The original purpose of a disaster recovery plan in general practice was to deal with the computer system failing, at a time when back-ups were vital and GP computer systems were still on their infancy. Nowadays, the plan must account for continuing to run a medical practice if the building itself, or the practice’s personnel, are suddenly not available.
At the time of writing, the country is being ravaged by floods, and premises are being inundated by water.
A disaster recovery plan is also part of the work 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.
The so-called disaster could range from a burglary to a fire, or a major accident involving vehicles damaging the surgery building.
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.
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.
Below is a list of six things I’d recommend a GP or practice manager writes 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.
1 Alternative 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. Identify alternative premises and review your list each year.
2 Emergency contacts for the practice
A file should be kept off site 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.
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. 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.
3 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.
4 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.
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.
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? You need a plan to cover their work, otherwise doctors and staff might not be paid.
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.
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.
5 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?
For example, if wate, gas or electricity is off for more than 24 hours, you have to tell the CQC ‘without delay’. Could you manage this?
6 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 payroll, as I found recently when transferring from a manual payroll to a computer payroll, can require a lot of research and can take a considerable amount of time. What salary scales do you use? It might not be as simple as looking up the latest Agenda for Change salary scales.
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.
- 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 is a retired practice manager. His website, kingfisherpm.com, which offers documents and training tools to help with practice management