We consider that the threats that are most likely to affect the services we provide are:
- Telephone line failure
- IT systems failure
- Equipment failure
- Failure of electricity supply
- Failure of water supply
- Strong winds
- Floods (including frozen pipes)
NB: Many of these threats to the business overlap. For example, severe fire damage may also involve disruption to IT and communications. The various sections of this plan should be read together, as necessary, in order to provide a complete solution to a given situation.
We have taken various proactive steps to reduce the risk of the threats identified above affecting our services:
- This policy is part of the practice website – since it is stored online, it is secure in the event of a localised system failure, disaster or emergency and may be accessed by any team member who is able to connect to the internet.
- This policy is also printed off and posted on the staff room noticeboard so that it is available for all team members to see.
- Telephone and email contact details for team members and essential support services (eg dental engineer, IT support, electrician, etc) are stored on the practice mobile telephone aswell as the practice computer network and in the practice address book.
- Every day we print off a paper list of the patients due to visit the practice in the next 24 hours (known as a “day list”); this list contains both names and telephone numbers that allow us to contact people to cancel appointments in the event of an emergency that results in the computer network being inaccessible.
- The business has buildings, contents, business interruption and practice expenses insurance policies to meet the cost of repairs and other practice overheads where necessary.
Telephone line failure: We have four different telephone lines at the practice. Two of these are ISDN lines that carry incoming and outgoing calls. The other two service the PDQ machine and alarm system, but they can be used as backups if the ISDN lines or practice switchboard fail. We keep a spare telephone at reception to plug into the other lines should the need arise and also have a practice mobile telephone.
IT systems failure: We renew IT systems on a regular basis (the complete network was last replaced in May 2016). All IT hardware is protected by antivirus & anti-malware software that automatically updates from the internet. We also employ firewalls to protect our systems from unauthorised access and malicious damage. Our operating systems automatically download and install upgrades to reduce system vulnerabilities. We carry out monthly checks to ensure that important software is up-to-date. We have a server with mirrored hard drives so that if one fails the system will continue to function on the other. The server also contains a third hard drive that carries out an incremental backup every day. Data from the dental software is backed up across the network from the server to the office computer every working day. We operate an encrypted “cloud” backup system that copies all critical data from the practice to a remote site. This has replaced the backups we used to make on removable hard drives because it is more reliable (it is fully automated, backing up all new and changed files every day) and improves data security (there is no movement of physical media that could be lost, stolen or damaged). Every day, we print the following day’s appointment list (which includes patient names, appointment times, appointment length and contact details) so that we can contact and reschedule patients in the event of an IT system failure.
Equipment failure: We carry out regular equipment testing and maintenance in accordance with our testing, maintenance, audit and compliance schedule in order to reduce the risk of equipment failure (refer to office document database). We also renew practice equipment at appropriate intervals. We carry spare parts and even spare equipment (in the stock cupboard, office cabinets and the loft). For example, we have a spare set of magnifiers (loupes), spare handpieces, a spare electric micro motor, spare suction pumps, spare intra-oral cameras, etc. Both surgeries are of the same design and equipped in an identical manner so that if one is out of service the dentist can move to the other with the minimum of disruption.
Failure of electricity supply: There is nothing we can realistically do to guard against a failure in the electricity supply since we are entirely in the hands of the utility company.
Failure of water supply: There is nothing we can realistically do to guard against a failure in our water supply since we are entirely in the hands of the utility company.
Strong winds: The practice is in a reasonably sheltered position. We keep the building well maintained and carry out tree surgery as appropriate, but otherwise there is little we can do to guard against strong winds.
Flood: External flooding caused by rainfall/meltwater: The practice is not in an area likely to be seriously affected by external flooding. The area beneath the bridge at the bottom of Malt Mill Lane does flood in the winter but the flooding has never reached our premises and the practice remains accessible from the top end of Malt Mill Lane. The practice is, in any event, built on a concrete raft foundation and the floors of the building are approximately two feet above the surrounding ground, making flood damage to the building extremely unlikely. Internal flooding caused by plumbing services: (such as burst pipes) is a more likely problem. In the winter months we leave heating switched on (but at a low setting) during periods where temperatures are likely to fall below zero degrees in order to guard against frozen (and therefore burst) pipes.
Fire: The practice has a comprehensive fire and intruder alarm system. This is linked to a remote monitoring service that will summon the fire brigade in the event of an activation. The fire station is less than a 3 minute drive from the practice premises. We have properly positioned and maintained fire fighting equipment and a fire evacuation procedure. We carry out fire drills to practice this. The electrical wiring in the building is fully tested by a qualified electrician every five years. Portable electrical appliances are tested every 12 months. Waste bins are emptied regularly.
Pandemic: There is little we can do to prevent or significantly influence a pandemic outbreak of human disease. The practice maintains approximately 1 month’s supplies of essential consumables so that we could continue to operate in the event of supply chain disruption. We keep supplies of face-masks, disposable gloves and alcohol based hand wash as part of our routine infection control.
Telephone line failure: The spare telephone kept at reception can be plugged into the line for the PDQ machine/internet service in the event that the main ISDN lines (or the practice telephone exchange system) fail. Should that happen, BT can redirect calls to the alternative number so that we can continue to receive and make calls using our normal telephone number. If all our landlines fail, calls can be redirected to the practice mobile.
IT systems failure: In the event of an IT systems failure, the first point of contact is the Practice Director, Neil Phillips, or the Clinical Director, Joanne Giddy, who will attempt to resolve the problem if possible. If they are not available or are unable to resolve the issue, the computer maintenance company Friend Computers Limited (FCL) should be contacted. The contact is Matthew Howard. Their contact number is 01803 663338. If the issue involves replacing/re-installing or dealing with an issue involving the dental software (EXACT) then the software supplier, Software of Excellence (SOE), can be contacted on 0845 3455767. Data backups can be accessed on the server, the office computer and from the “cloud” backup held by LiveDrive. We have discussed the issue of catastrophic system failure with our computer maintenance company and have been advised that the practice computer system can be reinstated within 24 hours, even if we have to purchase entirely new hardware and install new software on it (assuming that a data backup is available). If a systems failure should occur, the printed day list provides the information necessary to reach patients who will need to be contacted if we are unable to see them on the next working day.
Equipment failure: The first point of contact is the Practice Director, Neil Phillips, or the Clinical Director, Joanne Giddy, on 07734 898220. If they are not available or are unable to resolve the problem, then there are different people to contact, depending on the nature of the equipment:
- general dental & x-ray equipment: Colin Edwards of Edwards Dental on 01803 555739 or 07921 101111 OR Dan Barnes of DSB Maintenance 01752 932574 or 07568 504924;
- autoclaves/compressor: Peter Dawson of Medical Equipment Supplies on 01278 751288 or 07795 018354 or 01255 422283;
- other electrical equipment: John of JD Electrics on 01803 782225 or 07768 111000;
- plumbing: refer to Practice Director;
- replacement equipment: Kent Express on 01634 878777.
If the failure is such that we would be unable to provide an acceptable standard of care, we would contact patients with appointments booked in the near future and rearrange these, as necessary.
Failure of electricity supply: In the event of an electricity supply failure, it would be impossible to provide an acceptable standard of care until supplies are restored. The first action to take is to call Western Power Distribution on 0800 365 900 to try to establish the reason for the power failure and likely time scale for restoration of supplies. In the event of an interruption likely to last 24 hours or less, we would use (i) the practice backup telephone or (ii) the practice mobile (see above) to contact patients with appointments booked in the next 24 hours in order to rearrange their appointments, as necessary. The printed day sheet allows us to do this without access to practice computer systems. In the event of an interruption that is likely to last over 24 hours, we would contact FCL (see above for contact numbers) and arrange for them to access one of the practice computers or a backup of our data (this could be done at another site where power is available). This would allow us to contact affected patients and rearrange appointments as necessary. Where a patient is in need of urgent treatment before supplies are restored, we would contact the practices with whom we have reciprocal holiday cover arrangements (eg Manor Lodge in Totnes on 01803 863137 or the Devon Primary Link Team on 01392 823682) and ask them to make arrangements to see the patient concerned.
NB: We have researched the possibility of purchasing a generator to provide supplies in the event of an emergency. However, to run the essential equipment for just one surgery to operate requires a supply of 10.7kW (chair/unit 2.0kW; autoclave 2.1kW; ultrasonic bath/misc 0.5kW; suction 2kW startup peak; compressor 1kW; lights 0.5kW minimum; x-ray 1.0kW; computer, DSE & server 1.6kW; does not include heating or air conditioning) and such a generator is so large that we would have nowhere to store it. We will revisit this issue during the next practice refit.
Failure of water supply: In the event of a water supply failure, it would be impossible to provide an acceptable standard of care until supplies are restored. The first action to take is to call South West Water on 0800 169 11 44 to try to establish the reason for the supply failure and likely time scale for restoration of supplies. We would contact patients with appointments booked in order to rearrange these, as necessary. Where a patient is in need of urgent treatment before supplies are restored, we would contact the practices with whom we have reciprocal holiday cover arrangements (eg Manor Lodge in Totnes on 01803 863137 or the Devon Primary Link Team on 01392 823682) and ask them to make arrangements to see the patient concerned.
Strong winds: The most likely consequence of strong winds in our experience is to cause travel disruption as a result of downed trees, road accidents, cancelled trains, etc. This may prevent staff getting to work. If the dentist/hygienist is unable to reach the practice or not enough staff in total are able to get to the premises to provide an acceptable standard of care then we will rearrange the appointments of patients due to be seen in the next 24 hours (or as necessary). Where a patient is in need of urgent treatment before we can resume normal service, we would contact the practices with whom we have reciprocal holiday cover arrangements (eg Manor Lodge in Totnes on 01803 863137 or the Devon Primary Link Team on 01392 823682) and ask them to make arrangements to see the patient concerned.
Flood: Whenever the area beneath the bridge at the bottom of Malt Mill Lane is flooded it is impassable on foot other than in Wellington boots and can become impassable for vehicles other than four-wheel drives. At these times, we monitor the level and contact patients who are due to attend for appointments during the next few hours (the water rarely takes longer than this to subside) and warn them of the need to come to the practice via the top end of the lane. Flood damage to the building itself or flooding of such severity as would prevent staff and patients safely accessing the building at all is extremely unlikely: we have not come close to such a situation in the last 18 years, even during periods of extreme and unusually heavy rainfall and flooding in the local area. If there were flood damage to the building itself caused by a burst pipe, for example, the action to be taken would depend on the severity of the damage. If it were not possible to provide an acceptable standard of care as the result of flood damage, we would contact patients and rearrange their appointments as necessary. It is the responsibility of the Practice Director, Neil Phillips, to arrange repairs. If it is not possible to effect repairs and resume normal service within 14 days, we would contact other practices in the area to see if they had surgery space available to rent. Where a patient is in need of urgent treatment before we can resume normal service, we would contact the practices with whom we have reciprocal holiday cover arrangements (eg Manor Lodge in Totnes on 01803 863137 or the Devon Primary Link Team on 01392 823682) and ask them to make arrangements to see the patient concerned.
Fire: If the building were damaged by fire, the action taken would depend on the severity of the damage. If it were not possible to provide an acceptable standard of care as the result of the damage, we would contact patients and rearrange their appointments as necessary. It is the responsibility of the Practice Director, Neil Phillips, to arrange repairs. If it is not possible to effect repairs and resume normal service within 14 days, we would contact other practices in the area to see if they had surgery space available to rent. If the damage were so severe as to require the complete or partial rebuilding of the practice premises (and the attendant long delay), we have two alternative plans. PLAN 1: We would hire a set of Portakabins and place these in the practice car park (contact Plymouth Portakabin Hire Centre on 01752 663692). We would then fit these out with dental equipment, IT equipment, etc and continue to provide our services from there. We have consulted with our dental engineer and have established that we could have a complete surgery set-up installed within a week. Our IT providers can install a temporary network for us within a matter of days. Telephone lines can be diverted, a temporary power supply can be arranged via Western Power and water & sewerage connections can be made to existing services that run under and next to the car park. PLAN 2: We would hire a portable dental surgery from a company such as Concept Clinics (01709 549611 or 549575; www.conceptclinics.com) and place this in the car park. A temporary power and water supply, together with telephone services and IT, would be established in the same manner as in Plan 1. In case of implementing either plan, we would aim to resume service within 2 weeks. We have consulted the brokers who arrange our business insurance and they have confirmed that they would provide financial assistance in making arrangements to re-open the practice at the first opportunity. We also keep a financial reserve to help fund this. If a patient were in need of urgent treatment before we could resume normal service, we would contact the practices with whom we have reciprocal holiday cover arrangements (eg Manor Lodge in Totnes on 01803 863137 or the Devon Primary Link Team on 01392 823682) and ask them to make arrangements to see the patient concerned.
Pandemic: In the event of a pandemic disease outbreak, we will continue to provide services only if it is safe to do so both for our patients and our staff. We will adopt a “stay-at-home” policy for team members who report relevant symptoms (EG in the case of flu, this would include fever, cough, headache, sore throat, aching joints and muscles) and a “separation” policy to ensure that infected patients are only treated when this is essential and that, when they are, they are kept away from patients believed to be uninfected (EG infected patients can seen after the end of normal opening hours). We will also try to prevent visitors attending the practice where they display symptoms (EG infected people accompanying well patients). Face masks may be worn, disposable gloves used and hand hygiene measures introduced outside the surgeries (in addition to our normal infection control procedures). Tissues will be provided in the reception area and a lined bin placed there for their disposal. Alcohol based hand-rub will also be provided at the front desk and visitors will be encouraged to use this. Additional environmental cleaning procedures will be introduced (in particular relating to the reception desk and toilet areas). In the event of a severe or locally intense outbreak it is likely that we would choose to suspend services until the outbreak subsides. This decision is the responsibility of the Clinical Director, Joanne Giddy. We may, in any event, be ordered to suspend operations under the government’s emergency powers, in the same fashion that schools may be closed and hospitals restricted to emergency services only. We will monitor and follow guidance issued by the government (see www.direct.gov.uk and www.businesslink.gov.uk), the British Dental Association, Department of Health and National Health Service.
Reporting to the CQC
In the event that the practice is unable to continue normal operations, any service interruption must be reported to the Care Quality Commission. It is the responsibility of the Practice Director, Neil Phillips, to notify the CQC.
Web version 9 – 1.9.2017
Previous web versions: 11.2.2011; 3.3.2011; 14.4.2011; 26.1.2012; 15.3.2012; 13.3.2013 (reviewed 19.6.2014); 5.6.2015; 1.8.2016