Primary care consultant Daniel Vincent offers tips for strengthening your business continuity plans for the winter months
Business continuity planning has been tested to its limits over the past three years. If anything the challenge has become greater than during the height of the pandemic. I remember the days when the bright red folder by the door was picked up, dusted off and the contact details updated once a year. Very little changed in terms of the risk, and practical implementation of the plans was rarely required.
Without the usual dip in demand over the summer period (or let-up for the past three years) it is quite possible that you have not had opportunity to revisit your plans. It is also possible that you have had little opportunity to review the appointment systems you have developed and implemented in response to Covid-19. This is a hazardous combination.
The risk profile has changed significantly. In the past the only thing that might have stopped business would have been a catastrophic fire. Even then we had plans to shift operations to the practice down the road until the temporary buildings were rapidly deployed. The thought of staff availability causing a major problem was limited to the potential for more than 2cm of snow.
Now our greatest risk is maintaining a safe service with even minimal reduction in staffing. So fine is the balance between capacity and demand, we sit at this point most days even when fully staffed.
Establish your risk levels
Managing this risk is complex but best achieved using an internal Red Amber Green (RAG) rating.
1. Establish what your ‘normal’ looks like. This might be number of people, sessions or appointments. Start with your acute capacity – pool all clinicians who contribute to this ensuring that you set a minimum GP capacity for those needs that only a GP can fulfil.
2. This ‘normal’ is your Green rating – remember the bar is safe, not optimal. Sitting at green will still feel busy and the work that is safe to roll to the next day may well do so.
3. Discuss with your team what Amber looks like. In this space you will be taking action to increase capacity, seeking locum cover and canceling routine work. How many people, sessions or appointments do you have when you are in this state? This will depend upon your list size and usual demand profile. Remain in amber even if you bring capacity back to ‘normal’ levels through these actions.
4. Discuss with your team what Red looks like. When you reach Red you will be actively seeking to manage demand. Moving to an ‘Urgent Only’ service, signposting patients to all available services, closing e-consultation services. When you take these actions you risk a breach of contract and a decision needs to be made by a contract holder (partner) whether to seek permission or forgiveness from the commissioner.
5. Black is reserved for the most extreme circumstances where you feel you are no longer able to deliver a safe service. A contract holder needs to make immediate contact with the commissioner’s ‘Duty Director of Primary Care Commissioning’, to clearly outline the situation faced and the steps taken already to remedy it. This would also be a good time to make contact with the LMC as you are likely to require its support.
Plan extra cover and appointment contingencies
In the words of the great Sun Tzu: ‘The General who wins the battle makes many calculations in his temple before the battle is fought.’ Preparation is your friend here.
- Pre-plan your cover as much as is possible. Ask all staff to provide their weekly availability and desire to provide cover on the days they do not already work. This will help set expectations, ensure that those who want additional hours get them and only those who do not are asked to work.
- Make this information as available as possible. Make arranging cover part of your sickness reporting process. The person who takes the call starts the cascade on obtaining cover. Set up a matrix for each role and each day with a priority order for who to call and how to contact them.
- When it comes to clinical staff, build a list of as many local locums as you can. Even if they are booked through an agency ask for their direct contact details, so you can contact them quickly with the booking to follow (you must do this otherwise you will face penalty charges).
- Explore the opportunity to work with remote providers that offer packages of appointments rather than people. A relatively low base number of appointments (handy when nobody wants to do extended hours) can provide access to additional capacity when you need it.
- Ensure your contact list is up to date and is remotely accessible – Microsoft Teams is useful for this, for example.
- Ask the commissioner about the availability of additional funding to support increased access. If you have the cover in place you will be in Green+ , dropping to Green if a team member is unwell.
- Ensure all staff can work remotely – asking someone to do an hour of prescriptions work is a much easier sell than asking them to come into the practice. Don’t forget your reception and admin staff are also able to perform their role remotely.
- Consider a protocol for sending staff home to work remotely as a ‘firebreak’ if you feel that infection might be spreading amongst the team.
Being able to demonstrate that you have considered and planned for such circumstances is an essential component of the Safe domain for CQC inspections. Ensure that your thoughts are documented in a policy and the actions you expect others to take are in a protocol. Clearly document how you have shared this with the team and tested that they have understood it.
It may feel a little silly but to do this, you can simply stand in reception and call out: ‘This is a drill, Dr Roberts is unable to work today, what do you do next?’ Record the results of this test alongside your policy.
This preparation will ensure that you have reduced the risk, equipped your team to deal with foreseeable situations and, if required, demonstrate to the commissioner that you took all reasonable steps to deliver a safe service.
Daniel Vincent is a former practice manager and independent primary care consultant
