ࡱ> SUR[ m(bjbj *8ΐΐm $ ,t%%%%%Q,S,S,S,S,S,S,".0fS,S,%%h,WWW%%Q,WQ,WWr)+%hlBQ+=,~,0,c+6*1F*1$++*1+""W:NS,S,F,*1 :  Updated LMC Guidance on Business Continuity Planning for General Practices during an Influenza Pandemic 1.0 Background Currently (29th April 2009) the WHO has declared level 4 alert for a pandemic caused by swine flu arising in Mexico. It is possible that this will occur in the next few weeks, or die down only to reappear during the normal winter flu season. 2.0 Epidemiology Current models, based on previous pandemics, suggest an attack rate of about 35%. This will probably occur in more than one phase, but an initial wave lasting 14-15 weeks is likely with a peak at about week 7-8 during which perhaps 22% of infections will occur that means something like 7.5% of the population will fall ill at that time. Rural counties like Somerset may see a slower but more prolonged wave of infection. 2.0 Vulnerability of Staff However, in small organisations or communities there may be considerable variation in strike rate and the timing of infection. For statistical safety you should work with an assumed peak 50% infection rate. On top of this, staff may be unable to attend work because they are caring for family members with infection or have to be at home with children because schools have been closed 3.0 Business Continuity The essence of this concept is the need to decide which functions have to be maintained to allow your organisation to continue to operate under exceptional circumstances, and then to decide how these will be preserved so that after the episode has passed you can implement a recovery plan to get you back to normal operation. There is a range of guidance on this, most helpful are the Somerset PCT Practice Influenza Plan Template and the joint DH/RCGP/BMA guidance which are attached. 4.0 Essential Business for General Practices GPs are fortunate in having a relatively clear function providing in-hours primary medical care for our registered population. In a flu pandemic this may become more hazy, and during the most critical phase of infection GPs may end up working out of hours, providing what is usually secondary care, and for a much wider group of patients simply because there is an urgent health need and we feel ethically bound to do so. 5.0 Work Prioritisation Applying continuity principles to GP work gives a priority list in descending order that reads something like this: Lifesaving interventions Diagnostic triage Significant acute illness Repeat prescribing Major chronic disease management Moderate acute illness Terminal care Immunisation Minor acute illness Routine chronic disease management Health information & promotion Routine screening NHS reporting and contract management This list is not prescriptive and needs to be interpreted . Terminal care, for example, is relatively low down as much can be done through triage and repeat prescribing. On the other hand some routine functions like chronic disease management need to continue in some form because of the difficulty in catching up if the outbreak lasts for many months. Immunisation is a complex area. It is most unlikely a specific flu vaccine will be available during the first wave of a pandemic, and routine childhood immunisation may be suspended to reduce the risk of transmitting infection in clinics, but pneumococcal protection might become a high priority. However, the principle will be that as demand rises and capacity shrinks, work stops first on the areas of least priority, moving up the list in until you reach the point where you can match capacity with demand. This process is going to be dynamic, especially as a pandemic will, at best, last for a number of weeks. GPs can work 15 hour days for a short spell, but not for very long. 5.0 Core Business Functions Practices will be having to deal with a large volume of flu related work with depleted staff and resources. You need to have contingencies to deal with vital activity if key people are unavailable. 5.1 Finance Can you continue to pay staff and partners as well as routine bills if the practice manager and finance partner are both off sick. Do you have an emergency management handbook so that someone who is unfamiliar with your systems can get by? 5.2 Staffing Can you do the same with staff rotas? Do all your staff have the ability to cover reception/telephones and understand your basic patient contact arrangements? Have you a scheme for moving back office staff to the front desk? Do all your staff understand their own sickness pay arrangements? What happens if staff cannot come to work because they are themselves carers? 5.3 Contracts Have you any contracts for work outside PMS/GMS that might need to be suspended? Have you thought about what demand intensity and duration would trigger a notification to the PCT that you are suspending work on part of your contract? 5.4 Clinical Staff Front line staff may be more vulnerable to infection, so how would you manage medical and nursing staff provision in a pandemic? Would you be able to cover your community hospital? Is there scope for working with colleagues in other practices? What if the OOH services collapses? Should you consider sending some of your clinical staff home so that not everyone will fall ill at the same time? 5.5 Triage arrangements The Somerset plan anticipates as much flu work as possible being managed through telephone contact with as many sufferers as possible self caring at hime, but inevitably many patients will contact the practice. Can you rearrange your work to increase telephone consultation and minimise surgery attendances and house calls? This will not only reduce infection risk and increase efficiency, it increases the sustainability of what will anyway be an arduous work schedule for clinicians. 6.0 Transferred Work Not every organisation with whom we work will be resilient. Acute hospitals are likely to reach bed capacity very quickly. PCTs may struggle to perform their functions, care agencies and social services may run out of staff., and until the relevant civil contingencies are initiated there could even be problems with removing and storing dead bodies. Inevitably some of this work will fall back upon the practice so you need to decide where it fits in your priority scale, if at all. 7.0 Contract and Medicolegal implications Clearly there will be financial implications in this. The DH and the GPC have agreed an structure under which a majority of practice payments will continue during a pandemic even if some QOF and ES work cannot be completed. BACS payments will continue, and these matters will have to be sorted out after the event. Individual clinicians will inevitably find themselves having to make difficult decisions about resource allocation, and the work pressure will mean that practices will not be able to offer their usual standards of care. It will certainly help you to deal with complaints or legal action if you can show that the practice has been working to a predetermined plan written after consideration of local and national guidance. 8.0 Security In the event of the infection having a high morbidity and mortality, practices and clinical staff may feel themselves under threat if people believe they are carrying anti-viral treatments. The Somerset plan anticipates that all antiviral supplies will be from central distribution points and that practices, pharmacies , and primary care clinicians themselves will not be in the supply chain. It may be appropriate to emphasise this to patients during an outbreak 9.0 Joint working Smaller practices in particular may find that a high strike rate for infection means that they are not able to provide a service for patients during some part of a pandemic. We strongly urge all practices to discuss with their neighbours outline plans for cross cover arrangements. Clinical information is probably best shared by triplicate paper records one copy each for the consulting practice, the registered practice and the patient, perhaps using a simple database programme on your central server. In the event of a breakdown of the out of hours service the LMC and PCT will negotiate suitable emergency cover arrangements based on whatever seem to be the most practical localities at the time. Revised 29.04.09  .Sijkozp q - 1 H  / = *ݾ}u}}m}e}m}\eh I5CJaJhCJaJhCJaJhCCJaJhYCJaJh Ih I5CJaJh ICJaJh"K{h"K{CJH*aJh"K{CJaJhQ/CJaJhY5CJaJh5CJaJh"+5>*CJaJh"K{5>*CJaJhY5>*CJaJhC5>*CJaJh56jh56U$jkzo q , - H 45N`z & Fgd6gdU/Y '&#$/*OPfpQ345pFGM?hu7?jx[]νΩΩƩƩƩơƩhK5CJaJhKCJaJhf|5CJaJh}N`CJaJhf|CJaJhh5CJaJh5CJaJhCJaJh6CJaJh I5CJaJh65CJaJh"K{CJaJh ICJaJhQ/CJaJ37Iopfgthiw ;^`;gd5v ;^`;gdKgd6 & Fgd6 @BFQV !!!!F#####$%˺˲˺˲˲˲˩~vmehO;CJaJh"K{5CJaJh&'CJaJh CJaJhUhUCJaJhUCJaJhQ/CJaJh}N`CJaJh}N`5CJaJh"K{CJaJh5v5CJaJhf|CJaJh5vCJaJh5vh5vCJaJhK5CJaJh5vh5v5CJaJh5vhK5CJaJ' !!###%%%Z([(\(m(gd}N` ;^`;gd}N` ;^`;gd5v%%%%%9&B(Y(Z([(\(l(m(̹h&'CJaJh"K{hO;CJaJhCCJaJh&CCJaJhO;hO;CJaJhO;5CJaJhO;CJaJh"K{CJaJ (. A!"#$% _Dd6w \0  # AbeWd/ЌA1<DneWd/ЌA1AFTuԟDO^Ff'^e{ L X/`}VF 4@7B_ս &h0`uos@K?R_g]ȗg)w_7WܔA  7W@W _#Q~/۫;ޔLw+Џm,^"`=@G@/Ce,^ mΖZr%eO,Q?hfxE‹Ebud̯S(Kޢʰ$QWPeFphg>h DŽbS6{C?(J+*%tPOΧؕN%#ٌF"Ҩ@#(# wRߒV?iw3BLt PRcwlC2JE4G!ep3@b=+aqM wxZp+-1K ]x/&ySGM 1#5]Vך7ܟ։l<XC@t#17 ݿE 7 鮄~U)uX[D5]eGFZ m8w%]6;4DQU|(ޡ9GLtz Qk<4olP|HRM Knߠ5-R*hQ=R[½U&/˄p :4eOVK'Npk䖤ՄLÁ <,&!bl)g DAlh7P&Ů5f+ Ϝ|/7@@'@f*bL8P-#k4ty mx FrR~?({H"DrUvDl< 7))ISuY5~z&bdJHX⩶>B ]^\XqJCڏj%q$ 9̚ri1(.qzbdAU@<递(Qgs XFRs*7 ( J4I!jz׎ a,PD;Ft ?-̣Z]@`ZH0wk  xmHDP2IbD~- =F@fgHP5"; phFK҈ZCX;B(:[Yڗ @ͣ00<!H5iV-Q5.RP}@(Џi϶b.Aw}IpʕC(jw腟dS$Rc;3 ޘ⪀]xse1Dޗht¤Ꞡm8 FFyUCV9]Y)PRY x"k>1HbA1MD/*c,1!9PODU2ֱXAKeW3-khj# *肄 [@ K2C2#OQ\>z-aojv/g71f`V/"!󔚏h$!.ʊԳMZ'X@?DU:Ыx׶1־Q@)!jіPFlv47v&t)_yJk4L l2yI8)Vjn {:~Gփ$MB G"X2rx\RH,Fw(9ϑ x16-/@_EL h^kИɸbE hh2xNf\؟ARLl?C u=n:c4bk[)ݢLQ+F(m/ ౓g>5q% -܄+,)*JQ$/&qh$Ψd|V9Z뤫tΑD< CUS(0fȇ&>0@A6[& lk+\ P̘0F! #*(LʿĈ^ s *PLNVJ3>!4lU~xkU}:`[a 6kW#3_\-so.^= JwX mF{9F(}}瀺y瀂kL'=Nt&@BRoGQ9'Ax\J^]ЖlTQdPh(NQД߹#nUY;H]Zٖ}@Y@89;U^`'ίfDUC9+Ql;!ædn$Qa5U&hKL !~$)62\anH1`t+?[ Ӕ: Sd:nj td[bHG3)j`T\F^U]~yK$z3Vcz!kNCY]9qaR <{+kKZ.9-VuPwbۛNG jZ;bO[/Il t\eW]w `^]1EK}\yVzW y+}#^`x~*뤑9Y}p'پKc6L(Zˢ@4h ZԽrR˰dNpݼSdsgV-W`% mgڢdOF;?2x]@I4.8fԍiZN{v=hҔ6㏒Wǀb'ADi0y 9}Vԝ:nc]1C@gCj(^l 22H͉.OaSz.P3cNEg(1kQd^s2M t22B̳h5"911Dt<拓tBWhZ?0ti8ߗThITS;|7584<5)X~I}j5HٰK{}[X@)MS#68PVde ?3~@}q웬.g.)]L 6vyطM6H3yZ 3nF\XR '͹ -2KfG=9xf:Q QgF@˭$sOh6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH H`H Normal5$7$8$9DH$_HmH sH tH TT ] Heading 1$$5$7$8$9D@&H$a$ 5>*CJHH ] Heading 2$5$7$8$9D@&H$CJLL ] Heading 3$5$7$8$9D@&H$>*CJPP ] Heading 4 $5$7$8$9D@&H$^CJbb ] Heading 5.$$p5$7$8$9D@&H$^p`a$5CJDA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List HBH ] Body Text$5$7$8$9DH$a$CJ^C^ ]Body Text Indent $5$7$8$9DH$^a$CJ\R\ ]Body Text Indent 25$7$8$9DH$^CJbS"b ]Body Text Indent 3 $5$7$8$9DH$^a$CJPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] m 8*%m(m(8@0(  B S  ?\wto o 8*urn:schemas-microsoft-com:office:smarttagsCity9*urn:schemas-microsoft-com:office:smarttagsplace xIZg l x <@V_{s|o zk}bo   H S /;Q_$5A!cpoz o 33333333333333333333333333 <[ \ l o  <[ \ l o $[ 7PP;j=n[.b^)fPii>u* ^`hH ^`hH.  0 ^ `0hH.. \ 0\ ^\ `0hH... HH^H`hH .... ^`hH ..... `^``hH ......  <`<^<``hH.......  (#(#^(#`hH........ >^`>hH >^`>hH.  0 ^ `0hH.. s0s^s`0hH... ^`hH .... ^`hH ..... `^``hH ......   ` ^ ``hH.......  &&^&`hH........h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH 0^`0hH.0 0^`0hH. p0p^p`0hH.. @ 0@ ^@ `0hH... xx^x`hH .... HH^H`hH ..... `^``hH ......  P`P^P``hH.......  ^`hH........ 0^`0hH.0 0^`0hH. p0p^p`0hH.. @ 0@ ^@ `0hH... xx^x`hH .... HH^H`hH ..... `^``hH ......  P`P^P``hH.......  ^`hH........fPi0 P;j=P6 >u6 7Pz p@F[.bP8Tj30;41PLTj30;41PLTj30V;41PȝTj30;416u@ ^`OJQJo(         y"{oCy g"+O;&C ICI"OU/Y}N`"K{Y &'Q/SU'x6]565v~ Kf|jm o @m @UnknownG* Times New Roman5Symbol3. * Arial?= * Courier New;WingdingsA BCambria Math"Ahff::xx24] ]  2QHX ?]2!xxK:\Templates\LOGO.DOT useruser$      Oh+'0l   ( 4 @LT\d user LOGO.DOTuser2Microsoft Office Word@Ik@@lԽ@lԽ՜.+,0 hp  Somerset Health:]   Title  !"#$%&'(*+,-./0123456789:;<=>?@ACDEFGHIKLMNOPQTRoot Entry F#qVData _1Table)N1WordDocument*8SummaryInformation(BDocumentSummaryInformation8JCompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q