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Be prepared for the unexpected

Practices need a contingency plan so that in a crisis services can still continue.

The effects of unforeseen events, such as floods, on services can be reduced with continuity planning (Photograph: Alamy)
The effects of unforeseen events, such as floods, on services can be reduced with continuity planning (Photograph: Alamy)

I doubt that business continuity planning (BCP) is a phrase that gets most practices excited.

However, much is made of the fact that GPs are entrepreneurs and small business owners, and if we want to survive in the brave new world the White Paper envisages, we need to look at what other businesses do and copy best practice.

At this point, you may be thinking that your surgery does not need a BCP and that the spirit of the Blitz will keep you going - that when the faecal matter hits the fan, all hands will be on deck, pull their sleeves up and cope with anything.

Dr Paul: 'If GPs want to survive in the brave new world the White Paper envisages, we need to look at what other businesses do and copy best practice'

Relying on managers
A lot of practices rely on their practice manager to handle a water main burst or other disaster. But what if your manager is on holiday?

I know of a small practice whose practice manager was off sick. It came very close to not meeting the monthly payroll date because no one knew the banking passwords or how the timesheets worked.

You might hope that the patients will put up with inconvenient surgery arrangements in times of crisis, but will your staff be happy not to be paid?

I love Dragons' Den and recently read dragon Deborah Meaden's book Common Sense Rules which initially seemed superficial and light compared with other business tomes I have tackled.

However, she genuinely does distil issues down to common sense. She has a background in running leisure parks and devotes a section to BCP that should give an idea of how important it is.

Anything can go wrong
Her leisure parks dealt with the general public and all sorts of things could go wrong from electricity cuts to an outbreak of E.coli.

She was clear that her organisation worked up a BCP - and that all management knew what was in it and how to access it and that it was followed in times of crisis.

So set time aside to create a BCP as there are several stages involved (see right box). There are examples available from a range of sources to use as a template if you do an internet search.

Brainstorm, or use the list of suggestions above for possible scenarios from common to very rare that might happen.

Administration problems are the mainstay of BCP: things like power failures, blocked toilet, bodily fluid spills in public areas, computer crashes, printer failure, broken windows, break ins and theft.

There may be some things specific to your practice or location. For example, we had a real problem with our lift breaking down or stopping between floors and have a great plan for what to do when this happens. But to be honest, we wrote the plan after it broke down a few times rather than before.

You might want to link to a local major disaster plan. All public bodies have to have one so the PCT will. Do you know your role? Are you a site for casualties?

Dialogue with staff
Next, you need to work through what you would do in these cases. Involve the relevant teams and people in this discussion. You may find it is a useful way of reviewing your systems and processes and developing a dialogue with your staff.

You may even find they come up with better ways of doing everyday things.

A lot of what to do when compiling a plan is about listing who to contact including phone numbers, insurance policy numbers, names of suppliers and so forth.

This should all be drawn up into a document that is easily accessible to anyone who might need it. Key people should have a copy and, importantly, it should also be kept off site. The plan on what to do if your surgery burns down overnight is no good if it is in the charred remains.

Some of the discussions you might have at this time include:

  • Do you know who is in your building if there is a fire?
  • Can your appointment system produce a list of everyone checked in or in consulting/treatment rooms?
  • What happens if the power goes off? Have you got a paper copy of who is due for which appointment in the afternoon and their contact details?
  • Have you put a UPS (standby power system) on key machines to allow you to work?

At this stage you might find half the mobile phone numbers for your partners are out of date, as they have not bothered to tell you their new ones.

Once written and distributed, the BCP should be reviewed every six months or on change of suppliers/contractors. New staff, particularly those in an authority role, should be recorded as having read it. If the BCP is used, do a review to see if it worked and whether it can be improved.

A BCP is not all about terrorist attacks. It is about enabling a business to overcome any unexpected disaster to its premises, key personnel or to any important systems that it relies on in its day-to-day operations.

  • Dr Paul is a GP in Cheshire
Developing a Contingency Plan


1. Analysis - work out what risks your practice might face.

2. Solution design - work out what to do for each of the problems.

3. Implementation and distribution - make sure everyone has a copy of the BCP and understands it.

4. Testing - ideally set time aside to test it.

5. Review - do this every six months and on change of contractor/suppliers.

6. Insurance - make sure your cover is adequate.

Headings for Your Plan
Some suggestions:
  • Loss of main premises.
  • Loss of computer system/essential data.
  • Loss of telephone system.
  • Loss of medical records.
  • Incapacity of GPs.
  • Incapacity of staff.
  • Loss of electricity supply.
  • Loss of gas supply/gas heating.
  • Loss of water supply.
  • Loss of premises security (for example, break-ins).

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