Practice Management

1. Practice Management Radisson Blu Hotel, Athlone

2. Agenda for Today • Compliance & Audits • Health and Safety • Employment Law

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

4. 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

5. 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

6. 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.

7. 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

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

9. Risk Assessment

10. 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

11. 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

12. 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

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

14. 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

15. 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.)

16. 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 to like effect).

17. 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

18. 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

19. 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

20. 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 will be required to deliver healthcare • Monitoring: Unclear exactly how standards will be monitored (inspection/report or self reporting)

21. 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

22. 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

23. 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

24. 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.

25. 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

26. 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

27. 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

28. Documents You Will Need • Safety Statement • Fire Register • Statement of Purpose • Access Routes • Plans for Dealing with Emergencies • Written complaints process & complaints log • Feedback from Patients • Confidentiality Protocol • HR documentation

29. The Practice Environment • Access to the Practice & security • Housekeeping, general standard of repair • Infection Control • H& S Audit (Risk Assessments) • Keep records of improvements made • Consider having a premises development plan if necessary • Equipment should be safe and suitable, clean and well maintained and staff trained in proper use • Written schedule of maintenance visits

30. Thank You