Manor Park Surgery
Before becoming a practice manager, Ruth was Senior Manager for 12 years at Bradford Royal Infirmary, and also worked for 12 months in the voluntary sector. A keen runner, having done the London Marathon on a few occasions, Ruth also spends her spare time watching her son play rugby and taking her daughter swimming
On 22 July 2006, at around 1.30pm, I returned home from shopping for a planned barbecue to find my family at the doorway, with my husband telling me we had to go to the surgery as it was on fire. I thought at first it was some kind of joke, but the expression on my husband’s face told me otherwise.
I didn’t know what to expect as I made my way to the surgery. Naturally, I was hoping it was a small fire with limited damage. How wrong I was. I arrived to find 70 firefighters and 13 fire engines, the building extensively on fire.
I contacted each of my GP colleagues to tell them what I knew. However, it being a Saturday afternoon in the middle of the summer heatwave, most of them were unavailable. My colleague Dr Susan Elton was already at the surgery when I arrived. The only thing we could do was hug each other and look in disbelief at the total devastation we saw before us.
So many thoughts were going around my head at that stage. First and foremost was the fact it was the weekend and that the insurance documents were in the building. I knew the brokers, of course, and the company itself, but had no contact details. We phoned directory enquiries to obtain a number, but it was impossible – every number they gave us drew a blank.
I then contacted the head of primary care at the primary care trust (PCT) and informed her of what had happened. Arrangements were then made for us all to meet at a nearby clinic on the following Monday morning.
An immediate problem was with the telephones. Local Care Direct had heard about the fire and contacted me on my mobile to arrange to have the telephone lines diverted to them. This was no mean feat, especially as we had just changed our system to NEG Surgery Line and, again, all contact details were in the building. Fortunately, the lady from Local Care Direct was wonderful and managed to speak to the suppliers and arrange for diversion of the lines.
The police were also at the surgery, and the site was cordoned off as a crime scene; obviously they were looking at the possibility of an arson attack. We were given an incident number and told that we would be kept up to date on any developments.
By this time our senior partner, Dr Jennifer Tolley, and GP Dr Russell Gilmore had arrived, together with reporters from BBC Radio Leeds and local television. A statement was given, which included information for patients.
That evening, instead of the planned barbecue, my colleagues and I telephoned each other, writing down ideas on how to move forward and provide healthcare for approximately 14,000 patients.
The dust settles …
The next day, the fire was headline news. The practice staff all met up at 10.30am in one of our staff member’s houses who lived close by. Dr Tolley passed around suggested information leaflets for patients, which included information on prescriptions, emergency appointments and telephone numbers for out-of-hours services and NHS Direct. These were later put on the surgery gates. I emailed these to the local paper and BBC Radio Leeds so they could put out the same information. We also managed to contact our insurance company and made arrangements to meet with representatives later that day.
Those first 48 hours were a nightmare. Every waking hour was spent planning how we could function, offer basic services to our patients and support our staff, whose main concern was obviously job security. As it was nearing the end of the month, staff salaries were due. Once again, all details had either been destroyed or were in the building. We decided to ask staff to bring in their last wage slip and bank details and to pay them the same as last month and make the necessary adjustments later.
Help at hand
On Monday morning, the doctors and I arrived early at the nearby Bramley Clinic; I remember the whole day just passing in a haze. However, by the time we left, we had met with the PCT, who made arrangements for us to work from rooms at Bramley Clinic and for the dental annexe area to be refurbished specifically for our use.
Arrangements were made for our clinical system to be installed. Emergencies were seen by the doctors, who used Lloyd George cards. These were to be entered onto the clinical system once this was up and running. Arrangements were made with West Yorkshire Central Services (WYCSA) for replacement stationery, prescriptions, and so on. The insurance company was contacted, and arrangements were made for a copy of the policy to be faxed through. Enquiries were made as to having a Portakabin onsite. Accountants were contacted to weigh up the financial aspects and implications/losses, particularly in relation to the Quality and Outcomes Framework (QOF).
A press release was prepared with information for patients, together with a letter to be sent out by WYCSA, which included useful telephone numbers, arrangements for repeat prescriptions, urgent appointments and the temporary measures that had been put in place.
Amidst all of this, there was a constant barrage of telephone calls from fellow practice managers offering space, help, equipment – you name it. They were – and still are of course – wonderful. Local agencies/support services and hospitals were contacted and informed of the situation.
In fact, by the end of the day all faith in human nature had been well and truly restored. What happened that day, and what continues to happen, is a testament to teamworking – the GPs, staff, other practice managers, the PCT and outside agencies were all wonderful, and we will be forever indebted and thankful to them.
In the initial stages, what we had to try to do was basically squeeze a surgery built to accommodate 14,000 patients into four clinical rooms and three offices. One telephone line was made available to us in Bramley Clinic, to which our old telephone number was diverted. Mobile telephones were purchased to help with the lack of available telephone lines. Contact was made with medical suppliers to arrange emergency supplies of essential medical equipment.
The chemist (which was attached to the surgery and also destroyed) was relocated to alternative premises not far from Bramley Clinic. Temporary measures were put into place, although all neighbouring chemists pulled together to continue with delivery services/repeatprescriptions/emergency supplies, and so on.
The dreaded day came when a new server was delivered: had the data on the backup tapes survived the fire? Fortunately, it had. You cannot begin to understand how we felt at that moment. It was as though we had won the lottery.
QOF-ing up the money
The days that followed were spent in countless meetings and liaising with the insurance company, which highlighted a problem with the business interruption side of the cover.
As far as we were concerned, our policy covered us as a practice to make the necessary arrangements to get the business back up and running, and also for any associated loss of income. However, the insurance company did not fully grasp the complexity of the GP income structure, and were worried that they would have to pay out for the surgery’s guaranteed income, plus loss of income generated through QOF, and so on, plus any outlay to keep the business running.
Try as we might, we couldn’t convince them that only a certain proportion of our income was guaranteed; the rest was dependent upon how the surgery performed. In the end, they did agree to the business interruption side of the policy, but only to cover continuation of business, not loss of income.
No doubt at some future point we will experience a loss of QOF income, which we will not be able to recover. However, we have ensured this doesn’t happen again, as our policy now covers us for every aspect of the business, including QOF income.
The building was finally made safe a few days after the event. I don’t think I can really put my and my colleagues’ feelings into words when we went into the building for the first time after the fire. We were completely and utterly devastated.
The only saving grace was that the patients’ case notes looked as though they had survived, together with some equipment and files. The next days were spent in temperatures exceeding 30ºC clearing out the building, recovering what we could and transferring things to Bramley Clinic. I lost count of the number of meetings in which I was completely covered in soot! Sometimes I was hardly able to walk because I was covered in blisters and was wet through from all the sweat.
All the recovered patient notes were taken away for storage. These are currently in Oxfordshire. Most were water damaged so have been freeze-dried. We now have to decide what happens next with these notes. We have been given three options: they can just be frozen, then dried, at a cost of approximately £20,000; dried, then given a basic clean, for around £30,000; or the complete works for approximately £50,000. Whichever option we go for will make a large dent in our insurance.
We have learnt the following from our experience of the fire:
- Legal documents and important contact numbers – ensure copies are kept offsite; many wasted hours will be saved in the long run.
- Building plans – keep duplicate copies of all plans concerning your surgery; having a copy of these has enabled us to move forward more quickly with the rebuild.
- IT – we now have two sets of backup tapes. All tapes are signed in and out of the “Data Tape Record Book”. It is recommended that fireproof boxes have a 2-hour duration; most boxes we have found only have a 30-minute duration – so this policy has been introduced to ensure that we will always have patient data should anything like this happen again.
- Insurance policy – check this; many of you may find you do not have adequate cover. We are in the process of rewriting our policy; the new cover will ensure that we have adequate cover to include such things as restoration of patient records, loss of QOF income, and so on. Also, ensure that your policy covers you for adequate legal costs (ie, collateral warranties).
- Contents – ensure you keep up-to-date inventories of what you have within the surgery. We have spent hours putting together lists of what was in each room and trying to cost this out for insurance purposes, a lot of work that could easily have been avoided. Also, ensure you have adequate contents cover – NEG Surgery Line was installed a few weeks before the fire; the current estimate to replace it is £30,000.
- Keep regular backups of your work (eg, contracts of employment, policies/procedures). Use a memory stick to keep duplicates of all essential documents.
- Make sure your insurance company works for you – many hours have been spent looking at alternative accommodation, collating information, and so on, when other professional services can be appointed to do it.
Where are we now?
At the time of writing, rebuilding of the surgery is now well underway, and we should be able to move back to the premises in February.
We were aware from the outset that the space kindly given to us by the PCT wasn’t going to be a long-term solution able to accommodate the needs of the population, so an alternative had to be considered. In the end we decided to have a Portakabin onsite (planning permission was required, but could be done retrospectively) and keep the current annexe accommodation at Bramley Clinic. However, this option in itself hasn’t been without hiccups.
Extra insurance had to be taken out to insure the Portakabin and all aspects of the business being conducted there. IT has been an absolute nightmare, as there was confusion regarding connecting a clinical system over two sites. There could now be a delay of 6–8 weeks before systems are up and running. A private circuit needs ordering, and this is the lead time.
Telephone lines have been ordered, but BT does not give priority to services such as ours, so we have to wait the same length of time as everyone else, which is weeks. NEG are on standby with the equipment, but it obviously takes the same amount of people to change a lightbulb as it does for someone at BT to activate the telephone lines!
We have sadly been the subject of negative publicity in the local press (obviously this sells more papers than positive news!), who have done nothing to help the situation or the community spirit.
Doctors are currently “hot footing” between rooms to make as many appointments available as possible. We are slowly starting to bring things back up to speed with Choose and Book and QOF; however, there will be a definite loss here.
We made the decision to put a security fence around the surgery. Because of our experience, all trees and shrubbery are being cut down or taken out as an extra precautionary measure to try to prevent this happening again.
Three youths were arrested on suspicion of arson; one of them was charged and received a supervision order.
One thing that “beggared belief” in all of this was the booked locum, who turned up on the Monday after the fire, saw what had happened and went home. We are still being chased for payment for his fee, with the excuse that “we should have told him about the fire”. As well as the other many talents a practice manager has, being psychic isn’t one of them! (Or is it?)
However, many positive things have emerged from this tragedy. Mainly, it has shown what a tremendous team we have. None of this could have been achieved without the full support of everyone – from the doctors to the staff. Relationships have changed – we all have a new-found respect for each other.
There is still a long way to go, but we remain positive. I can only once more extend, on behalf of Manor Park Surgery, our sincere thanks to fellow practice managers, friends, family, colleagues and everyone involved in working together to get the practice back up and running. And to the hundreds who have sent cards and flowers, we thank you.