Businesses have a statutory duty to provide a safe working environment for employees, visitors and service users. Employees must take reasonable care that their own behaviour does not cause harm and must co-operate with their employers.

The Health and Safety Executive (HSE), which has responsibility for enforcing the Health and Safety at Work Act, has considerable powers. Health and safety (H&S) inspectors can:

• Visit premises.
• Check and assess documentation.
• Interview anyone.
• Observe working conditions and practices.
• Investigate incidents.
• Identify lessons to be learned.
• Detect breaches of H&S legislation.
• Serve notices that force practices to:
•     -    Halt an activity immediately (prohibition notice).
•     -    Put in place remedial action by a specified date (improvement notice).
• Prosecute and issue penalties, which may include imprisonment.

It is not unheard of for GP practices to be served improvement and prohibition notices.

In addition to the Health and Safety at Work Act 1974, the Health and Safety (Offences) Act 2008 came into effect from 16 January 2009. This act was the consequence of promises made by both the then government and the HSE to increase the sentencing powers that courts have in relation to
H&S crimes.

The act does the following:

• Raises the maximum fine that may be imposed in lower (Magistrate’s) courts to £20,000 for most H&S offences.
• Makes imprisonment an option for more H&S offences in both the lower and higher (Crown) courts.
• Makes certain offences, which are currently triable
• only in the lower courts, triable in either the lower or higher courts.(1)

What should practice managers do?

H&S policy
Businesses with five or more employees must have a written H&S policy and written risk assessments must be carried out. The HSE website has a useful policy template, which is easily downloadable (see Resources).

Your next responsibility is to identify what could cause harm (“hazards”).

Risk assessment
After you have established your H&S policy, your next step is to identify hazards and assess risk. Proper H&S management cannot be effective without working through this step.

The sample policy on the HSE website is accompanied by a basic office-based business risk assessment form. However, it is the business’s responsibility to identify any kind of risk in the workplace and a medical practice poses additional hazards risks to staff and patients or visitors.

Staff should be informed of their responsibilities and given training in how to identify hazards and how these should be reported, recorded and actioned. The same applies to reporting accidents.

Identifying risk areas
Practice managers are usually responsible for H&S management in the practice, sometimes jointly with a practice nurse. You should ensure you have the right knowledge and tools at your disposal to undertake this responsibility, but it is not usually necessary to buy specialists in. You need to identify what the risks are, who might be harmed and how, and this should be recorded:

• Talk to people to identify risks.
• Walk round the practice and observe physical surroundings and conditions and working practices.
• Examine substances and equipment to assess the risk they pose.
• Check out whether you have had any recent accidents.
• Record what you see as you go.

People at increased risk
Particular attention should be given to considering all the groups or individuals who may be especially at risk of harm. This could include:

• New staff.
• Young staff.
• Older staff.
• Pregnant staff.
• Staff with disabilities.
• Patients, especially the very young, very old and patients with disabilities.

You should undertake specific risk assessments for these groups because of the increased possibility they have of coming to harm.

Activities involving risk
Office working
Although our offices and premises are familiar to us, they do pose risks. The HSE website has a useful office risk-assessment online tool (see Resources). Registering is easy, it is free of charge, and will send you reminders to review your risk assessment. This assessment covers areas such as general storage and trip hazards, visual display unit (VDU) workstations, eyesight, lifting and handling heavy objects, sharp objects and electrical equipment.

Fire and explosion
The Dangerous Substances and Explosive Atmospheres Regulations are relevant in circumstances where there is dust, gas, mist or vapour mixed with air. If you have an oxygen cylinder in the practice, you must carry out a risk assessment of its use (see Resources).

Your risk assessment should include the identification of other fire risks. This will include:

• Risk of electrical fire.
• Combustible materials.
• Heater guards.
• Fire equipment, including fire doors, extinguishers and alarms.
• Fire exits.
• Fire plan.

Infection control
This is a broad-ranging risk area, and practice managers will find that their nursing team is an excellent source of information and support when assessing infection risk. Areas assessed may include:

• Furniture, flooring and work surfaces.
• Couches and curtains.
• Handling samples.
• Trolleys.
• Toilets, handwashing and drying and bins.
• Cleaning equipment.
• Sterilisation.
• Body-fluid spillage.
• Waste disposal – clinical and non-clinical (sealing, storage, collection).
• Toys and furniture in the waiting area.

Sharps
Again, the practice nurse team will be a useful resource when assessing risk from:

• Needlestick injury.
• Disposal of sharps.
• Accidental injection of substances.

Hazardous substances
Hazardous substances are managed under the Control of Substances Hazardous to Health (COSHH) Regulations 2002. The HSE website includes information about Safety Data Sheets and details on COSHH assessment (see Resources). A COSHH assessment will involve:

• Gathering data about hazardous substances in
• the practice.
• Using Safety Data Sheets to identify the properties of these substances, health risks associated with them and hazards arising from using them – for example, getting onto the skin.

Electrical equipment
Risks from using electrical equipment include electric shocks, burns and explosion (if flammable material
is present).

VDU usage
Working practices have changed considerably in the last 20 years and all staff and doctors spend considerable time at their VDU every day. A risk assessment sheets for VDU workstations is available (see Resources).

Putting in control measures
Having identified each risk, it should be quantified. You must do everything ‘reasonably practical’ to prevent people from harm.

Ask the following questions for each risk:

• Can we eliminate this hazard completely?
• If you cannot get rid of the hazard, what can you put in place to reduce the risk of harm as much as possible?
• What resources are available to inform us about what good practice would be in the circumstances?
• Is there a less risky option?
• Can we limit access to the hazard?
• Can we warn people about it? If so, how?
• Do we need personal protective equipment (PPE) to be available and what training might be needed in its use?

Record the control measures that need to be taken. The next step is to identify what action needs to be taken to introduce the control measures. Agree whose responsibility it will be and within what timescale the action needs to be taken. This will depend on the magnitude of the risk, the number of people who could be harmed by it and how serious that harm could be.

The practice needs to show that:

• A proper check was made.
• You identified the people who might be affected.
• You dealt with all obvious significant hazards.
• The precautions you took were reasonable.
• The remaining risk is low.
• You involved and consulted with staff in the process.

Continuing for the future
Finally, you need to review the risk assessment, the control measures and their effectiveness on a regular basis. Remember that you must also undertake risk assessments when working practices change, if something goes wrong, or if a member of staff becomes pregnant.

Staff should be trained in the control measures you put in place and responsibilities for taking action should be clear to everyone. It will be the practice manager’s responsibility to monitor the effectiveness of the control measures regularly.
H&S is a huge topic and a single article does not do justice to the range of issues to consider. However, the HSE’s own website does contain a wealth of information and guidance. Sample risk assessment forms are also commercially available from other sources and there is no need to formulate these documents from scratch. What is important is that this is an ongoing process in the practice.

Fiona Dalziel is an independent practice management consultant. An experienced primary care trainer and facilitator, she is the national RCGP Quality Practice Award Adviser and has advised on both the original and the review of the Quality and Outcomes Framework of the 2004 GP contract.

References
1. Health and Safety (Offences) Act 2008. Available from: http://www.opsi.gov.uk/acts/acts2008/ukpga_20080020_en_1

Resources

HSE – Write a H&S policy for your business
www.hse.gov.uk/simple-health-safety/write.htm

HSE – Beginning your assessment
records.hse.gov.uk/connect.ti/officeriskassess

HSE – Fire and explosion
www.hse.gov.uk/pubns/indg370.pdf

HSE – COSHH frequently asked questions
www.hse.gov.uk/coshh/further/faq.htm#coshh-assessment

HSE – VDU workstation checklist
www.hse.gov.uk/campaigns/euroweek2007/pdfs/vduchecklist.pdf