Practice Management

1. Practice Management Rochestown Park Hotel, Cork

2. Agenda for Today • Compliance & Inspections • Employment Law • Health and Safety • HIQA • Data Protection

3. Inspections into General Practices • NERA • Health and Safety Authority • HIQA (in future)

4. National Employment Rights Authority • Inspectors have right to • To enter any premises at a reasonable time • To demand sight of records • To inspect records • To take copies of records • To interview and require information from any relevant person

5. Best Practices, Good Record Keeping High-performing, happy staff = good employment. Having high performing paperwork = good employment law!

6. Records for NERA Inspection 1. Employer registration number with the Revenue Commissioners 2. Full Name, Address and PPS Number for each employee (full-time and part-time) 3. Terms of employment for each employee 4. Payroll details (Gross to Net, Rate per hour, Overtime, Deductions, Shift and other Premiums and Allowances, Commissions and Bonuses, Service Charges, etc.)

7. Records for NERA inspection (2) 5. Copies of Payslips 6. Employees’ job classification 7. Dates of commencement and where relevant, termination of employment 8. Hours of work for each employee (including starting and finishing times, meal breaks and rest periods). These may be in the form of Form OWT1 (or in a form substantially similar).

8. Records for NERA inspection (3) 9. Register of employees under 18 years of age 10. Whether board and/or lodgings are provided and relevant details 11. Holidays and Public Holiday entitlements received by each employee 12. Any documentation necessary to demonstrate compliance with employment rights legislation (e.g. work permits)

10. Essential Employment Law Checklist • Contract (Terms & Conditions of Employment) • Grievance Procedure • Disciplinary Procedure • Annual Leave • Public Holidays • Records of Hours Worked and Breaks • Payslips showing gross to net • Any other relevant special documentation

11. Health & Safety Authority • Primary focus is preventative and educational • Inspection focus • Safety Statement • Risk Assessments • Safety Representative • Awareness of all staff of their responsibilities • Accident Reporting

12. Safety, Health and Welfare at Work Act 2005 • Design, provide and maintain a safe place of work including safe access and egress • Provide safe equipment • Prevent risks from the use of any article or substance used at work • Manage work activities so as to ensure the safety, health and welfare of people at work • Prevent improper behaviour or conduct which could put people at risk

13. Safety, Health and Welfare at Work Act 2005 • Provide welfare facilities • Provide suitable protective equipment / clothing • Provide appropriate training / information • Appoint one or more competent persons to specifically advise the employer in relation to Health and Safety • Ensure reportable accidents / dangerous occurrences are reported to HSA.

14. Risk Assessments Fire - Electricity - Manual Handling - Equipment Needlesticks - Clinical Waste - Slips, Trips & Falls Chemicals - Liquid Nitrogen - Ergonomics & VDUs Compressed Air & Gases - Stress - Violence

15. Risk Assessment

16. Risk Assessment (Sample)

17. Safety Statement • Describes the organisational and physical arrangements for safety, including the assignment of responsibilities to individuals and a statement of co-operation required from employees to maintain those standards • Must refer to the specific hazards in the workplace and indicate the risks associated and the controls in place for each hazard

18. Essential Fire Safety For Your Practice • Fire Register – record keeping • Fire alarm system – tested weekly (keep records) • Fire extinguishers in place with maintenance contract for annual service (keep certificates) • Emergency evacuation plan in place • Appoint fire warden/s to ensure evacuation of all people • Ensure adequate signage • Fire drills – every 6 months (keep records) • Prohibit smoking in the building • Regularly inspect electrical apparatus & replace / repair

19. Safety in GP Practices • Oxygen cylinders • Risk of fire or impact damage • Should be stored upright and chained securely • Should be kept in a place where the risk of being damaged by bumping; and away from flammable or combustible materials, direct flames, electrical or heat sources • Should be transported in an upright position • Keep the MSDS sheet for any gas in your practice

20. Safety in GP Practices • Liquid Nitrogen for Cryotherapy • Lung damage or asphyxiation if inhaled • Skin / eye damage if splashed • Explosion risk if warmed • Keep a MSDS sheet for liquid nitrogen • Cold protection gloves, lab coat, closed shoes and safety glasses should be worn, even for handling small amounts • Pour slowly & carefully to avoid spillage

21. Other Safety Concerns in General Practice • Sharps and needlestick injuries • Blood or body fluid spillage • Latex allergy / dermatitis • Slips, trips • Working at heights / falls • Manual handling • Ergonomics & VDUs • Stress • Violence

22. Essential Health & Safety Checklist • Safety Statement • Risk Assessments • Log of Incidents / Accidents • Records of fire drills • Records of equipment tests • Records of maintenance of equipment • Records of improvements made

23. HIQA • National Quality Standards for Residential Care Settings for Older People in Ireland (Feb 2009) • Report & Recommendations on Patient Referrals from General Practice to Outpatient and Radiology Services (March 2011) • National Standard for Patient Referral Information (March 2011) • Standards for Health Information Governance • National Standards for Safer Better Healthcare

24. Safer Better Healthcare Standards 8 “Themes”: • Person Centred Care • Leadership, Governance and Management • Effective Care • Safe Care • Workforce • Use of Resources • Use of Information • Promoting Better Health

25. What to Expect? • Standards to be published (which are general & apply to almost all areas of healthcare) • Guidance documentation (to be issued specific to different areas of healthcare) • Licencing system - a license may be required to deliver healthcare • Monitoring - Unclear exactly how standards will be monitored (inspection/report or self reporting?)

26. Similarities to UK • Care Quality Commission in the UK – licensing legislation passed in 2010 • Out-of-hours providers to register by 2012 • Primary medical services required to register by 2013

27. Lessons from Care of the Elderly • Time & duration • Methods employed: Observation, Record Check and Interviews (patient, family, staff). • Drilling down in specific areas • Overview at end of visit with major issues identified there and then • Right to reply • Report – agreed action plan • Follow up visits

28. Focus of Inspections in Care of the Elderly • Statement of purpose and function • Clear accountable management structures • All relevant policies in place • Risk management (both policy and practice) • Complaint handling and resolution • Finances / accounts • Notification of incidents to HIQA in accordance with regulations

29. How Best to Prepare? • How can we demonstrate that we provide a quality, safe service? • Consider responsibilities and identify the lead person or people in your Practice – both for clinical aspects (Dr / Practice Nurse) and other people in charge (Practice Manager). These people will need to become very familiar with the standards once published. • Involve all staff through education / practice. • Log and follow up patient complaints / comments.

30. How Best to Prepare - Clinical • Structured approach to quality assurance • Conduct any necessary clinical audits & keep the records (BMA guidance, HIQA guidance once published) • Record how you improve your service • Conduct analysis of any adverse events on a regular, defined basis and keep a record of lessons learned from this • Involve staff and patients

31. How Best to Prepare - Governance • Clear supervision structures • Hold structured meetings and record minutes • Have appropriate policies, procedures and guidance documents in place • Make sure these policies, procedures and guidance documents actually reflect practice on the ground • Ensure staff are trained in / familiar with policies, procedures and guidelines • Review documentation regularly

32. How Best to Prepare - Staff • Have a policy on recruitment and induction • Ensure you have CVs, references, background checks, garda clearances, job descriptions all on file • Demonstrate that you have assessed staff training needs • Ensure staff receive all mandatory training • Keep good records

33. The Eight Rules of Data Protection 1. Obtain and process information fairly 2. Keep it only for one or more specified, explicit and lawful purposes 3. Use and disclose it only in ways compatible with these purposes 4. Keep it safe and secure

34. The Eight Rules of Data Protection 5. Keep it accurate, complete and up-to-date 6. Ensure that it is adequate, relevant and not excessive 7. Retain it for no longer than is necessary for the purpose or purposes 8. Give a copy of his/her personal data to an individual, on request

35. Data Protection Checklist • Do you have appropriate security measures in place both internally and externally to ensure all access to data is appropriate? • Do you have procedures in place to ensure that data is kept up-to-date? • Do you have a defined policy on retention periods for all items of personal data? • Do you have a data protection policy in place?

36. Data Protection Checklist • Do you have procedures for handling access requests from individuals? • Are you clear on whether or not you should be registered, and are you registered? • Are your staff appropriately trained in data protection?

37. Data Protection Requests • Individuals can request if you have information about them – reply must be provided within 21 days • Individuals can request a copy of data kept - a fee of up to €6.35 is payable • Copies of the information held must be provided within 40 days • If information isn’t provided, the individual can complain to the Data Protection Commissioner.

38. Marketing… Opt -In or Opt-Out? • Opt in = you must have their consent • Opt out = you must have offered an opt out option which has not been availed of

39. Marketing… Opt-In or Opt-Out?

40. Thank You