By Robert Campbell

Famously, Matilda shouted fire so often that her final call of ‘Fire’ was ignored and the house burnt down.  In the days when the poem was written no one was aware of the need for a Risk Assessment.

To me, I would associate a risk assessment with the inspection of a building looking for ‘hazards’ that might cause a fire or prevent quick and easy egress from the building. The Health and Safety Executive, www.hse.gov.uk ,  offers guidance and advice on ‘risk assessments’ and help can be obtained from your local Fire Prevention Officer carrying out your assessment. Your Security firm might also inspect your building and offer advice on your security arrangements, such as the burglar alarm, CCTV, and central locking systems. Your Infection Control service will draw attention to potential problems with the standard of cleaning and the safety of clinical areas. And so it goes on. The advent of Care Quality Commission inspections has made practices look more widely than just ‘buildings’ and has emphasised the need for ‘safe’ practices. So we now look at the desirability of employing individual members of staff and safeguarding patients who are vulnerable.

What is a Risk Assessment anyway?

So what steps might you take and record to ensure that you have undertaken appropriate and necessary ‘risk assessments’.

Identify the Risk

In every part of the surgery, with every person working in the surgery and with every patient and visitor attending the surgery there will be some ‘risk’ involved. For instance, the following incidents occurred in surgeries I worked in:

• A patient slipped and broke her arm in the car park on an icy day.
• A patient disrupted the waiting room by throwing a chair.
• A patient attacked a receptionist at an open reception counter.
• A nurse incurred a needle-stick injury
• A fire exit was locked and the key was nowhere to be found
• A patient pushed and held a doctor against a wall in his consulting room
• A young person entered the surgery, walked around the building freely and stole credit cards from a coat hanging on a chair in a GPs consulting room.
• A central heating boiler had not been producing hot water for months on end.
• A GP was found not to be registered with the GMC and another had not paid his annual retention fee.
• A nurse was found to have a criminal record, after thefts occurred.

These are just a few examples, but I am sure that you either will know your practice well, or will get to know it quickly by looking around and talking to colleagues. Here are some questions to ask:

• Have your fire extinguishers been checked recently?
• Are drugs and vaccines kept in a locked cupboard unexpired?
• Is there a thermometer in each room and in the vaccine fridge?
• Is there a panic alarm? Do you know how to reset it?
• Is there a fire alarm? How do you reset it?
• Is there a burglar alarm? Do you know how to set and reset it?
• When was the last high level and deep clean of the treatment and consulting rooms carried out?
• Is there a recent Infection Control report?
• Where is the accident book kept?
• When was the last hazard inspection carried out and do you have a copy?
• Where is the first aid box, is it well-stocked and who is a trained first aider?
• Is the CCTV system switched on and can recordings be played back?
• Are toilets and showers inspected regularly?
• Has a legionella test been carried out?
• When was the last PAT test carried out?
• Have staff and clinicians had CPR and Safeguarding training in the last 2 years?
• Do you know the Hepatitis status of clinical staff?
• Have DBS reports been obtained for staff working with ‘vulnerable’ patients
• Can you demonstrate good recruitment practices?

Writing a Risk Assessment ‘report’

Armed with your own observations and concerns along with answers to the above questions you may need to prepare a risk assessment report. The Risk Assessment might relate to a specific subject, and simply describe what ‘risk’ has been recognised or established and offer a view or measurement on the seriousness or possible incidence of such a risk. It may simply be black and white.  There is either an ‘obvious’ risk or no ‘obvious’ risk. The problem with ‘risk assessment’ is that whilst some risks might be plainly obvious others might require a ‘specialist’ to find the problem and offer an assessment of the risk. The other problem with risk assessments is that it might be argued by the unpersuaded that it is your view not theirs.

One example of a ‘risk’ that springs to mind is the presence or suspected presence of ‘asbestos’. It can be found in any building built before the year 2000 and causes over 5,000 deaths each year. The HSE web site provides an extensive source of information which can help with an assessment. I am no expert but if you suspected that say the roof of your building was made of asbestos your employer has a legal obligation to manage the risk.

Reporting the Risk

Once the existence of a risk has been established, whatever it is, it is important to make members of the practice aware of the potential risk. This might take the form of warning notices, or setting out the ‘assessment’ in a report. The report might set out action to remove or reduce the risk and to provide any necessary training on how to deal with or avoid the risk. If the ‘risk’ is an ongoing one, there should be a review date set.

And finally the CQC inspection itself is one hell of a ‘risk assessment’ and a study of the reports of practices that required improvement or were placed in specials measures will highlight what you need to concentrate on.

In summary

• Identify the hazards and recognise the ‘risk’
• Investigate the nature of hazards and risks
• Review existing reports, hazard inspections, infection control reports, accident books, hazard warning or safety notices etc. Review legislative requirements
• Identify who might be at risk – clinicians, staff, patients, general public
• Evaluate the level of risk – you cannot be expected to anticipate unforeseeable risks
• Record your findings
• Recommend or stipulate what action needs to be take.
• Set a Review Date and specify lead persons responsible

In conclusion, let me examine one area of concern that has caused consternation and confusion for Practices – the question of the case for criminal records checks. Whilst one view is that all practice staff should have a CRB/DBS check carried out, there is another view that only those staff that have direct contact with vulnerable patients should be the subject of checks. However, a practice might take the view that it wishes to ensure that all staff have a clean record and in fact have no criminal records in order to employ them in a trustworthy position, for instance when dealing with practice funds.  It may be necessary therefore to justify why a particular line is taken sufficiently so to convince CQC Inspectors that a practice is ‘safe’.

HSE – A brief guide to controlling risks in the workplace