

Electric – EON – 0345 055 0065

Insurance – Towergate – 01438 739891

Alarm – Javes - 01843 590363

InPS – Helpdesk – 02075017105

NELSCU – IT Helpdesk 03000 424242