This document is written to assist in business continuity in the event of the declaration of Influenza Pandemic.

Pandemic influenza can vary in its effect – from a mild disease causing minimal disruption to one causing significant morbidity and mortality. Hence any document of this form will be generalist in nature and subject to day to day changes in its implementation.

1: Prevention of infection to Practice Staff

2: Prevention of infection to Patients attending the practice

3: Means of informing patients of changes in practice circumstances

4: Managing workload

Influenza virus is most commonly spread by the passage of virions in exhaled air to the mouth or respiratory tract of another person. There are exceptions to this – the Avian influenza virus H5N1 which is still present significantly in the far east and Egypt is passed through the gut of birds and is present in bird faeces. Simple hand and respiratory hygiene is fundamental to prevention of spread of influenza.

All staff to wash hands regularly using soap and water and the available alcohol cleaners

Telephones, desk surfaces, door handles, chair arms and under seat where held, computer keypads and mice to be cleaned between users with alcohol or similar wipes

Personal protection equipment(PPE) is stored in Flat 5 and will be issued to front line staff in the event of significant numbers of patients coming to the practice for assessment. This will be issued on the advice of Dr Higson. PPE may include face masks, goggles/face shields, aprons, gowns and gloves – the extent an individual requires protection will be assessed following an assessment of their likely contact with infected patients.

To prevent infected patients coming into contact with staff, when circumstances require it, the practice will follow one or more of the following actions

3: Patient access will be controlled by the locking of the front doors of the surgery – each can be unlocked by electronic means to allow access once entry permitted.

4: Patients will be asked to provide either stamped addressed envelopes or to collect medications from their pharmacies to avoid having to attend the surgery premises.

5: Telephone triage systems will be introduced to avoid patients needing to attend for consultations in person

6: Patients attending for appointments will be issued with disposable face masks and sat in different sections of the waiting areas. Relatives/friends will not be allowed to attend unless absolutely necessary

7: Seating and furniture in the waiting areas will be washable only – all fabric seating will be temporarily withdrawn from waiting areas. All surfaces to be washed down daily.

8: Consultations will be restricted and suitable personal protection equipment utilised .

Much of what has been written in section 1 above will also prevent cross infection to other patients.

In addition, consultation appointments will be adjusted to ensure that the minimum number of practitioners are consulting at any one time to decrease the numbers of patients sat in the waiting room. Practitioners will be required to work to time to avoid patients waiting beyond their appointment time. Patients will only be allowed access to the waiting room a maximum of 10 minutes prior to their designated appointment.

Hand cleaning equipment is provided and access will be refused until a patient has donned a mask and used the hand wash which will be provided outside each surgery entrance

The Practice website will be updated with the latest advice to patients as will the practice telephone system (option 1).

Notice boards will be placed outside the surgery – using either powerpoint displays or static posters – advising of any restrictions or access provided.

Newsletters may be posted to all patients if appropriate

General messages will be sent to all patients for whom the practice has an email address

It is assumed, though not guaranteed, that the media will be used by the NHS to inform patients of the general situation regarding influenza activity and personal protection

The practice has two main sites for patient consultation linked by the same computer system for both clinical and appointment management. All practitioners have home computers and the practice has invested in systems to allow access to the clinical data and appointments from the clinician’s home. This is password protected and the password is managed on a minute to minute basis by Dr Higson.

It is expected that some or all of the following will be utilised to manage workload resulting either from an excess demand for consultation/advice or resulting from incapacity of practitioners

1: Telephone triage will be introduced – either from the surgery site or from the clinicians own home. This can be extended beyond the normal operating hours of the practice to spread our the workload

2: Consultations (face to face) will be available for acute illness, essential disease monitoring, and for maintaining levels of community immunisation(essential otherwise secondary infections such as Meningitis, measles or pertussis may result as complication of influenzal disease). Consultations not requiring face to face assessment will be conducted by telephone. The majority of patients with hypertension have been given home sphygmomanometers and these are utilised for home management. If observation of blood pressure is required, then the patient will be required to use the machines in the waiting area of either surgery and personal contact with clinician is not necessary.

3: Repeatable medications will be managed by requests received electronically, on paper, or by telephone. Collection of prescriptions will not be allowed – these will either be sent to the pharmacy by facsimile or by mail drop on a daily basis.

4: Administration workload will be appropriately managed to provide, in order of priority

-telephone access for advice/triage

-management of repeatable prescriptions

-Uploading of clinical information from letters received

-Registration/de-registration of patients

-dealing with requests for information from third parties