The news headlines about the recent global IT outage, which affected various walks of life in the UK and the NHS, included words like “chaos”, “bedlam” and “digital apocalypse” – suggesting serious and potentially life-threatening situations.

In reality, the health service coped well and primary care, in particular, rose to the occasion and quickly adapted its workflow to deal with the problems, largely thanks to the business contingency plans that practices have ready and the hard work of their people.

The outage started to become apparent in the early hours of 19th July when CrowdStrike, a cybersecurity firm, released a content configuration update for the Microsoft Windows sensor, but this update resulted in a Windows system crash.

Transport, banking, broadcast services and healthcare were all affected, including those GP practices that use the EMIS system to manage appointments, conduct patient consultations and update and store patient records, as well as using it to send prescriptions to pharmacies.

Although some hospitals, pharmacies and laboratory services experienced disruption, GP practices that use EMIS were most affected in healthcare.

The BMA’s Deputy Chair of GPC England, Dr David Wrigley, put it into context: “Friday was one the toughest single days in recent times for GPs across England.

“Without a clinical IT system, many were forced to return to pen and paper to be able to serve their patients. While GPs and their teams worked hard to look after as many as they could, without access to the information they needed, much of the work has had to be shifted into the coming week.”

GPs and practice staff had been “pulling out all the stops” to deal with the effects of the outage, he added, saying: “We thank them and their staff for their hard work under exceptionally trying circumstances.”

RCGP Chair, Professor Kamila Hawthorne, said: “The outage caused considerable disruption to general practice across the country, but GPs and our teams have been working hard to minimise the impact this has had on the care and services they have been able to deliver for patients.

“We’re very relieved that the IT issue appears to have been resolved, but the incident has left many practices with a backlog of patient appointments and administrative duties that will likely take time to catch up on.”

IT outage impact

The impact was significant, but practices stepped up to deal with the problem as one Practice Manager in London, who wishes to remain anonymous, explains: “It affected the GPs most because they had no patient history and very little information, so it was probably high risk for them, but the biggest complaints were ‘I didn’t know it took so long to handwrite a prescription’.

“What they did was they had a Word document open on one screen, EMIS Business Continuity on the other and they wrote their consultation on the Word document with a page per patient, wrote the prescription by hand and we photocopied it.

“Basically, they safety-netted the patient, made them safe, gave them what they could and then put down on this document that they should come back for a follow-up. Some of the doctors copied the Word document into the EMIS system when it was working properly and admin people helped as well.”

Another Practice Manager from North Somerset, who also wants to remain anonymous, says: “We did have problems, but we used EMIS’s business continuity module which was helpful to see which patients had booked in, with which clinician, and we knew what they were coming in for – so long as the reception team had entered little comments when they’d booked, which they mostly would do.”

Despite the technology problems, the GPs still managed to see and treat patients, as they explain: “The continuity module was a help, but no clinicians could see any consultation history or medication history, so they just had to go with what the patient said.

“However, some of them quite enjoyed the principle of just dealing with the patient in front of them and what they said. Other cases were more complicated, and we couldn’t send a referral per se that day.

“In our case, we’ve had a fair number of power cuts in the past, so we’ve had practice in dealing with technology problems, but we’ve never been without EMIS all day.”

Nicola Davies, Chair of the Institute of General Practice Management, comments: “As a SystmOne practice, thankfully, we were not affected by the IT outage. I am aware, however, that a number of my colleagues were affected quite considerably.

“Business continuity plans (BCPs) would have been enacted immediately with an ‘all hands on deck’ approach, which Practice Managers are known for. 99% of what we do is connected to a computer, but by applying the BCP swiftly, practices dealt with emergencies and urgent requests for medication in a safe and efficient way, minimising disruption to patients despite being hugely disrupted in their practices.”

Patient reaction

Patients were understanding about the problem, observes the Somerset manager whose practice acted quickly to let people know of the IT issues.

“We put a sign outside both main entrances to the practice, letting them know that the computer system was down but that we’d help them as best we could.

“We also posted on social media and shared our posts to a local Facebook group so we could reach more people. There was also a message on our website. It helped that the BBC News and others were reporting on this issue that morning, so most patients knew something was up.”

The London manager adds: “The patients were really good. As soon as we started telling them there was a problem, instead of booking them in, we said ‘give us your name and number and what the problem is, and we’ll call you back to let you know what we’re going to do’.

“The problems were mentioned on the news, so we didn’t even fill our emergency call-backs, so not many patients were calling us. Nobody got annoyed or unhappy or shouted at us.”

Confidence

The outage problems don’t seem to have shaken Practice Managers’ confidence in IT, as the Somerset manager says: “We’ve made some changes and I’ve updated our business continuity plan. If some members of staff weren’t here on a certain day and no one else had log-in details for our Facebook page, for example, that’s a problem, so I’ve updated our continuity plan with all the details of log-ins.

“Computer systems can break and when systems have a monopoly and something goes wrong, it can affect a lot of people. I know IT goes wrong all the time, but we’re good at working as a team.”

The London manager adds: “It showed us that we need a couple more analogue fail-safes. It vindicated our systems and processes, showing that they work and that our decision-making trees work.

“We have to make sure we’re aware of what to do and how to do it when the computers aren’t working. We still have business continuity so we had computers and we could use the internet. Not being able to access one bit of our system wasn’t catastrophic.

“We’re required to have business continuity plans and we have more than one site, so we always have contingencies. General practice survived, as it always does.”

Useful resources:

Business continuity policy (England) [PLUS]
Business continuity policy  (Wales) [PLUS]
Business continuity policy (Scotland) [PLUS]