PRACTICE CONTINUITY / DISASTER / Practice Recovery Plan (2018)


My Computer has ‘crashed’!

The original purpose of a Disaster Recovery Plan in NHS general practice was to deal with the computer system failing, at a time when local back-ups were vital and GP computer systems were still in their infancy. Nowadays, the ‘contingency’ plan must account for continuing to run a medical practice if the building itself, or the practice’s personnel, are suddenly not available. The weather has also caused concern in recent years with the risk of flooding in low lying areas or simply ‘burst pipes’. What if a Practice Manager dies, or a singlehanded practice is suddenly without it’s GP. The Care Quality Commission is now inspecting practices nationwide and this is one of the important areas they are taking a look at.

Beware of ‘tractors’!

As I have said a Disaster Recovery or Contingency plan is also one of the documents required from practices by the Care Quality Commission. This is not simply a box-ticking exercise; rather, it is one that might save your practice from major losses following an unforeseen disaster.

I know Your Name?

Do you for instance have in one place all the information, names, addresses, telephone numbers, insurance policies etc that you might need if you cannot gain access to the premises. The so-called disaster could range from a burglary to a fire, or a major accident involving vehicles damaging the surgery building. I recall one surgery building was once rammed by a tractor deliberately. I have certainly experienced burst pipes spoiling the carpets in most of our consulting rooms. Added to that the death of a practice manager, and the failure of the computer system. One erstwhile GP managed to delete important word files from the practice’s hard drive. Tadcaster suffered serious flooding when a bridge collapsed. The surgery was close to the river.

Don’t break a leg please!

It might be a gas explosion or a power cut. In the short term, inclement weather might prevent practice staff getting to work and restrict the provision of services on a day-to-day basis. What do you do on a snow day? Who clears the car park and at what risk? If you do are you at risk of claims if someone falls and breaks their leg?

Beware of ‘walkers’!

When the country was under threat of swine flu it was thought that many practices would have to close as staff would not be well enough to work. And what happens if key personnel are suddenly not available? Illness can be disastrous for a practice team. A key member of staff might just walk out. It happens. I know!

Some suggestions – a check list

Below is a list of six things I’d recommend a GP or GP Practice Manager write into a disaster recovery plan. If you have already written yours, it might be helpful to use this article as a checklist to make sure your document covers all possible concerns.

Alternative Surgery Premises

The most serious type of disaster would involve the premises not being available, requiring the prompt availability of alternative accommodation. The larger the practice, the larger the alternative premises might need to be. The surgery might be located on land that has space for a temporary building such as a portakabin or large caravan. There might be a plot of land available nearby that could house a temporary structure. There might be a local hall or another surgery with space. Identify alternative premises and review your list each year.

Emergency Contacts for the GP Practice

A file should be kept off site at more than one location with the names, contact telephone numbers and email addresses of all practice staff and professional healthcare workers. The partners, practice nurses and senior staff should know the location of the file or retain both a paper and a digital copy of it. The file should also contain information about surgery insurances, mortgages (account numbers), defence union membership (registration numbers) and a list of suppliers.

Replacement of IT System

Ideally, the practice’s computer system would be web based and the requirement to load a back-up and risk of losing data would be limited. The local NHS IT provider needs to have a plan to replace lost equipment. But in any event, any temporary building would still need all services connected – electricity, water and telephones – so it is important to create a second file of utility contacts, for the computer software provider, the NHS IT help desk, the PCT or its successor, the electricity and gas suppliers and the water authority.

Contacts for the wider NHS

Once the practice is up and running, it will need access to a range of general information about NHS hospitals and private health services. The internet clearly provides a major resource, but a hard copy of a ‘bible’ of the main contacts the practice uses on a day-to-day basis might not go amiss.  Do you keep a hard copy list of all the email contacts you generally use?

A Personnel Plan

It is not uncommon for a doctor, nurse or member of the practice staff to be absent unexpectedly on sick leave.  The absence might last a day, a few days or a long period. In my experience, practices vary in how they deal with absences. Doctors might employ a regular locum who is well known to the practice and its patients, or they might use an agency. Either the locum’s or the agency’s number should be kept in case of emergencies. Insurance policies are available to cover long-term absence. It might be an idea to keep a file of key documents such as CRB/DBS reports, and confirmation of registrations with the General Medical Council and the Royal College of Nurses.

Arrangements usually exist among nursing staff for them to cover each other and work extra hours when a nurse is absent. A similar scenario may exist for reception and administrative staff to cover sickness and holidays. It is good practice to pair staff so that they can cover each other when on holiday or sick. Staff might also be trained on a wide range of duties to allow flexibility, without a loss of expertise.

You might not think that this level of detail would be included in a plan, but what would happen if your practice manager fell ill and went on long-term sick leave or, worse still, died in service or just walked out?  Yes, it has happened. I know. You need a plan to cover their work, otherwise doctors and staff might not be paid.

Practice Managers Manual

A separate manual might be required setting out the duties of the practice manager and how the work is carried out. The manual should cover the preparation of the payroll and practice accounts, making payments and making NHS claims. These documents can take a long time to prepare.

Perhaps the most important part of the plan is to have a management lead and a clinical lead who will make the decisions together to get the show on the road again. Remember that Rome was not built in a day, and too many cooks spoil the broth.

A map of key documents

The QOF and CQC have required practices to create and set up considerable documentation about the work that we do – this might include model contracts. It probably is impossible to copy everything to another location. I think it is more a case of priorities – what documents are you likely to need? How easily can you find documents from other sources?

Back up Practice records

Again, back-ups kept off site might be invaluable here and I wonder whether many practices keep up-to-date back-ups of payroll and practice accounts data. Reconstituting a GP practice payroll can require a lot of research and can take a considerable amount of time. I had to do it once. What salary scales do you use? It might not be as simple as looking up the latest Agenda for Change salary scales. As I did recently I had to ask all the staff for personnel details again to set up a computer payroll. The practice only had a manual payroll.

Contact Numbers

Your list of contact numbers should include details of your surgery insurance policies. Hopefully, these will cover the catastrophe you have encountered. You may have to use a list of builders and suppliers designated by the insurance company. Failing that, you could keep a list of builders and other trades that you might require to carry out your emergency repairs.

It might not be a bad idea to check your insurance cover to see what will be done and what will be paid for if you have a disaster.

Disaster Recovery – Summary

  • Have a plan for relocating your premises if you are unable to use your surgery site
  • Keep an off-site list of contact details of key personnel and contacts, including your insurers
  • A hard  copy of day-to-day contacts will get the practice up and running while the IT system is being restored
  • Produce a manual detailing how key tasks are undertaken, such as payroll and NHS payments
  • Keep off-site back-ups of key administrative data
  • Study your  insurance policies to see what you are covered for

Robert Campbell – Revised July 2018


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