Guidance

Health and Safety

There are a number of areas to consider for Health and Safety and this document lists the areas for consideration.

Please note this list is not exhaustive, and we have categorised into five sections for ease of searching.

Page Contents

Compliance Controls

  • Controlled Drugs
  • COSHH
  • CQC-Enforcing Safety
  • Infection Control
  • Public Health
  • RIDDOR & when to notify the NHS
  • Risk Asessments

Emergencies

  • Disaster Recovery Plan
  • Emergencies
  • Emergency Drugs and Crash/Rescue Bag

Equipment

  • Calibration of Medical Equipment
  • DSE
  • Fridge Log Book & Cold Chain
  • Oxygen
  • PAT Testing
  • Portable Hearing Loop

People

  • Accident Book
  • First Aid
  • Hep B for Staff
  • Lone working policy
  • Manual Handling
  • Needlestick Injuries
  • Occupational Health
  • Supervising Contractors on Site
  • Visitors Book & Signing In for Staff

Premises

  • Asbestos
  • Building Mantenance
  • CQC
  • Fire
  • HSE Poster
  • Legionnaires Disease
  • Lifts & Evacuation Chairs
  • Lighting in the Surgery
  • Recycling & Refuse Contracts Clinical Waste

Videos & Podcasts

 

Compliance Controls

Controlled Drugs
COSHH
  • See http://www.hse.gov.uk/coshh/
  • Undertake an audit of all substances in the practice and identify those that are hazardous (have a warning label), determine if you can eliminate the substance or replace it with a non-hazardous alternative
  • Obtain a Material Safety Data Sheets (MSDS) for all hazardous substances you cannot eliminate or replace with a non-hazardous alternative.
  • Undertake a COSHH Risk Assessments for all the hazardous substances you have, remembering the assessment is specific to how that substance is being used, so a substance that is mixed or used in different ways may have more than one assessment
  • Ensure COSHH assessments are undertaken by a competent person
  • Make COSHH assessments available to staff and ensure they are reviewed and remain current
  • Where contractors (such as cleaners) use hazardous substances on your premises ensure they have undertaken COSHH assessments and provide you with copies.
CQC – Enforcing Safety
Infection Control
Public Health
RIDDOR & when to notify the NHS
  • http://www.hse.gov.uk/riddor/
  • Please note the rules for reporting for employees and public and others are different.
  • For employees specific injuries and incidents need to be reported either immediately or within a specific period.
  • Accidents must also be reported where they result in an employee being away from work, or unable to perform their normal work duties, for more than seven consecutive days as the result of their injury. This seven day period does not include the day of the accident, but does include weekends and rest days.
  • Accidents to members of the public or others who are not at work must be reported if they result in an injury and the person is taken directly from the scene of the accident to hospital for treatment to that injury. Examinations and diagnostic tests do not constitute ‘treatment’ in such circumstances.
Risk Assessments
  • Advice and templates are here: http://www.hse.gov.uk/risk/controlling-risks.htm
  • Ensure risk assessments meet the test of “suitable and sufficient” and are undertaken by a “competent person” and that they are available to those undertaking the activities to which they apply.
  • Define how often you will review your risk assessments to keep them current, ensure they are reviewed in accordance with this, plus if there are changes that affect the risk assessment such as change of personnel, change of equipment or premises, an audit or inspection revealing short comings, or an accident or incident.

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Emergencies

Disaster Recovery Plan
  • Once written, keep up to date and at least one copy off site
  • Make sure all know of its existence and make a list of who has access to it
Emergencies
  • To run through some examples of emergencies that might occur in surgeries, run the Wessex LMC Lunch & Learn training over a lunchtime with staff Wessex LMCs Lunch and Learn: Emergencies & Business Continuity
  • Practices should have emergency plan/s in place for emergencies that may occur and especially if they can have a wider impact, possible events to consider are: Fire, bomb threat call, bomb or other device sent through post or placed in building, gas leak, explosion, flood, release of dangerous substance. These will be determined by the nature of your activities and the hazards present at your practice.
Emergency Drugs and Crash / Resus Bag
  • Ensure all staff know where it is and how to use the basic equipment
  • Show this to locums and all new staff on their first day
  • Make sure all staff are up to date with their BLS/CPR training Wessex LMCs: Mandatory Training for Practice Staff
  • In the event of a fire or other emergency evacuation ensure staff are identified to take crash bag, AED & Oxygen bag etc. from the practice to the assembly point so that if necessary, you main able to render emergency care whilst you are not able to access the practice.

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Equipment

Calibration of Medical Equipment
DSE
  • DSE – Display Screen equipment
  • Know your obligations as an employer http://www.hse.gov.uk/pubns/indg36.pdf
  • Ensure DSE assessments are in place for all habitual DSE users at all workstations they use, don’t forget this applies to homeworkers as well
Fridge Log book & Cold Chain
Oxygen
PAT Testing

It is not necessary to PAT test every electrical appliance every year, what is legally required is to set a policy for your organisation that recognises the types of equipment used, its uses and the risk.  Testing must then be undertaken and recorded in accordance with your policy.

Portable Hearing Loop
  • If you have one, ensure staff know how to use /maintain it
  • If you do not have one, consider installing one, for more info Action on Hearing Loss

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People

Accident Book
  • For info and how to purchase see here: http://www.hse.gov.uk/pubns/books/accident-book.htm
  • The accident book is a legal requirement and should be completed for all who have an injury in your workplace (Employees or members of the public), it can be completed by anyone.
  • Remember if you own external areas such as carparks, footpaths, gardens or pavements injury accidents in these areas should also be recorded in the accident book.
First Aid
  • http://www.hse.gov.uk/firstaid/
  • First aiders should be appointed and details of who the first aiders are should be published.
  • You should have sufficient numbers of first aiders appointed to ensure that first aid can be rendered without delay by suitably qualified people at all times when people are at work. Numbers should be sufficient to cover lunch breaks, shift working, extended hours and planned and unplanned
  • First aiders must either hold a current first aid certificate (valid 3 years) or other approved qualification to be able to fulfil the role of a workplace first aider, once the certificate has expired staff can no longer fulfil this role.

Doctors, nurses and paramedics can form part of your workplace first aid provision, however they must meet the following criteria:

  • They must be formally appointed by name as a workplace First Aider and appear on the list of workplace first aiders
  • They must be registered with GMC, NMC or HCPC
  • They must be able to demonstrate current knowledge and skills in first aid and they must be able to keep them current (approved first aid treatment protocols change at least every 5 years). Additional training in first aid or emergency medicine skills may be required for Doctors and Nurses as they may not have current or appropriate first aid skills. .
  • They must be able to respond and render First Aid immediately should the need arise (when undertaking minor surgery, some lengthy examination or home visits they will not be able to render emergency First Aid) and this may mean it is difficult for some doctors, nurses or paramedics to undertake this responsibility.
Hep B for Staff
Lone working policy
Manual Handling
  • Be aware of your obligations as an employer http://www.hse.gov.uk/msd/manualhandling.htm
  • Ensure all manual handling operations have a manual handling assessment in place, remember manual handling refers to a wide variety of activities including lifting, lowering, pushing, pulling and carrying
  • Ensure staff are trained in manual handling and safe lifting techniques and that this training is documented and kept current.
Needlestick Injuries
Occupational Health
Supervising Contractors on Site
  • Let all staff on duty know when to expect them
  • All visitors much sign into the visitors book and show ID
  • Depending where they are working, confidentiality agreements may need to be signed
  • Make sure you have checked the public liability insurance of all contractors and that you have asked for an obtained copies of their risk assessments relevant to the work they will undertake prior to commencement of work.
Visitors Book & Signing In For Staff
  • Let all staff on duty know when to expect visitors
  • All visitors must sign into the visitors book and show ID
  • Depending where they are working, confidentiality agreements may need to be signed

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Premises

Asbestos

If you have asbestos containing materials (ACMs) within your building, these should be identified (labelled) and should be recorded in an asbestos register. When contractors work on your building you should make them aware of the register and where Asbestos is. Asbestos can only be removed by licenced asbestos removal companies.

Building Maintenance and Equipment (boilers, gas, water, auto doors, air conditioning)
  • Make sure you know where the paperwork is
  • Record when maintenance/servicing is due
  • Contact names for troubleshooting should be made know to staff
  • Be aware of the relevant statutory requirements for certain equipment (lifting equipment, fire equipment etc.)
CQC
Fire
  • For advice look here: http://www.hse.gov.uk/toolbox/fire.htm
  • Wessex LMCs Podcast with Gary Hepburn from Sirius Business Services Ltd. Fire Evacuation – is your practice compliant?
  • Fire Safety and Risk Assessment in Healthcare premises- HM Government Fire Safety Risk Assessment in Healthcare Premises (FSIHP)
  • The Fire Service and your Evacuation Plan “The plan should not rely on fire and rescue service involvement for it to be effective”. (pages 30 and 31 of the above document under the heading of Emergency Evacuation of Persons with Mobility Impairment)
  • Fire Evacuation Exercises – The Regulatory Reform (Fire Safety) Order 2005 (RRO) states that: “The responsible person must establish and, where necessary, give effect to appropriate procedures, including safety drills, to be followed in the event of serious and imminent danger to relevant persons.”. Fire emergency procedures “should be tested at least once, but preferably twice, in each 12-month period and there should be a test evacuation of the entire building at least once per year”.
  • Refuge Points “Where refuges are provided, they should be enclosed in a fire- resisting structure which creates a protected escape route leading directly to a place of safety and should only be used in conjunction with effective management rescue arrangements. Your fire evacuation strategy should not rely on the fire and rescue service rescuing people waiting in a refuge”. (pages 75 and 76)
  • A refuge is an area where a person in a wheelchair (for example), or with another form of difficulty, may rest or wait in relative safety for a short while, allowing others to use the route normally until assistance is available from appropriate numbers of staff who may use specific equipment provided for the purposes of evacuation ie evacuation chair or resQmat. Where equipment is provided it must be maintained and inspected and staff must be trained in, and practice its use so it can be effectively used during an evacuation.
  • Personal Emergency Evacuation Plans (PEEP) – A PEEP is a plan for a person who may need assistance, for instance, a person with impaired mobility, to evacuate a building in the event of an emergency. The following document on PEEPS from Lancashire Fire and Rescue gives the background, considerations and a template to use. https://www.lancsfirerescue.org.uk/wp- content/uploads/2018/09/personal_emergency_evacuation_plans pdf
  • The current HM Government guidance on PEEPs can be found in Fire Safety Risk Assessment: Means of escape for disabled people. Information on PEEPS starts on Page 6 and PEEP templates are on page 44 and 46. The guidance also suggests that a sign should be displayed in reception (see page 48) requesting those with a disability to notify a receptionist on arrival so that arrangements can be made to evacuate them in the event of a fire whilst they are in the building.
  • Standard Emergency Evacuation Plans – A standard plan is used where there are visitors or casual users of the building who may be present infrequently or on only one occasion. The provision of standard PEEPs takes account of the following:
    • the disabled person’s movements within the building;
    • the operational procedures within the building;
    • the types of escape that can be made available;
    • the building systems, g. the fire alarm; and
    • the existing egress plan.

Standard evacuation plans are written procedures that can be used as options for disabled people to choose from. They are held at the reception points within the building and are advertised and offered to people as part of the entry/reception procedures.

  • Fire Risk Assessments (FRA) – The RRO requires a fire risk assessment to be carried out for all non-domestic and some types of domestic properties.
    • It is the responsibility of the appointed ‘Responsible Person’ or ‘Duty Holder’ to ensure the FRA is undertaken by a ‘competent person’ and that the assessment is ‘suitable and sufficient’.
    • Where a business employs five or more persons, the significant findings of the fire risk assessment must be recorded in FRAs must be kept up to date and reviewed and updated when numbers of staff change, buildings are modified, new activities under taken in the building, or following an incident.
  • Testing of Fire Alarms – The RRO requires employers and building owners to maintain and test Fire Alarm All fire alarm systems in commercial premises need to be tested weekly.
  • Maintenance and testing – All fire protection installations and equipment should be serviced annually by a competent contractor (fire extinguishers, fire alarms), here is a table detailing what is required:

  • Fire Wardens – Part 2 of the RRO states that a sufficient number of ‘competent persons’ to assist in implementing preventative and protective measures, including safety drills, should be appointed depending on the size of the building, to cover all hours of operation and in suitable numbers to cover for planned and unplanned leave and when appointed wardens are away from the building.
HSE poster

If for any reason you are unable to display the HSE poster, you must supply a leaflet (available from the HSE, purchase or free download) to every member of staff that contains the information that would be available on the poster.

Legionnaires Disease – Water Temperature
Lifts & Evacuation Chairs
  • Make sure you know how they work
  • Communicate contacts for troubleshooting
  • Regularly check that evacuation chairs and ResQmats are in place and in good order
  • Practice evacuations using Evac Chairs and ResQmats so that those expected to use them are very familiar with their use and problems that may arise
  • Ensure statutory inspections of lifts are undertaken and records retained
Lighting In The Surgery
Recycling & Refuse Contracts Clinical waste
  • Check who is your contact and who runs the contracts
  • Check whether you are entitled to reimbursements
  • Clinical waste – make sure the right bags/boxes/bins are used Wessex LMCs: Clinical Waste & Sharps Boxes

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Videos & Podcasts

Educational Podcasts and Videos Focusing on Health and Safety

Covering:

  • Basic Fire Safety and Extinguishers
  • Fire Evacuation – is your practice compliant?
  • Fire Wardens
  • Health & Safety in the Medical Practice
  • Health and Safety Tips

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