Bolton General Practice Business Continuity Plan

Background

Business Continuity Management (BCM) is a process that helps manage associated risks to ensure the smooth running of an organisation or delivery of a service, thus ensuring the continuity of the critical business/service functions in the event of a disruption, and to aid the effective recovery afterwards. There are clear National drivers that are Government led which aim to ensure all organisations have a clear understanding of BCM and its importance, and foster discussion of how best to achieve business continuity across all service sector organisations.

The BCM process itself is a generic management framework that is valid across the public, private and voluntary sectors. It is an ongoing process that helps organisations anticipate, prepare for, prevent, respond to and recover from disruptions, whatever their source and whatever aspect of the business they affect. The primary 'business' of private sector organisations is the generation of profit, a process that BCM seeks to protect. Other organisations such as the NHS provide services to the public, and it is equally if not more important to the general public that these services are protected and resilient.

Although there is an abundance of literature in respect of how large organisations and companies can plan and manage the BCM process at the point this work commenced no specific research was identified specifically around BCM for General Practice (GP) particularly as a General Practice can be viewed in business terms as a small to medium enterprise (SME). General Practice is often overlooked, it must be recognised that primarily GP’s are independent businesses and need to be viewed as micro companies they are contracted almost exclusively to the NHS with remuneration through capitation fees for service and various allowances. These services form a crucial and essential arm of the NHS and nationally this network provides extensive services to the general public. As employers, they have as any other business a statutory duty to comply with health and safety legislation.

Commitment to this area of work is essential given the ‘nature of the business’ and the consequences that could be faced by the GP’s, their staff and ultimately the service users in light of a serious untoward event.

The Business Continuity Plan is underpinned by a definitive number of risk assessments and the plan itself specifically deals with either ensuring the continuity of critical activities and functions during an incident and/or mitigating the effects of the disruption of critical activities. This will include specific actions to be taken to ensure continuity of the critical activities covered and actions to be taken in the event of disruption of one or more of these critical activities.

CONTENTS

Section1: Anticipation, Assessment, Prevention & Preparation

Page

1.1 Introduction 6

1.2 Who is the plan for? 6

1.3 The Definition of Untoward Incident 6

1.4 Type of Incident General Practice may face 7

1.5 Training and Exercising 7

1.6 Official reporting of Incidents 7

1.7 Plan, review, distribution and update 7

1.8 What resources are available and likely to be needed? 8

1.9 What is the role of the Practice 8

1.10 Support For Practices 8

1.11 Accountability – Roles and Responsibilities 8

1.12 Communication cascade 9

Section 2: Response

2.1 Notification Procedure 11

2.2 General Practice Incident Response Procedures 12

2.3 Incident Log Form 13

2.4

2.4.1

2.4.2

2.4.3

Roles and Responsibilities

Senior Partner

Practice Manager

Support Team

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2.5 Mobilisation of Staff and Areas of Responsibility 15

2.6 Incidents rooms 15

2.7 Serious Incident Log 15

2.8 Professional Advice 16

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Section 3: Business Continuity

3.1 Activation Flowchart 18

3.2 Business Continuity Incident Room 19

3.3 Business Continuity Management Policy 20

3.4 Business Impact Analysis 20

3.5 Business Continuity Incident Procedures 20

3.6 Human Resources 22

3.7 Operational Service Resumption 22

3.8 Communication 23

3.9 Seasonal Activity 23

3.10 Specific Incident Guidance 23

3.11 General Practice Overview 24

3.12 Action Cards 25

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Section 4: Recovery

4.1 Recovery Stage 28

4.2 Response to an Extended Incident 28

4.3 Incident Stand Down 28

4.4 Declaring an Incident Over 29

4.5 Incident Report 30

4.6 Social, Psychological and Psychiatric Support 30

4.7 Documentation 30

4.8 Debrief 30

4.9 Psychological effects of traumatic events 31

Section 5: Blank Forms

5.1 Telephone Incident Log 355.2 Incident Log 36Section 6: Telephone Numbers

6.1 Emergency Contact Numbers 396.2 Stakeholder contact details 406.3 Confidential GP contact details 42Appendix

Amendment Sheet 44

Department Current Status Form 45Winter/Disaster Recovery Contingency Planning affecting service delivery

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SECTION 1

In the Event of a Major incident turn immediately to

Section 2: RESPONSE

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SERIOUS INCIDENT & BUSINESS CONTINUITY PLAN

1.1 INTRODUCTION

The Civil Contingencies Act 2004 (“The Act”) and its supporting Regulations (The Civil Contingencies Act 2004) (Contingency Planning) Regulations 2005 (“The Regulations”) require local responders to prepare for the unexpected by carrying out the following activities:

a) Risk Assessment,b) Business Contingency Management (B.C.M.),c) Emergency Planning: andd) Maintaining patient awareness and arrangements to warn, inform,

and advise patients.

Although the current legislation does not identify General Practice within Level 1 or Level 2 responders. it is widely recognised as good practice to have a basic Business Continuity Plan in place.

1.2 WHO IS THE PLAN FOR?

All personnel within individual Practice must to be aware of the existence and content of the plan and their individual contributions to the implementation of the plan.

This plan attempts to describe what needs to happen, and who needs to do what, in the event of a serious incident, that could have an immediate impact on the Practice or part of the Practice.

Senior Partners, and Practice Managers have the responsibility to identify key personnel who are likely to be involved in the incident response and ensure that they have the appropriate knowledge, training and equipment to be able to respond safely and efficiently to an untoward incident. Furthermore, SSP Health/Practice Manager must also ensure they are sufficiently familiar with the contents and requirements of this plan and that they are ready and able to mount an immediate response in accordance with the provisions of this plan.

In the event of a serious incident, it is possible that several practices could respond.

1.3 THE DEFINITION OF UNTOWARD INCIDENT A serious incident could be described as any event that could present a serious threat to the practice, and prevents the delivery of full healthcare services.

Each individual NHS organisation must plan to handle incidents in which its own facilities, or neighbouring ones may be overwhelmed. Planning successfully for these wider disruptive challenges will require more than simply scaling up the current local arrangements of individual practices.

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1.4 TYPE OF INCIDENTS GENERAL PRACTICES MAY FACE

This plan is designed to respond to local events that could prevent a practice delivering its “normal” quality of health care services. Towards this objective a full and comprehensive risk identification exercise has been completed. The tool used to complete this part of the plan is the Australian - New Zealand Risk Management Standard (AS/NZS 4260 1999 Risk Management). A total of ten risk assessments have been produced as an additional resource for Practice Managers and it is the intention for this work to promote and support further work the Practice may feel they need to undertake in direct relevance to their services.Refer to supporting document, Business Continuity Plan: Risk Assessments

1.5 TRAINING AND EXERCISING

The Regulations (1) (2) also clarify the requirement in regards to arrangements for training. Training should be provided for an appropriate number of suitable personnel within the Practice.

1.6 OFFICIAL REPORTING OF INCIDENTS

If any action has been taken by the Practice in relation to an incident, this should be reported through the Significant Event Audit reporting procedure.

1.7 PLAN REVIEW, DISTRIBUTION & UPDATES SSP Health/Practice Manager will have responsibility for the review of the Plan on an annual basis. The next review date will be marked in the footer of the Plan.

SSP Health/Practice Manager should ensure that any amendment sheets are distributed to the full range of Practices as listed below.

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Name of Practice Practice Contact

3D Medical Centre 01204 396003

Ashton Medical Centre 01942 709080

Astley General Practice 01942 876339

Bolton General Practice 01204 521000

Bolton Medical Centre 01204 463900

Bowery Medical Centre 01744 813329

Braithwaite Road Surgery 01942 718221

Great Lever Practice 01204 462390

Higher Ince Surgery 01942 247958

Lower Ince Surgery 01942 481141

Platt Bridge 01942 862738

New Bank Health Centre 0161 277 5600

Newton Community Hospital Practice 01744 627600

Newton Medical Centre 01744 624885

Orrell Park Medical Centre 0151 525 3051

Park View 0151 330 8929

Rawson Road Surgery 0151 928 7576

The Height General Practice 0161 736 5282

The Pike Practice 01457 832561

Upton Rocks Medical Centre 0151 422 9794.

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WHAT RESOURCES ARE AVAILABLE AND LIKELY TO BE NEEDED?

The following personnel and resources are all likely to feel the effects of any increased demand for emergency healthcare as a result of a serious incident:

General Practitioners Practice Managers Practice Nurse/s Clerical/Reception personnel Vehicles IT/Communications Supplies and Equipment

The resources identified above are likely to be required at different stages of the response in relation to the incident.

1.9 WHAT IS THE ROLE OF THE PRACTICE?

Practices are responsible for providing general and emergency medical services to the patients within the practice and others who may be affected by the incident. This could include:

Provide information and advice to the public. Replacing missing medication and providing general medical services.

Etc

1.10 SUPPORT FOR PRACTICES.

In the aftermath of an incident Practices may be required to:

Deploy additional personnel and resources at the scene to provide immediate support for the patients and others who may be affected by the incident.

Route and refer requests for information and advice through the CCG and other agencies

Assess and treat minor injuries and minor medical emergencies during and after the incident.

1.11 ACCOUNTABILITY – ROLES AND RESPONSIBILITIES

SSP Health is responsible for ensuring that effective arrangements are in place for responding to a serious incident and that these arrangements are regularly reviewed, monitored and updated.

Unless otherwise stated the nominated Emergency Planning Lead will be the Practice Manager who is responsible for:

Ensuring that arrangements for responding to a serious incident is maintained, monitored and reviewed.

Ensuring that the Practice’s Serious Incident Plan is co-ordinated with those other relevant Practices within their cluster.

Ensure that appropriate training is provided.

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SECTION 2

RESPONSE

IN THE EVENT OF A SERIOUS INCIDENTPLEASE USE THIS SECTION TOGETHER

WITH SECTION 3: BUSINESS CONTINUITY

TO MANAGE THE PRACTICE RESPONSE

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2.1 NOTIFICATION PROCEDURE

If you receive a call regarding an incident or alert you should:

The Practice is to ensure the incident details are validated and appropriate action is initiated

CONFIRM CALLER’S DETAILSName, Organisation, Number

Time of callWrite these down before passing

the callon as the Caller may have to hang

up or be cut off before being

Surgery Hours: Monday 8:00 to 18.30Tuesday 8:00 to 18.30

Wednesday 7:00 to 18.30Thursday 8:00 to 18.30

Friday 8:00 to 18.30Call to be referred to

Vicki Hoinville 07872304025

Out of HoursCall to be referred to

SSP Health Chief Operating Officer Noeleen Bailey

Tel: 07525986785

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2.2 GENERAL PRACTICE INCIDENT RESPONSE PROCEDURES

SSP Health/Chief Operating Officer

Assess the Practice Response:

Are any practice facilities affected? Are any of the practice staff affected? Are there any patient/public health

risks? Are there road closures? Do you need to send information to the

CCG/ NHS England? Are there any business continuity

issues affecting the practice? Is the media involved? Have you informed all the relevant

agencies? Do you need more information?

If you are not sure if you should have taken any action, review the practice business continuity plan for further advice or contact the initial caller for more information about the incident. The Practice Manager for their records must retain the completed incident log.

Check if there are any practice facilities or staff affected by the incident.

If there are patient/public health implications, ensure relevant practice staff and CCG if necessary are consulted.

In the event of a serious incident the Senior Partner or Practice Manager must inform the CCG immediately

See section 6

Consider the following actions and ensure the incident log form is completed

NO ACTION MINOR INCIDENT SERIOUS INCIDENT

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If you have been notified about a fire and been advised that the affected building contained acetylene cylinders. This means following an initial assessment the Fire Service could place a 200 m hazard zone around the area for at least 24 hours.

This may affect local residents and businesses. Confirm if any road closures have been made that could affect access and check if local residents have been evacuated?

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2.3 INCIDENT LOG FORM

Time Call Received: Actions

Callers name:

Title / Dept:

Location / Address:

Contact Number:

Out of Hours contact:

If there is any doubt about the authenticity of the call, the alert must be verified by calling a recognised number for the alerting body.

Incident Address (if known):

Summary of incident / request (include actual time of incident):

Other organisations involved:

Name: Date:

Position: Time:

Other Action Taken:

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2.4 ROLES AND RESPONSIBILITIES

2.4.1 SSP HEALTHThe success of the management of an incident will depend largely on the quality of leadership provided. To this end, SSP Health or the Regional Manager will assume the role of Incident Co-ordinator for the duration of any declared incident. In normal working hours SSP Health Regional Manager will assume the role. Out of hours SSP Health or Designate will automatically assume the role for the initial response.

The Incident Co-ordinator will be responsible for:

Managing the situation from start to finish Overseeing the arrangements for maintaining continuity of the practices

core functions for the duration of the incident Informing and involving the relevant authorities Declaring the incident to be over and initiating the Stand Down procedure Managing all record-keeping and the completion of reports Liaison with the patients/public, relatives and the media as necessary

(See Action Card 1: Business Continuity Manager in Section 3 of the plan)

2.4.2 PRACTICE MANAGER The Incident Co-ordinator will liaise with the Practice Manager to make an assessment and to decide whether to assemble an Incident Team. The composition of the Team will vary depending upon the nature and scale of the incident.

Examples: Manage business continuity Ensure SSP Health is fully informed on the management of the incident Regularly brief all relevant personnel within the Practice Inform patients/public as necessary Consider the welfare of all staff engaged in managing the incident Establish a help line (or work with NHS Direct) for enquiries from public,

health care professionals etc. Maintain accurate records/log Assist the Incident Co-ordinator to produce a detailed report of the incident

(See Action Card 2: Continuity Team Member in Section 3 of the plan)

2.4.3 SUPPORT TEAMThe functions and responsibilities of the Practice Support staff will be to ensure the safe delivery of services with minimal disruption to staff and patients alike.

Examples: Communications lead Administrative Support (General) – to assist the Incident Co-ordinator and

Practice Manager Help Line Operator and Administrative Support (Major Incident Log)

2.5 MOBILISATION OF STAFF & AREAS OF RESPONSIBILITY

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Incident Co-ordinator Will identify and call in personnel as required and direct personnel to their individual duties to support the service delivery. The Practice Manager must hold (ensuring security and confidentiality) the contact details for staff under their management.

Support Team Will be directed to areas of work as appropriate to maintain a sustained response to manage the incident or maintain business continuity.

It must be noted that all staff may be required to undertake duties that would not normally be part of their daily work. (E.g. general clean ups/housekeeping manning phone lines etc)

2.6 INCIDENT ROOMS

If appropriate an area within the practice or a neighbouring practice may be set up as an incident room to enable the management and co-ordination of the business continuity process.

2.7 SERIOUS INCIDENT LOG

A serious incident log must be kept by the Incident Co-ordinator as an accurate record of the decisions and actions carried out during the incident. Everyone involved in the Practice response must keep a record of their actions and make copies available to the Incident Co-ordinator.

The major incident log must record dates and times of all information given and received, decisions, actions and all other communications relating to the incident. All written documents, letters, memoranda and fax messages should be dated and time of receipt recorded, with cross reference to the log where appropriate.

Incident Coordinator

Practice Manager

Support Team

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See Section 5: Blank log sheets Telephone recording sheets

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2.8 PROFESSIONAL ADVICE

PRACTICE LEGAL ADVISE - LEGAL REPRESENTATIVES

To be provided by Dr. S.K. Pitalia if required.

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SECTION 3

IN THE EVENT OFA BUSINESS CONTINUITY INCIDENT

PLEASE USE THIS SECTION TOGETHER WITH SECTION 2: RESPONSE

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3.1 ACTIVATION FLOWCHART

Senior Partner notifiedVerify information if necessary

Are any practice facilities / staff affected?

Assess the impact

Business Continuity Team required?

YES NO

Notify relevant staff –

If only to dispel rumours and ensure no further action is required.

Ask staff to complete Status Form (if necessary)

Identify essential functions

Ensure essential staff are not sent home before clarifying their role (if any) in the incident

Encourage staff to work in unaffected areas

Ensure relevant staff, suppliers, partners and other organisations are informed of the disruption to services and kept updated as to situation and return to normality.

Ensure staff are kept up to dateIdentify an area as a focus point for information

Once incident is stood down, brief Emergency Planning Lead

Further information on GP Response to external incidents can be found in Section 2: Response.

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3.2 BUSINESS CONTINUITY INCIDENT ROOM

The location of the room chosen to host the business continuity team will depend on the location of the incident. The COO/RM (Senior Partner/ Practice Manager) should choose a suitable location based on the following:

Health & Safety (including use of sanitary facilities) Availability of resources, utilities and communications Location of incident Communication to staff

The Practice Manager should ensure that regular rest breaks are taken, refreshment facilities are available and that staff are rotated on a regular basis.

The business continuity room will be located at: Bolton General PracticeMarsden House, Marsden Road, Bolton BL1 2AY

Out of Hours Access: The 111 Service 18:30 to 8:00 am the following day Monday to Friday and all day Saturday Sunday In the event of the loss of GP building, the essential services indicated in this plan can be relocated to:

3D Medical Centre, 200 Deane Road, Bolton BL3 5DP or Bolton Medical centre 21 Rupert Stree Bolton

3.3 BUSINESS CONTINUITY MANAGEMENT POLICY

3.3.1. Definition of Business Continuity Management (“BCM”)Business continuity means ‘maintaining the uninterrupted availability of all key business resources required to support essential business activities’. (ANAO: 2006)

3.3.2. LegislationCivil Contingencies Act, (2004), the current legislation does not identify General Practice within Level 1 or Level 2 responders. However, it is good practice to have a basic business continuity plan in place.

The Department of Health Emergency Planning Guidance (2005) and the Business Continuity Institute’s Good Practice Guidelines (2005) and Publicly Available Specification for Business Continuity Management (PAS56) have been used to develop the GP Business Continuity Plan.

3.3.3 Publication and DistributionDistribution of the full information contained within this section will therefore be restricted to Practice staff that are directly responsible for responding to business continuity incidents only.

3.3.4 Review Policy The business continuity plan will be reviewed, amended and updated on a regular basis by SSP Health/Practice Manager in consultation with key personnel. The Business Impact Analysis will be reviewed on an annual basis, or more frequently depending on the level of incidents that may have occurred. In the event of an incident affecting the GP structure or services, the plan as a whole will be reviewed to

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reflect any lessons learned, best practice or additional information. Any minor changes may be made directly by SSP Health

3.4 BUSINESS IMPACT ANALYSIS

Risk Assessments have been carried out to identify the potential risks to business continuity occurring and the subsequent impact of a business interruption.

Minor business interruptions occur on a daily basis and are dealt with using normal services and resources, e.g. The Practice personnel to deal with minor incidents and have plans in place to deal with larger incidents.

3.5 BUSINESS CONTINUITY INCIDENT PROCEDURES

3.5.1. INITIAL NOTIFICATIONFor minor incidents and most incidents during office hours, staff should follow existing procedures and lines of communication. The following numbers may be of use:

Number ContactMaintenance & Repairs 0161 929 9993 Planet construction IT Dept 01617656687 Help DeskElectricity 0800 404 090 Help deskGas 0800111999 British GasWater 01925 237 000 United utilitiesTelephones 0161 625 7166 NHS Property

Out of Hours:SSP Health/Practice Manager should be contacted, following the standard procedures outlined in Section 2. ` They will then assess the incident as a whole and take appropriate action as required. SSP Health/Practice Managers will generally deal with any minor business continuity matters out of hours or refer them to the relevant individuals to deal with within working hours. 3.5.2. DECLARING A BUSINESS CONTINUITY INCIDENT

SSP Health or Practice Manager may declare a business continuity incident to make all staff aware that there is a serious problem with the provision of normal services. Once a business continuity incident has been declared the Primary Care Development Manager should be appointed to oversee and co-ordinate the response.

In the event of a minor incident, or one that can be dealt with using normal services and resources, the relevant staff will deal with the affected service / area. The incident then would be reported to SSP Health/Practice Manager

3.5.3. BUSINESS CONTINUITY MANAGER/PRIMARY CARE DEVELOPMENT MANAGER (see also Action Card)

The role of the Business Continuity Manager/Regional Primary Care Development Manager is to oversee the response to the incident and ensure that decisions are made and implemented to reduce the impact of the incident on the premises or service. The nature of the incident will affect the length of time it will take to recover ‘normality’, for instance, a flood may be over in a few hours but the clean up time could take weeks.

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The Regional Primary Care Development Manager should also ensure that health & safety legislation is strictly adhered to. No staff should be asked to enter areas without the proper safety equipment and/or training. Outside contractors may need to be hired to deal with the assessment of a building after a fire or flood and to assess its structural integrity before staff can be allowed in to assess the damage to equipment and paperwork.

The Business Continuity Manager/Regional Primary Care Development Manager should appoint a business continuity team to assist with the assessment, mitigation and recovery process. This will depend on the nature and extent of the impact and could be limited by the number of staff available, especially if a major incident team has also been assembled.

3.5.4. BUSINESS CONTINUITY TEAM

The business continuity team will require input from key staff in order to assess the incident, mitigate any damage and prepare a recovery plan. The make up of the team will depend on available staff and the nature and the location of the incident.

3.5.5. STAND DOWN & RECOVERY

The Business Continuity Manager/Regional Primary Care Development Manager may handover the role as the incident progresses into the recovery stage and at the end of the incident the number of staff required might reduce until the final issues become part of normal procedures. If a business continuity incident has been declared, a debrief meeting should be held and a report compiled as outlined for a major incident in Section 4: Recovery.

3.5.6. BUILDING EVACUATION AND INVACUATION

All premises should follow standard fire evacuation procedures and alarms, which are tested regularly under Fire Safety Legislation. However, bomb threats may require staff to vacate premises further than their usual fire evacuation points. Debris from an explosion may cause damage over a wider area than a controlled fire hazard. It is essential that staff and visitors reach a safe location and co-operate with the emergency services before re-entering any building. In the event of a serious incident, SSP Health/Practice Manager should fully assess the building and if necessary engage approved contractors to assist with further assessments before allowing any staff to re-enter the building.

Staff in other GP Practices/Primary Care Trust premises may also be called upon to provide immediate shelter for anyone evacuated by the emergency services, this may be because of a threat or real incident. Any trained nursing or first aid staff should be alerted to deal with any individuals directly affected by the incident. Additional non-medical staff should assist in maintaining communications facilities until a suitable reception centre can be set up.

3.6. HUMAN RESOURCES

The Business Continuity Manager/Regional Primary Care Development Manager will need to consider staff welfare, both during the immediate incident and recovery period. Health & Safety legislation must take priority in ensuring staff do not return to work before it is safe to do so, either for their own health or for the safety of the premises. Practice Managers must keep a record of emergency contact numbers for staff and it is the responsibility of all members of staff to keep this information up to date. Counselling services may be required for staff that have witnessed a traumatic event or suffered stress from dealing with its aftermath (see S4: Recovery).

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3.7. OPERATIONAL SERVICE RESUMPTION

There are various options to be considered in order to resume the provision of a service, however, these will be affected by the availability of suitably skilled staff, resources and ability of the clients/patients receiving the service to travel to alternative locations. The Business Continuity Team will consider whether they need to:

Budge Up – can the service share resources? Displacement – priority services replace non affected low priority services Remote working – including home working (access to IT may be required) Reciprocal arrangements –share with other Primary Care Premises/ Practices Third Party alternative site – private healthcare provider / local authority Portable Premises – port-a-cabins, temporary accommodation Alternative staffing – or asking part-time staff to increase hours, other CCG staff

to provide service on secondment Hospital – is the service provided in or by the hospital, can its facilities be used Do Nothing – service is low priority or can be made redundant

3.8. COMMUNICATION

It is important to get clear and useful advice to staff at all stages of a business continuity incident. Lack of information is the main complaint during the response to an incident. When dealing with staff it is essential to:

Briefly describe the problem, don’t speculate, if you do not know, say so

Tell staff what actions you need from them, stay and help or go home

If you are sending staff home, make sure they know who to contact for information when they can return or where they should report to instead

Ensure key staff attend regular briefings so that they can disseminate information

Use key points to display message, reception areas, main access points, refreshment areas or toilets are good places to get information across to a wide range of staff

Don’t rely on email to relate key messages – not all staff have access or read their email regularly

Set up a helpline number for staff – this can be used by the Business Continuity Manager to provide recorded information or allow staff to update their availability or answer queries

3.9. SEASONAL ACTIVITY

The GP practice capacity for responding to incidents may be determined by the time of day, week, month or year. The following seasonal activity has been identified:

Financial Year End Winter /Cold Weather Pressures etc

3.10 SPECIFIC INCIDENT GUIDANCE

For specific guidance please refer to:

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▪ GENERAL PRACTICE BCP RISK ASSESSMENTS

3.11 GENERAL PRACTICE OVERVIEW

Address Marsden House,Marsden Road,

BoltonBL1 2AY

Telephone 01204 521000Estates Dept Planet PropertyLandlord Hadrian Properties 01543 410 944

OOH 03456044084Security Tailored Fire and Security 0161 874 1941Mail Royal MailCleaning SSP Health cleanerWaste Bolton Council – General Waste

Cannon Hygiene – Clinical

The Business Continuity Manager/COO/Regional Primary Care Development Manager should decide relocation for all office-based functions on a priority basis.

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3.12 ACTION CARDS

BUSINESS CONTINUITY MANAGER/PRIMARY CARE DEVELOPMENT MANAGER

START THE INCIDENT LOGDeclare a Business Continuity Incident if necessary

Convene a Business Continuity Team if requiredInform all relevant staff of the incident and what is needs to be done immediately

Relocate to the Business Continuity Incident Room if required

Address immediate staff concerns

Ensure staff are briefed about the incident and given clear instructions on whether they should stay, relocate or go home (and when they are expected to return)

Consider how the incident will affect the practice and practices in neighbouring areas.Inform neighbouring NHS organisations / local authorities / social services if appropriate

Agree local practice strategyWhat can be done in the short term to mitigate the incident and relocate staff?

Prioritise existing workIdentify those responsible for continuity of normal operations

Supervise effective managementHold regular meetings with the Incident Team and ensure staff are briefed

Ensure Health & Safety Regulations are adhered to by staffTake regular breaks and hand over to another member of staff

Assess and monitor the responsesEnsure you have a good overview of the tasks being carried out by other staff

Authorise the stand down from serious incident statusEnsure debrief meetings are arranged

Report to the Primary Care Trust if necessaryCompile a report on the incident including lessons learnt

Points to Note:

Once the main issues have been dealt with, you may wish to scale down the business continuity team or hand over to a relevant member of staff who will deal with the medium and long-term issues, or the day-to-day recovery of the incident.

If an incident is going to go on for more than 4 – 8 hours, establish a rota for staff within the team and regular hand over for the BC Manager role.

BUSINESS CONTINUITY TEAM MEMBER

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YOU MAY BE REQUESTED TO ASSIST WITH THE FOLLOWING:

ASSIST IN SETTING UP THE BUSINESS CONTINUITY INCIDENT ROOM IF REQUIREDEnsure the major incident room is operational and equipment is fully functional

PROVIDE ADMINISTRATIVE SUPPORTYou may be asked to provide admin support or find someone to fulfil this role.

VERIFY AND GATHER INFORMATION – EXTERNALYou may be asked to gather information to determine:

Nature of the incident, what has happened exactlyStaff affected and what messages they have been given / information they requireServices affected and whether they need to be re-instated immediatelyPremises what areas are affected and who needs to be informedInfrastructure how has this affected the infrastructure, including telephones & equipment

INFORM PRIMARY CARE TRUST PREMISES / STAFF / SERVICE PROVIDERS IF NECESSARYAssess if any operations will be affected by the incident and inform them of the situation i.e. closure of practice.If any action is required, ensure this is fed back to the BC Manager.

CONTACT LOCAL AGENCIESYou may be asked to liaise with various local agencies. Ensure that you record whom you are speaking to and any direct telephone numbers. You may require contract or account numbers when dealing with suppliers.

UPDATE THE BUSINESS CONTINUITY MANAGEREnsure that the Business Continuity Manager is kept fully briefed about your actions.

ENSURE HEALTH & SAFETY REGULATIONS ARE ADHERED TOEnsure you take regular breaks and have access to refreshments.

ENSURE THAT REGULAR MESSAGES ARE COMMUNICATEDKeep everyone involved in the incident informed on a regular basis and check that messages are being received and understood.

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SECTION 4

RECOVERY

4.1. RECOVERY STAGE

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In the immediate and intermediate response phases, Practices will focus on responding to the urgent and obvious needs. Longer-term action can be planned and absorbed into normal services.

4.2. RESPONSE TO AN EXTENDED INCIDENT

This is more likely to happen if a ‘rising tide’ continues to rise or a ‘big bang’ incident becomes broader and more protracted. A “Recovery Working Group” usually led by the Local Authority is likely to be brought into use. A CCG lead (often in close collaboration with the local authority) may be needed for such incidents. There would need to be a clear hand over from the emergency services in keeping with the agreed multi-agency command and control arrangements.

The initial incident team should take stock and make reassessments

After the first few hours the initial incident team should then again review, take stock and make any reassessments. They should consider:

What now is the nature of the incident? What resources are likely to be needed? What is the impact on the practice population? What skills are needed within the Practice to mount a response? Who takes the lead within the Practice (e.g. SSP Health in the first two

hours might hand over to a definitive team leader)?

4.3. INCIDENT STAND DOWN

As the effects of the incident begin to reduce, a positive decision should be made to disband the group and lift control measures. Before it disbands, the team should decide how to ensure that experience gained and lessons learned are not lost. They should agree ways to:

prepare an incident report learn from the incident, perhaps consider using an external facilitator revise major incident plans and ways of working in the light of lessons learned share lessons learned with other practices and organisations; the CCG may be able to assist in this process.

Aftermath

In the aftermath comes another role, of taking stock of the overall impact, and facilitating the restoration of normal general medical services. Tasks for the practices could include:

checking that adequate arrangements have been made to protect the long- term health of staff that may have been personally affected;

consideration of the legal and financial risks that might ensue.1

4.4. DECLARING AN INCIDENT OVER

1 3.0 - 3.2 NHS Guidance: Planning for Major Incidents Chapter 7 (Sept 2002)29

SSP Health will declare an Incident over for the Practice following consultation with all key personnel and any key external stakeholders that may have become involved i.e. the CCG.

The following considerations will need to be covered:

The Incident has been controlled. The immediate needs of affected people have been met. The Practice concerns have been addressed.

This will result in a notification to staff to ‘stand down’ from all emergency procedures.

Issues to be considered:

SSP Health will debrief staff following a stand down, outlining the recovery process and delegating responsibilities. The recovery stage follows the standing down of a major incident. The process should be seen as an opportunity for learning and improvement of plans. It is vital that SSP Health assumes responsibility for ensuring that the under-mentioned recommendations are undertaken, and that the records and files created with regard to the incident are collected, safely stored and, if required, produced for the revision of plans, the preparation of an official report or to assist with the gathering and preparation of evidence for any subsequent inquiry.

The appointment of a senior member of staff to oversee the debriefing and recording process.

Apart from ensuring that all relevant areas of concern are formally addressed, debriefing meetings can enable individuals to relieve stress and frustration. It will also formally reinforce that the contribution of every employee is valued and appreciated.

Conduct a formal review, feeding results into a review procedure. Evaluation of the response to the incident. How was the incident handled? What problems were there? What needs to be changed to ensure a better response next time if appropriate?

Assessing the continued health needs of those affected by the incident including the assessment of any psychological needs.

Identification of any support services required by personnel involved in the Incident.

All relevant documents should be collected and an incident report prepared. Thisreport will be a public document and may be used in legal proceedings. Patientconfidentiality must be respected at all times.

The Practice must ensure also the secure storage of all records relating to the incident. This should include all papers, logs and notes made during and related to the incident response. No copies of draft reports, incomplete messages or calculations should be discarded. All such papers must be retained. These may be requested by the HSE or other investigative body should that be considered necessary by Government.

Where appropriate consider undertaking a survey of the victims of the incident to ascertain their opinions on the efficacy of the response made by the Practice.

Review insurance cover.

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Review the support and assistance provided by other practices and the CCG.

Consider the need for additional training to be undertaken by members of staff.

Identify any on-going issues.

Consider the impact of the incident on the ability of the Practice to maintain or prioritise the delivery of its services.

Review Health & Safety issues.

Consider making the Report and its recommendations available to other practices to enable them to adopt best practice confirmed by the response to the incident.

Recognise the role of the media and hold a post-incident meeting with representatives from the media and discuss their reporting of the incident and their relationship with the Practice. Create a protocol for future incidents.

4.5. INCIDENT REPORT

An Incident report should be produced within four weeks of declaring the Incident over. SSP Health should write the initial report and pass this onto the Incident Team for comment. It needs to be borne in mind that the report will be a public document and may be used in any public enquiry or legal proceedings. Patient confidentiality must be maintained throughout the report.

Following the publication of the Report, a formal review of the incident plan should be instigated, immediately addressing any areas of concern raised by the report.

4.6. SOCIAL, PSYCHOLOGICAL AND PSYCHIATRIC SUPPORT

SSP Health/Practice Manager should ensure that practice personnel have access to counselling services. If necessary advice can be sought from the Occupational Health Service . Please contact Head of Human Resources for assistance with Occupational Health.

4.7 DOCUMENTATION

It is essential that all decisions and actions taken by Practice staff be documented. In the event of a public enquiry or legal action this documentation may be called upon. Staff must be reminded to record all information in an appropriate manner, either using the major incident log or an agreed form of documentation with the Incident Director. It is important that incoming calls are documented as well as outgoing to show the flow of information.

At the end of an incident a report should be drawn up. This can be used at the debrief and for future planning and training by the CCG.

4.8. DEBRIEF

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Debriefing provides an opportunity for everyone involved in an incident to comment on the organisational response. In retrospect it is nearly always possible to identify things that could have been done better. Criticisms should be constructive and not attempt to apportion blame. When debriefing identifies what went well, individuals should be congratulated and good practice disseminated.

Debriefing may be in large or small groups. It may be easier to admit failures within your peer group than when others are present. There should be an opportunity to provide written comments. Whatever the form of the, debrief it should take place as soon as possible after the event. The purpose of debriefing is to capture the lessons learned for subsequent analysis. A debriefing session after an incident, if necessary with other practices (see 3.7) will help to:

inform future training

improve procedures

collect evidence for any enquiry

identify and respond to the needs of staff.2

The protocol and related forms can be downloaded from the Association of Greater Manchester Authorities (AGMA) Emergency Planning Website. If you do not have a login, you can request this information from the AGMA Policy Unit and Secretariat.

4.9. PSYCHOLOGICAL EFFECTS OF TRAUMATIC EVENTS

Overview

Any traumatic incident or disaster, whether natural or man-made, has a psychological impact on those involved – survivors, the bereaved, witnesses, rescuers, responders and health professionals, and their families, relatives, friends and workmates.

Traumatic events provoke strong reactions. These can include pride and professional satisfaction in responding well to a difficult task, a sense of purpose and solidarity, but also profound sadness, anger, rage and grief.

Most of those affected will adjust gradually, over time – some will need more support than others.

Any incident that causes fear and uncertainty may be accompanied by an increase in health concerns, anxiety and somatic symptoms in the public. Somatic symptoms are caused by the physiological response to anxiety – they are not ‘imaginary ’ or ‘all in the mind ’ – and can be easily confused by the persons themselves, and by health professionals, with symptoms of exposure. Estimates suggest that the numbers of persons presenting with health concerns and anxiety may outnumber the directly exposed by 5-20 to 1. Providing reassurance and allaying anxiety are important both in preventing long term symptoms in this group, and in preventing collective behavioural disturbance and mass panic.

Risk factors for more sustained responses and for the development of post-traumatic stress disorder, depression, anxiety disorder, or substance abuse include: proximity to the event, multiple stressors, a history of trauma, unresolved anxieties, and pre-existing chronic illness.

2 NHS Guidance 1998 page 33

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Common responses to a traumatic eventEmotions Cognition Physical Other effectsNumbness, feeling nothingSadness, griefFearfulness for selfFearfulness for othersFeeling overwhelmedBlaming others/selfFeeling depressedVolatile emotions, angerIrritability, jumpiness

Difficulty in concentratingShortened attention spanPoor memoryDisorientationIntrusive/unwanted memoriesHeightened alertnessDifficulty in making decisionsDifficulty in sleeping,poor sleepBad dreams, nightmares

Tiredness, exhaustionHeadache, other achesand painsDizzinessNausea, gastrointestinal upsetRapid heart rateProfuse sweatingTremor, shakingJaw clenching, teeth grindingBreathing difficulty,Chest pain

Emotional outburstsIncreased argumentativenessWithdrawal, silenceTemporary loss/increasein appetiteChanged interest in sexIncreased smoking/restartingsmokingOveruse of alcohol,substance abuseInability to restUnnecessary risk-taking

Caring for health care professionals:

▪ Few of us perform better – either physically or mentally – after prolonged sleep deprivation: ensure that professionals have adequate rest

▪ Whatever the emergency, try to limit time on duty to no more than 12 hours a day; rotate staff from highly taxing to less taxing functions, and, if practicable, from tasks requiring direct involvement to more routine tasks

▪ Encourage staff to take brief, frequent breaks from the scene; provide somewhere quiet, safe and private ‘off scene ’ for staff to eat, drink and rest without interruption, and try to ensure that staff are able to stay in touch with friends and family

▪ Support staff in taking steps that will help to maintain their well-being – there is nothing unprofessional about being responsibly self—caring

▪ Make sure that staff are aware of the availability of other sources of support (e.g. their own GP; chaplains and other religious or spiritual advisors) and provide telephone numbers for access to confidential listening or counseling services

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SECTION 5

BLANK FORMS

34

IMPORTANT

Please remember to replace any used forms as soon as possible

after the incident

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5.1. TELEPHONE INCIDENT LOG

Time Call Received: Actions

Callers name:

Title / Dept:

Location / Address:

Contact Number:

Out of Hours contact:

If there is any doubt about the authenticity of the call, the alert must be verified by calling a recognised number for the alerting body.

Incident Address (if known):

Summary of incident / request (include actual time of incident):

Other organisations involved:

Name: Date:Position: Time:

Other Action Taken:

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5.2. INCIDENT LOG DATE: PAGE:

Time Issue Action

COMPLETED BY: ROLE:

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SECTION 6

TELEPHONE NUMBERS

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TELEPHONE NUMBERS

6.1 Emergency Contact Numbers

6.2 Stakeholder Contact Details

6.3 Confidential General Practice Contact Details

6.1: EMERGENCY CONTACT NUMBERS

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AGENCY Emergency Contact Number

SSP Health 01942 510468

United Utilities 0845 746 2255

Water 24 hours Control Centre (East Desk) 0800 33 00 33

Water Supply Enquiries (public & non emergency)

0845 746 2200

Electricity 020 78860234

Electricity Supply Faults (public & non emergency)

0800 404090

British Gas 0800111999

Immunisation Advice Team – Health protection team

0844 225 1295

Health & Safety Executive – Ian Stringer 0151 295 3092

Urgent Care (Public No.) The 111 111

Urgent Care (Private No.) The 111 111

Health & Safety Incident Contact Centre North West

0345 300 9923

Out of Hours 0151 922 9235

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Location Organisation Name In Office Hours Out of Hours

Bolton

Local Authority

Bolton MBC 01204 333333 01204 336900

Local CCG Bolton CCG 01204 462000 01772 86740

Hospital Royal Bolton Hospital 01204 390390

Manchester

Local Authority

Manchester City Council 0161 234 5000 0161 223 7222

Local CCG Central Manchester CCG 0161 765 4754 0161 276 1234

Hospitals

North Manchester General (Pennine)

Manchester Royal Infirmary & Booth Hall

Wythenshawe Hospital (South)

0161 795 4567

0161 276 1234

0161 998 7070

Wigan Local Authority

Wigan MBC 01942 244911 01942 404040

Local CCG Wigan Borough CCG 01942 482711 01942 482711

6.2: STAKEHOLDER CONTACT DETAILS

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NWAS North West Ambulance Service

01772 867640

(On Dialling this number you will reach the NWAS Health Control Desk where you should ask for the CCG Director on Call for your area

Hospital Wrightington, Wigan & Leigh NHS Trust

01942 244000

Location Organisation Name In Office Hours Out of Office Hours

SalfordLocal

AuthoritySalford City Council 0161 794 4711 0161 794 8888

Local CCG Salford CCG 0161 212 4800 / 4811 Pager: 07659 584525

Hospital Hope Hospital 0161 206 7373

Sefton

Local Authority

Sefton Borough Council 0845 140 0845 0845 140 0845

Local CCG South Sefton CCG

Southport & Formby CCG

0151 247 7000 0151 247 7000

01704 387010 01704 387010

Hospital University Hospital Aintree

Southport & Formby District General

0151 525 5980

01704 547 471

Liverpool Local Authority

Liverpool Health Authority

0151 296 7000 0151 296 7000

Local CCG Liverpool CCG 0151 296 7000

6.2: STAKEHOLDER CONTACT DETAILS

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Hospital Royal Liverpool/Broadgreen Hospital

Aintree Hospital

Alder Hey Children’s Hospital

Liverpool Women’s Hospital

0151 706 2000

0151 525 5980

0151 228 4811

0151 708 9988

Location Organisation Name In Office Hours Out of Office Hours

Thameside & Glossop

Local Authority

Tameside MBC 0161 342 8355 0161 342 2222

Local CCG Tameside and Glossop CCG

0161 304 5300 0161 304 5300

Hospital Tameside Hospital 0161 922 6000

Halton & St Helens

Local Authority

St Helens MBC 01744 676789       0845 050 0148

Local CCG St Helens CCG 01744 627596         01744 627596

Hospital Whiston Hospital 0151 426 1600

Hospital Chorley Hospital 01257 261222

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Confidential Contact Information

Name Job Role Contact E-mail Contact Surgery Hours

Contact Out of Hours

Jane Wallace Area Manager Jane.wallace4@nhs.net 07809693369 07809693369Vikci Hoinville Practice Manager vicki.hoinville@nhs.net 01204 524897 07872 304025Leesa hamer Receptionist Leesa.hamer@nhs.net 01204 521000 N/A

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APPENDICES

Amendment Sheet

Department Current Status Form

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AMENDMENT SHEET

Serious Incident & Business Continuity Plan

Plan Date

Version

Page(s) to be amended / added

Section Page

Title

Amendment / Addition Request

Attach photocopy of page with amendments marked if possible.

Name Date

Practice

Contact No

Actioned Date

Please send this form to:

SSP Health, First Floor, 120 Wigan Road, Ashton in Makerfield, Wigan, WN4 9SU

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DEPARTMENT CURRENT STATUS FORMPracticeDATE:

TIME:

Completed By: Resource Impact Action Required

Staff

Lighting

Heating

Telephones

Fax

Email

IT Hardware

Accessibility

Office Space

Furniture

Essential Work

Timescale

Alternative Arrangements:

Key Contact: Tel:Other Contact: Tel:Other Contact: Tel:

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Appendix -: Winter/Disaster Recovery Contingency Planning affecting service delivery

Name of Practice: Bolton General Practice Name of person completing this assessment: Jane Wallace Practice Manager Contact details: 01204 521000 / jane.wallace4@nhs.net

How will this impact on your service?

Possible impact on service due to bad/severe weather conditions/effects of surge on electrical equipment/loss or reduction of fuel supplies/Cyber-attack:

Reduced or No GP on site Reduced or No PN on site Reduced admin/clerical on site Conditions affecting building ie heating, water,

floods Loss of use of electrical equipment including

computers, vaccine fridges, lighting No heating within the practice

How will you ensure business continuity for your service.

Our network of clinical/admin staff can be readily mobilised to support planned/unplanned absence. Flexible contracts to provide assurances that staff can cover multi sites if required/portfolio careers provide clinical ‘bank’ sessions to us for emergencies.

Staff are locally recruited to allow ease of getting to surgery.

Each site has local staff who can still physically access the practice.

HQ staff are trained as practice staff and in emergency are diverted to practice.

We work as a cluster of practices to benefit from economies of scale

Book on the day appointments only. Possible cancellation of routine

appointments. No routine visits to be booked, only

emergencies.

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GP access will be managed remotely via telephone consultations/triage.

GP access will be managed at other SSP Health practices.

Patents will be directed to WIC/A & E in case of emergencies.

Local and Locum GP cover will be sought. PN access will be managed remotely via

telephone consultations/triage. PN access will be managed at other SSP

Health practices. Local and Agency PN cover will be

sought. Existing staff rota changes Shared transport Lines diverted if required Escalation to RM Escalation to NHS England Contact with building maintenance for

repair/replace of electrical equipment Vaccines transported to buddy practice

where timescales have not been exceeded

Escalation to SSP IT Dept Introduction of surge protection equipment

for critical equipment for future proofing Escalation to CCG and local IT

Departments to ensure following local and national guidelines

Implementation of ‘paper’ back-up system Alternative temporary heating

arrangements implemented , e.g.

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electrical heaters, until fuel shortage is rectified

Revert to Business Continuity Plan for any issues regarding building.

What practice will buddy up with you.

Nearest SSP Health practice as per Business Continuity Plan.

Local solutions in place via collaborative working.

Passwords are available to enable log on from either site. This will enable either site to generate scripts, perform telephone consultations and deal with any urgent queries should this be required.

Storage of any vaccinations on a temporary basis to allow for clinics to continue was disaster is resolved.

Information posted on our website for emergency patient access.

Remote access via clinical system allows action for clinically urgent issues.

What functions within your service/team can be suspended for up to 3 hours

Care that if delayed or suspended would not cause a great detriment to the patient:

Routine visits for housebound patients. Routine Nurse Appointments. Non urgent scripts. Non urgent post. Non urgent meetings/training.

GPs to provide emergency cover only. No routine appointments, visits or admin.

Practice development time can be utilised to catch up.

Non urgent house bound visits can be rescheduled.

Routine GP appointments to be rescheduled.

Nurse appointments to be rescheduled.

What functions within your service/team can

Routine Nurses appointments/chronic disease appts.

Practice development time to be utilised to catch up if required.

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be suspended for up to 1 day

Routine prescriptions. Routine house bound visits. Non urgent meetings/training. Non urgent paperwork.

Ensure admin staff fully aware of possible increase in telephone calls due to lack of routine appointments.

If practice needs to close. Contingency plan in place for relocation. Refer to

Business Continuity Plan. Contingency plan in place for relocation.

Refer to Business Continuity Plan.

Does an interruption to another service impact on your service delivery.

Emergency Services for vulnerable patients.

Ensure all agencies have been informed and communicating effectively to ensure continuity of care during this time.

Practice to liaise with NHS England/community matron/district nurses regarding vulnerable patients who may require care during this time.

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