Business Continuity Plan

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.

This document substantially uses the First Practice Management – Business   Continuity & Recovery Plan, as its basis. Amendments have been incorporated to reflect Welsh Policy however there is no intention to update this document. Practices who wish to keep abreast of developments on Business Continuity may wish to subscribe to First Practice Management, their contact details are: http://www.firstpracticemanagement.co.uk/

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 Wales 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

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

Staff

Responsible for:

• Holding a hard copy or an electronic copy of the plan accessible from home
• Contributing to the plan content
• Advising management 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: The Waterfront Medical Practice

Telephone: 01446 734131

In the short term patients are to be requested to telephone the surgery number 01446 700350 and to listen to the recorded message which will give up to date instructions. This number may, in due course, be transferred to the OOH service for permanent monitoring, at which time the OOH service will be fully informed of the situation in order to update patients.

Immediate Action to be taken or considered:

• Evacuation of building if in working hours – staff to take personal         belongings including house keys, mobile phones, essential records (see below) and contact information
• Contact the telephone system (EVAD) to put an evacuation message.
• Lock records cabinets. Remove keys from site
• Staff to remove their cars from the car park
• Patients to remove their cars from the car park
• Close off the car park permanently with cones or vehicles
• Staff to be instructed to access practice website on a regular basis for up to date information if sent home. Advise staff that the Cascade       communication system may be initiated
• Ring the police and fire service if appropriate (see contact list)
• Ring the gas board and the electricity board if appropriate
• Ring the LHB and speak to a senior staff member (see contact list)
• Ring Clinical Supplier if applicable (see contact list)
• Ring telephony service provider (see contact list). Ensure surgery         number is still available with the suitably recorded message. Re- record special message if appropriate
• Ring Alarm Company (see contact list)
• 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 (see below)
• 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 home of the Practice Manager, 16 Herbert St, Barry as soon as possible following the event. This will be the command centre until suitable alternative accommodation has been arranged. A laptop or other suitable computer, printer and a telephone(s) will be available at that location. The address and telephone number is in the Contacts List below. Any outstanding action from the evacuation points above may be undertaken at this time.

The backup USB stick in the possession of the Practice Manager where available should be used to immediately restore management data to the computer systems/laptop in the Emergency Centre in order to access insurance, contact details, staff details, details of suppliers etc.

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
• The LHB 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 and the insurance company 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 using the cascade system.

The Practice Manager will liaise with the insurers, landlords, loss adjusters 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 the practice can access limited patient computer records via the Business continuity set up on each clinician’s computer.

Reception will revert to a paper-based call system and a paper record of appointments will be maintained. Clinicians can either:

• Revert to paper records if available, and will implement paper notes recording    individual consultations if not, (paperwork can be found in the Contingency Folder in the back office). Or

• Utilise the practice ipads & laptops until normal service is resumed.

Loss of hardware is covered by the Practice insurance policy. Note that the LHB/BSC Primary Care IT teams should be consulted about replacement equipment (see contact List).

Long Term Loss

Computer back up tapes are made and are stored with Vision, INPS at Mamhilad, Pontypool.

In the event of long term system loss the backup tapes (where applicable)    will be used to recreate the practice at a new location or on a new computer system. Liaise with the clinical supplier (see contact list) and the BSC Primary Care ICT team (see contact list).

Hand-write prescriptions if pads are available. If not ring the LHB (see contact list) who will arrange the urgent supply of replacement pads.

Loss of Access to Paper Medical Records

The paper medical records are stored in the attic in 42 filing cabinets, 4 carousels and are not protected from any untoward event apart from fire doors. The cabinets are not fireproof.

If they were to be damaged in any way, records since 2005 could be constructed from data held on the computer system.

The stationery required to construct the medical records may be obtained from the LHB or BSC who are also able to produce address labels with      name, address DOB and NHS number for each patient. The LHB or BSC are also able to supply a printout of all the patients registered to the Practice.

Cyber Security Incidents impacting Systems & Service

The Practice will contact the DHCW service desk, suppliers and any other organisations providing technology services to allow the incident to be investigated, receive technical advice and support to contain the incident and restore services, alongside informing others of potential spread.

For short term loss, the reception will revert to a paper-based call system and a paper record of appointments will be maintained. GPs and other healthcare professionals will revert to paper records if available and will implement paper notes recording individual consultations if these are not accessible.

For the long term restoration of services, the Practice will contact the DHCW service desk to ensure computer records can be accessed in a secure environment and be used to recreate the practice at a new location or on a new computer system should the need arise.

In the event of long term system loss, the Practice will liaise with the Primary Care Service Desk and the respective clinical system supplier e.g., Vision / EMIS.

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:

• All backup USB’s are stored with the Practice Manager
• Paper based medical records are in filing cabinets/carousels
• Letters and correspondence from today (these will not be included within the previous evening’s tape backup)
• Printed patient lists for today’s appointments and a full printed    summary of each (these will not be included within the previous       evenings tape backup)
• Printed prescriptions and referral letters awaiting collection
• Blank prescription forms

Procedural records, protocols and clinical guidelines are maintained on the practice intranet.

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 nearby practices, or the practice has an Emergency Stationery Box containing the most commonly used forms including prescriptions, appointment cards and FP8s etc. If time allows these items should be removed from the premises in the event of an emergency.

Hardware and Software Specifications

Full specifications of all IT equipment on the premises including system details and installed software is contained within the asset register this is held on the G Drive.

Essential Equipment

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

Loss of Telephone System

Short Term Loss

Contact Evad on Tel 03300 536201 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 mobile phones if extra outgoing lines are needed. Appendix

Long Term Loss

Initially, contact the out of hours service (see contact list) to accept our calls. The OOH service may be advised of the nature of the problem, provided with our mobile (or other contact) number, and advised that up to date information will be posted on our website for the information of patients. They must be kept advised of significant changes to our circumstances.

Contact Evad/Focus Group on Tel 01332 327040 and ask them to have our number diverted by agreement to the OOH service (check that the OOH service switchboard is operational at this time of day), or to a mobile phone.

Evad/Focus Group on Tel 01332 327040 maintain the telephone system under contract, and should be consulted immediately a problem arises and asked to attend if the property is still accessible. The 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. Lines are provided by BT.

Arrange, via the telephony system supplier, for BT to intercept the ex-directory number and have this diverted to the OOH service. Arrange also for the fax number to be temporarily suspended to prevent un-actioned faxes from being received in the surgery premises.

A request may be made for phone lines to be provided into temporary accommodation and a transfer of all calls made to 07884083299 to the Practice Managers mobile telephone until the telephone system is repaired or replaced. If the Emergency Control Centre is to operate this may be given as a contact number, but is not for patient use. Patient calls would normally be directed to the temporary accommodation which can be manned by reception staff.

The telephone system is dependent upon the electricity supply, and there is 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 are no “power fail” telephone sockets in the surgery.

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 boardroom.

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)
• Telephones
• Heating
• Security Shutters (as these are electronically powered)
• 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 other local surgeries for temporary storage.

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 gas meter box situated on the outside wall between Room 9 and Room 8.

Open windows and the building should normally be evacuated.

The gas company should be called.  If the boiler or pumps fail call Loumac Plumbing Tel 02920 224432 or 07989 716543 who have the maintenance contract (see contact list).

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 – using the kettle may be considered.

Incapacity of GPs

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

If a partner is incapacitated through ill health from providing medical services to the patients, the remaining partners will cover when possible, for a period to be agreed, after which time the partners will make a decision whether to employ a locum. Short term cover is provided by employing a locum.

A list of current locum doctors with full GMC / Defence / LHB certification is situated on the shared G drive > Val > Locum Folder > POH Locum List.

The computer system will hold details of all patients registered to that partner from this arrangements will be made with the LHB for the remaining partners to provide medical services to those patients, if they so agree.

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.

All clerical and management routine procedures are fully documented on can be found on the practice Intranet.

Loss of Burglar Alarm

This is covered by a service contract with SGD Security Tel 029 2083 9940, Fax 029 2083 9941 and can be telephoned on the emergency number for an almost immediate response.

Loss of Fire Alarm

A service agreement exists with Plexus Fire and Security Ltd Tel 01792 561333(24Hours) and can be telephoned on the emergency number for an almost immediate response. Where the alarm cannot be repaired within the contracted time the building is to be closed. Consider the actions detailed in Section 2.1 above.

Loss of Burglar Alarm 

This is covered by a service contract with SGD Security Tel 029 2083 9940, Fax 029 2083 9941 and can be telephoned on the emergency number for an almost immediate response.

Loss of Water Supply

The stop valve for the water can be found in Room 6 – Tap on the right side of the window, half way up the wall.

Any problems contact Welsh Water Tel 0800 0520130. In the event of need, the large mineral water containers from the cold drink machine are available for use, and an emergency bulk supply may be ordered from the bottled water company (see contact list)

Fire

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

Epidemic / Pandemic

In the event of an official alert the Practice Manager will liaise with the Emergency Planning Officer at the UHLB 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 will liaise with the cluster re transfer of telephones See APPENDIX 2

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 as the interview room where symptomatic patients can wait – this will be subject to special cleaning / infection control arrangements.

To discuss with the Cluster changing the  hub too a Hot Hub as this is 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 cluster 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 a designated clinic room (treatment room or consultation 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 on the front door, practice website and social media.
• All staff will be issued with PPE/FFP3 Particulate 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 LHB
• 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 the LHB 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 – Transco - 0845 6056677

Electric – National Grid - 0800 6783 105

Water supplier (mains) - Welsh Water - 0800 0520130

InPS – Helpdesk – 0330 200 8048

Telephones - EVAD - 03300 536201