14.2 Emergency planning

Business continuity planning

Risk analysis and contingency planning help maximise patient safety and ensure access to ongoing health care through coordinated and continued delivery of general practice services in the event of a disaster or major incident.

Business continuity planning is not just about how the practice will operate during the disaster or significant event but should also consider requirements (including viable alternatives) that enable the practice to continue operating in the short to medium term after the significant event

The business continuity plan

A business continuity plan should include the following key elements:

• options for alternative premises should the emergency/significant incident mean the usual general practice premises are no longer usable (even in the short term)
• a list (including contact details and key account reference details) of all major utility providers used by the practice.

A range of options for access to alternative utility services (or workarounds) should the practice’s normal providers of services be unable to supply any essential services when needed. 

Examples of essential utility services may include:

• power (equipment, lighting, heating)
• water (service provision, cleaning, drinking, hygiene)
• toilet facilities
• IT solutions (PMS/patient information)
• phones
• medical supplies

A copy of the practice’s business continuity plan should be maintained off-site in either an electronic or hard copy format that can be readily accessed and used when required. Key team members must be familiar with how to access the plan at any time.

It is also important for business continuity planning that alternative resource options are examined for reliability. For example, an alternative to mains electricity may include the use of a generator, so it will be important to hold discussions with an electrician to ensure that essential medical or other equipment requiring a power source can still be operated safely and effectively using the alternative power source. Ongoing access to fuel may be required if the practice has access to a generator

The practice should maintain a ‘power down’ kit containing paper forms, prescription pads, pens, marker pens and other resources to support the manual processing of patients should the practice experience a prolonged power outage (power down) situation.

The ability to access and maintain patient information may be important especially when moving into a re-establishment phase after a major event. The practice should have access to a valid and recent back-up of essential patient health information that the practice knows is capable of being restored and used.

It's recommended that the practice has a detailed list of all their current equipment, furniture and stock levels, should the practice need to re-establish or relocate after a significant event.

Business continuity plans for general practices should also include planning for a situation in which the business may be impacted for several months or more, such as a health emergency like a pandemic.

During a health emergency, practices may experience:

• high numbers of practice team members on leave due to illness or caring for dependents
• practice team members called away from their usual work to be seconded to other related roles
• high demand on GP services
• disruption to supplies
• social distancing measures which may restrict how many patients are allowed in a waiting room or how many team members can remain in the building at one time
• changes to the way treatments and consultations are carried out (for example,. virtual consults or consultations and administering of treatments off site /in erected tents/in patients’ cars).

General practice team members should plan to address the following in the case of a health emergency:

• how to maintain services for patients and the community with practice team absences
• what essential goods and services the practice can rely on and how the practice will manage any potential disruptions to the supply
• how the practice can implement alternative work practices (i.e. telemedicine)
• how the practice can protect practice team members and patients to reduce the spread of illness in the workplace

Emergency response planning

In situations when an emergency event such as a fire, flood, earthquake or prolonged power cut requires extraordinary actions, there should be a planned set of responses that all practice team members understand. This includes a documented fire evacuation scheme approved by Fire and Emergency New Zealand.

The plan should cover expectations of immediate responses by team members roles and responsibilities; provision of services; and allocation of resources for each type of emergency occasion or situation. 

Other forms of emergencies that should be covered may include bomb threats, active shooter scenarios, hold-ups, prolonged computer outages, aggressive patients and significant incapacity of a team member (for example,. through sudden illness or death).

The plan should cover responses to emergencies that may be confined to the immediate practice facilities as well as any responses that may be made externally to the local community when the emergency is of a greater scale.

The emergency response plan

The Emergency response plan should include:

• how to maintain services for patients and the community in the event of practice team absences
• how the practice will manage any potential disruptions to the essential goods supply and services the practice relies on 
• how the practice implements alternative work practices (for example,. telemedicine)
• how the practice protects practice team members and patients to reduce the spread of illness in the workplace
• detail on where the plan is kept/made accessible offsite.

Business continuity plans and emergency response documentation should be reviewed and updated annually. Plans should be dated and include a next review date.