Business contingency plan
It is imperative that general practices have clinical risk management systems to enhance the quality and safety of
their patients. Practices must be able to demonstrate how they regularly monitor, identify and report near
mistakes in clinical care. Practices must also have plans in place to manage business continuity, and continuity of
care, in the case of normal practice services and processes being disrupted.
Practices need to have contingency plans for unusual events that may disrupt patient care such as natural
disasters or disease outbreaks that overstretch the practice’s capacity, or the sudden, unexpected absence of key
members of the team.
Standards requirements
3.1.2E√ Our practice has a contingency plan for adverse and unexpected events such as natural disasters,
pandemic diseases or the sudden, unexpected absence of clinical staff.
General overview
All practices are different, and may encounter different types of events. It is suggested each practice review what
type of plans might be needed given its individual circumstances, and develop its contingency plans accordingly.
Practices sometimes confuse general contingency plans with having a documented business continuity plan. In
terms of meeting the current Standards, business continuity plans are in relation to continuing IT processes, such
as managing an entire system crash or having appropriate back-up systems in place to restore practice data. This
Standards requirement falls under Indicator 4.2.2C. The principles behind developing and testing both plans are
similar; however, please note that having documented IT systems, policies and procedures, including a business
continuity plan, is not the same as having documented contingency plans for unusual events.
Staff should be familiar with the business contingency plans, and ideally it will be discussed during new staff
member’s induction program. It is important staff know where to start in the case of a disruption, for example,
who to call in the event of a disaster or incident.
Many practices maintain a ‘emergency box’, which holds all the equipment and documentation needed, to assist
staff in the event of a disruption. Ideally, this box will be kept onsite and although it may be rendered useless in
the event of a major disaster such as a fire or flood, it could be useful to have available in the event of a disaster
which allows you to still use the practice building, such as a blackout, equipment failure, computer failure, or theft.
The following list is only a small number of items you could include in your box, things like:
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A copy of the practice’s contingency plans
Torch
Printouts of appointments
Paper based appointment book or sheets
Backup and software disks (in addition to off-site backup systems)
Daily recall and reminders for the next three days
Blank progress notes pages
List of fees
Medicare vouchers, DVA vouchers and manual card swipe machine
List of doctor’s provider numbers
Manual receipt book
Message pad
Pens
Mobile phone
GPA has developed the following business contingency plan guide, and template, to assist practices in establishing
their own contingency plans documentation.
GPA ACCREDITATION plus
GPA ACCREDITATION plus
Accredited by Joint Accreditation System of
PO Box 83 Gundagai NSW 2722
is General Practice Australia Accreditation Plus
Australia and New Zealand Acc No
G2601102AS
Phone: 02 6944 4042
Fax: 03 8888 9988
Quality Practice Accreditation Pty Ltd
ABN: 26 081 986 932
(insert practice logo here)
(Name of practice)
(Address of practice)
General practice
Emergency / Business Contingency Plan
Author:
Date of issue:
Date tested:
Date of review:
Date of next review:
Version number:
Contents
Introduction
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Document review
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Staff training
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Activating the plan
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Business continuity
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Priority order of services provided
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Medical records
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Failure of telecommunications
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Failure of electricity supply
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Failure of gas supply
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Failure of water supply
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Disruption to supplies
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Fire
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Flood
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Staff shortage, including pandemics management
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Cooperative arrangements with other practices / services
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Arrangements for replacement of medical staff
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Arrangements for replacement of nursing staff
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Arrangements for replacement of administration and management staff
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Communicating with patients / clients
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Appendix A: Contacts list
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Activating of plan
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Staff contacts
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Utilities / services contacts
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Tradesman
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Other practices with whom we have mutual arrangements
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Suppliers of products / drugs etc.
Introduction
Essentially, there are three elements to this plan:
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GPs and primary care teams responding to an incident;
The business continuity of the practice during an incident that affects the community; and
The business continuity of the practice in the case of an internal incident affecting the business of the
practice.
Documentation review
This document will be reviewed on a six monthly basis or when there is a change in the working systems of the
practice or changes to the contact arrangements of staff or suppliers that affect the content. The review date will
be recorded on the front of the document, along with the next review date. This will be the responsibility of (insert
name and position)
NB. Nominated practice clinical leader, or the practice manager, is often the staff member nominated
Staff training
The emergency and business contingency arrangements within this plan will not be effective if the staff expected
to implement them at the time of an incident are not aware of them. To ensure this does not happen, all staff will
be made aware of the plan as part of their induction training. If there are any significant changes to the plan that
affect the way in which staff respond, these changes must be communicated to the staff team.
The arrangements within this plan should be tested at least once per year. This will help to confirm their
effectiveness and highlight any gaps in the plan, which can then be amended.
Activating the plan
It is the responsibility of the nominated person to decide whether the plan, or any part of the plan, is activated will
be (insert name and position) and the deputy in case of his/her absence or unavailability will be (insert name and
position). Contact details are (insert contact details for primary and deputy).
The decision to activate all or part of this entire plan can be done using the following process. (insert practicespecific process)
Business continuity
It is essential that general practices are able to maintain business continuity in the event of an emergency or
business interruption.
Contingency plans should endeavor to cover the areas where the practice potentially could be required to
implement business continuity arrangements. According to International Organisation of Standardisation (ISO), a
business continuity management system emphasises the importance of:
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Understanding continuity and preparedness needs, as well as the necessity for establishing business
continuity management policy and objectives.
Implementing and operating controls and measures for managing an organisations overall continuity risks.
Monitoring and reviewing the performance and effectiveness of the business continuity management
system.
Continual improvement based on objective measurements.
Priority order of services provided
General practices offer a wide range of services to their patients. Table 1 below, is a list of the services that this
practice provides in order of priority. In the event of an emergency or business interruption, this practice will
endeavor to maintain services to usual, or as close to usual standard, however, it may be evident that this is not
possible. At this point (insert name and position) will decide which are the priority services that the practice must
continue and which will be reduced or stopped.
Table 1 Example:
Patient consultations
Ability to schedule appointments
Home visits
Allied health / specialist consultations
Nurse led consultations / clinics
(Please add all the core and other services the practice provides in priority to patient need)
Medical records
The practice’s medical records are stored in (insert measures that are employed to securely store patient’s medical
records, any protection against fire/water damage that is in place, security arrangements, and include external IT
companies details, if applicable. Briefly include IT security measures implemented, as per the RACGP Computer
and information security standards).
If medical records are lost or damaged, these may be constructed using the data held on the computer backup
network systems. Refer to Criterion 4.2.2 Information security in the RACGP Standards for general practices 4th
edition and the RACGP Computer and information security standards.
Failure of telecommunications
The telephone system provider is (insert name of communication company and contact). The lines provider is
(insert name of network, for example Telstra, and contact). In the event of a fault with the line it should be
reported to (insert name of network). If there is no fault on the line then contact the system provider if different
to the network (list providers).
If the practice’s system is dependent on electrical supply, check the power. If found to be an electrical problem
follow the instructions for loss of electricity.
If the land line fails, redirect all calls into the practice to (insert nominated mobile phone number). This mobile
phone will require constant manning.
Line numbers for the practice are (insert other practice numbers, for example, reception desk, treatment room,
fax, EFTPOS).
A hard copy of all emergency contact numbers is available at the reception desk (or alternative location).
Failure of electricity supply
The electricity fuse box for this practice is located (insert location of fuse box). In the event of failure in the
electricity supply our supplier is (insert name of supplier) and the emergency contact is (insert emergency contact
name and number).
Emergency torches, if required, are stored in (insert storage locations). It is recommended practices store torches,
with spare batteries, in case needed. A backup generator is utilised (describe generator system and when it
activates, if applicable).
In the event of a power failure, first check the safety switch in the fuse box. If this is not the cause, contact the
supplier and report the failure. Ask for an estimated length of time the power might be disrupted, for planning
purposes.
A decision should then be made as to whether the general practice business can be continued safely, or if
relocation to an alternative site will be required to maintain business.
Systems and appliances that will be affected during a power failure include:
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Computer systems/software (administrative, billing and clinical)
Lighting
IT systems
Telephones (if this is not the case, then omit)
Heating (if this is not the case, then omit)
Air-conditioning (if this is not the case, then omit)
Refrigerators (including vaccine fridge)
Diagnostic equipment (this may not be the case. If not, omit or otherwise list equipment)
Alarm systems
(add additional items if required)
The above points will each require further consideration. Staff should follow the section specific to each system.
Computers – The practice’s IT provider is (insert name of organization, contact name and number, if applicable. If
managed internally, insert name of the practice’s IT leader). A downtime (disaster recovery) box is available at
the front reception desk and contains: (insert downtime box inclusions). The box is routinely checked (insert which
staff member is responsible and how frequently it is checked).
It is recommended to also have a doctor’s disaster recovery pack available, in case needed.
A doctor’s pack is available and contains:
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Prescription pad
Prescription pad authority
Letterhead paper
Patient history sheets
Medical certificates
Paper copy of medical software address book
MIMS
Manual referral pads (or keep copies of and use computer referral paper templates)
Heating – if the heating is interrupted, assess the effect of the loss of heating relevant to the time of year and
general temperature, including the forecasted temperature. If applicable: The heating service provider, (insert
name and contact details) should be contacted as soon as possible. Ask for an estimated length of time the
heating might be disrupted, for planning purposes.
Vaccine refrigerators – if failure is for a significant period, which will be detrimental to the contents of the fridge,
the contents will be assessed and any temperature critical vaccines will be relocated to (insert contingency
arrangements, as per cold chain management disaster procedures) to maintain them at optimum temperature.
Diagnostic equipment – if diagnostic equipment does not have internal re-chargeable batteries, consider the
implications of not having it at your disposal. If equipment does have re-chargeable batteries, ensure the length of
time the equipment can be used is known. See Table 2 for details. Ensure spare batteries are available.
Table 2 (insert relevant equipment)
Equipment
Internal batteries (Y/N)
If yes, duration/times it can be used
Failure of gas supply (if relevant)
The gas shut off valve for the practice is located (insert location). If the gas supply is interrupted, contact (insert
the gas supplier / emergency contact details) to report the failure and request if they are able to given an
estimated time the supply will be disrupted, for planning purposes.
Failure of water supply
The ‘mains water shut off’ within the practice is located (insert location), and the mains water stopcock external to
the practice premise is located (insert location).
The water supplier for this practice is (insert name of supplier), and their emergency contact is (insert emergency
number).
For internal plumbing issues contact (insert name and contact).
In the event that water supply fails, assess the impact on the practice and consider:
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Toilets
Hand hygiene
Drinking water
Toilets – if toilets will be unavailable for a significant length of time, consider arranging for portaloos to be hire
from (insert name and contacts of relevant hire companies).
Hand hygiene – anti-bacterial hand wash is available for staff and patients. Disposable gloves are available for
staff use and are located (insert location). In regard to hand hygiene, (insert current hand hygiene protocols).
Drinking water – the practice has a store of bottled drinking water located (insert storage location).
Disruption to supplies
During an unexpected emergency, there may be interruptions in the supply of medicines, medical consumables
and equipment required by the practice. This could be the result of an incident at the supplier factory, such as fire,
or could be due to disruption to the transport network, such as the case during a fuel crisis.
In such an event, (insert staff name and position) will be responsible for assessing the impact on the business
continuity of the practice. If the practice needs to obtain supplies from another source the options are:
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Cooperation from another practice
Cooperation from another health service (could be local hospital or chemist)
Contact another supplier (list all your suppliers and alternative suppliers in appendix A)
(insert any relevant cooperative arrangements with other practices / health services)
Fire
On discovering a fire, or on suspicion of a fire, raise the alarm by (insert the practice’s alarm / emergency
operation procedures) and phone 000, clearly stating the full address of the practice premise.
In the event of a fire, the fire alarm sounding will be a (insert fire alarm sound and type i.e. siren or continuous
bell etc.). All staff have a responsibility to evacuate the premises ensuring that all patients and visitors are
assisted via the identified fire exits (see Table 3). Emergency exit maps of the premises are displayed throughout
the building, highlighting recommended exit pathways and fire extinguisher locations. All persons will congregate
at the fire evacuation assembly point (insert designated assembly point), where (insert name and position) will
check that all persons have been evacuated.
If it is suspected there are persons still inside the premises, do not re-enter. On arrival of the Fire Brigade, (insert
name of fire warden / WHS person of the practice) will greet them and provide the following information:
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Location of fire or suspected fire
Persons suspected of still being inside, with possible location
Location of any flammable materials / oxygen cylinders
Plan of interior of the premises (if available, it may help to have this available to emergency services)
The practice exits are located at:
Table 3
Practice premise area
Nearest exit
E.g. waiting room / treatment room / consultation room
1, 2 and 3 etc.
Flood
In the event of flood warnings, the practice should prepare as best as possible to protect the premise and contents
from water damage. In such an event, (insert staff name and position) will be responsible for assessing the impact
on the practice and its business continuity.
(insert applicable processes to be implemented in the event of a flood warning and who is responsible for which
components of the process)
Emergency plans to consider include:
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Security procedures – can usual procedures, such as locking doors and setting alarms, be done in an
emergency
Operating the practice from a temporary location – is it possible to continue patient consultations from
another location while the practice premise is unavailable
Hazardous materials – the practice must ensure that any chemicals, oils and other substances in its
possession are kept safe and do not contaminate floodwater. Who is responsible for securing these
materials safely, either moving them to a higher place or waterproofing them.
Work health & safety for employees – staff induction/orientation programs should include emergency
evacuation procedures. Ideally, each job description will include emergency duties including floor
procedures.
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Warning systems – a system to alert staff that all staff recognise and understand, which is regularly
checked.
Important contacts – refer to supplier telephone numbers in the event of having to contact gas, electricity,
water and telephone providers.
Key locations – know the location of cut-off points for gas, electricity and water.
Staff – make a list of employees’ contact details in the event of an evacuation. Make note of any staff that
may need special assistance, for example elderly, or hearing impaired.
Protective actions – note key stock, equipment and possessions that may need special protection from
floodwaters. Also consider things that may be needed during or after a flood, for example sandbags. If
possible, move key stock and equipment to another location.
Suppliers and external links – identify products and services you won’t need in the event of a flood, or
which suppliers may not be able to provide. Make back-up plans or arrangements for short-notice
cancellation of deliveries. Identify people, and/or contractors, sho can help you before, during and after a
flood.
Staff shortage, including pandemics management
There may be occasions when individual staff members are incapacitated for a number of reasons. Staff’s absence
will have a varying effect depending on the role they are responsible for. In many cases roles can be covered by
other staff ensuring that knowledge and skills are shared between groups of staff. Other staff roles might be
specialised and cover will need more thought and planning, especially if a service depends on that person alone.
There may also be the situation when a number of staff are all incapacitated at the same time such as an influenza
pandemic scenario.
Once it is apparent there is going to be a shortage of staff, (insert name and position) should be informed. This
person will be responsible for assessing the impact on the practice and business continuity, and the contingency to
be engaged to maintain continuity of service.
Options:
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The absence of staff for a short period does not have a significant impact on the business of the practice.
Continue to monitor situation.
The absence of staff will have direct impact on the front line services / business of the practice. Divert
workload to, or between, other staff that are capable of covering.
The absence of staff will have a direct impact on the front line services / business of the practice, however,
there is not another employee who is able to cover the role/s. Seek appropriate casual staff to cover.
The impact of one or a number of staff being incapacitated is such that the practice is unable to continue
services. (insert name and position) will be responsible for assessing the capabilities of the practice and
possibly which services might be reduced (see list of priority services in Table 1), or through cooperative
arrangements be diverted to other practices. (If the practice is going to invoke cooperative arrangements
with other practices, these will need to be pre-arranged. Insert these arrangements here).
Cooperative arrangements with other practices
(insert arrangements with other practices / health services, including contacts)
Arrangements for replacement medical staff
(insert practice arrangements)
Arrangements for replacement nursing staff
(insert practice arrangements)
Arrangements for replacement administration and management staff
(insert practice arrangements)
Communicating with patients / clients
In the event that a practice interruption is so severe that alternative arrangements for the provision of care needs
to be communicated to patients, the clients, of the practice. This will be done via (insert options, such as placing
signs on the front door of the practice, updating the telephone message or advertising in the local paper if time
permits).
It is vital to maintain communication with patients and clients during any period of business interruption. The
objective should be to reassure patients, and clients, with regular information on the progress made in returning
to normal business.
Appendix A – Contacts list
Activating the plan:
Primary
(Position or name)
(Contact details)
Secondary
Staff contacts:
Name
Position
Contacts
(add rows as required)
Utilities / services contacts:
Service
IT systems
Telecommunications
Electricity
Gas
Water
(add rows as required)
Provider
Contacts
Tradesman:
Trade
Provider
Contacts
Electrician
Plumber
Heating
Air conditioning
Builder
(add rows as required)
Other practices / health services with whom we have cooperative arrangements:
Cooperation available
Practice / Health service
Contacts
E.g. after hours clinic / temporary
vaccine storage
(add rows as required)
Suppliers of products (medicines, medical consumables and equipment etc.).
Product
(add rows as required)
Supplier
Contacts