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Saturday 1 October 2016
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Premises: Outta space

Premises: Outta space

Providing adequate physical storage that meets a variety of needs is an overlooked challenge for practice managers

If I said the word ‘storage’ to my daughters their first thoughts would be gigabytes, clouds and USBs - but if I mentioned the same word to my mother she would think about shelves, cupboards and the fridge. Of course, they are all right. While practice managers must look after electronic data, the storage of other important pieces of information, equipment and items with a street value requires similar deliberation.

To store…

Storage might first appear be a straightforward, perhaps slightly boring, issue for the practice manager. Surely it is just about putting things on shelves, in cupboards or the computer. Well, yes and no. Not only do we have to find the appropriate physical storage for different items, eg. dressing packs in one area and clinical waste bags in completely another, we have to ensure the security of stored items - not just in terms of preventing theft but in order to protect confidentiality too. Added to this there is often legislation to consider, such as health and safety and data protection. Storage is therefore anything but straightforward, as the following wide ranging list and associated issues for the PM to consider demonstrates.

Patient records 

Despite working mainly with electronic records, most of us still house paper records and with this comes a responsibility to ensure confidentiality is maintained and guarded. Records should be kept in a lockable area that cannot be accessed by anyone outside of the primary health care team. This is still an area that needs to be cleaned. Who supervises the cleaners as they work in the records area? Does this happen during office hours? Do they live locally, perhaps registered, with your practice?  Have they signed a confidentiality clause?

Financial and legal documents

It is crucially important that these documents – accounts, tax computations, partnership agreements, leases/mortgages – are properly stored and protected.  However, these are often bulky and so can be a logistical nightmare for practices to store appropriately. Could you improve on your current storage arrangements, perhaps moving to electronic files? This would resolve the space issues, but the IT challenges around secure filing, limiting access and secure back up would have to be addressed instead. 

Personnel records

Are these kept under lock and key at all times? If held electronically, who else knows the password(s)? Are there backup copies – and if so, are these held somewhere safe too?

Health and safety paperwork 

You will need to be able to evidence various aspects of Health & Safety, e.g. RIDDOR, whether as a recent electronic notification or an old form from the foolscap RIDDOR pads of old.  Make sure this documentation is kept in a locked cabinet/cupboard or secure electronic folder.

Quality and outcomes framework (QOF) evidence

Given all the hours that go into collecting QOF data, it feels as if these folders and backups should be showcased in a glass cabinet! But just in case you are ever asked to evidence your diabetes clinical QOF points for 2006, make certain you have sorted each year and stored everything in a safe but easily retrievable place.

Business continuity/resilience plans

In an emergency you should be able to put your hand on these instantly - in fact more than one copy held by a few key members of staff is recommended. Accessibility is vital here – but given the sensitivity of the information security is also important. The practice team should regularly discuss business continuity plans so that everyone knows who is expected to do what/have available in an emergency.

Practice minutes

When did you last review which members of the team have access to which minutes? Is this level of access appropriate? Are these records in the correct file, folder or drive? Older paper minutes could be archived and stored in a less frequently used area, eg. basement. Over time most minutes become less relevant but you never know when you might need to refer to an earlier practice decision so it is wise to hang on to them.

Prescriptions

Where do you keep scripts waiting to be picked up by patients? Could someone stretch over your reception desk and grab these? Where do these go at the end of the day? What about the prescription paper in the printers - do the GPs and nurse prescribers always lock this away each night? And pads in GP bags – how secure are these?  

Medicines

Before you tell me that all drugs are kept in locked cupboards – with the controlled drugs in a wall-mounted safe – take a look around. Is this really the case? Try spot checking  clinical rooms – are there  medicines lying by the sink, is there a collection out of date medicines waiting to be sent abroad, are there samples lying in a drawer? A quick inspection never does any harm.

Equipment

Where do you house your larger pieces of equipment – echocardiogram (ECG) machine, defibrillator? Have you achieved the balance between ease of reach in an emergency and minimising the potential of items being stolen? Do GPs always lock their consulting rooms when they go out? Even basic pieces of equipment, for example sphygs or auriscopes, can add up to a significant purchase if these have to be replaced. And what about the small pieces of portable office equipment such as dictaphones and practice mobiles - are these stored away at night and at weekends? I appreciate that practices will have insurance cover (you do, don’t you?) but there is still the inconvenience factor following a theft and, naturally, the increased premium the following year.

Petty cash, stamps and stationery

Are you confident that cash and stamps can only be accessed by appropriate staff?  Are your recording systems robust enough? Do you store most of your stationery in a locked space or in the main office? How do you deter people from pilfering? 

Dressings, paper towels and all other bulky items 

There is definitely a trick in ordering enough of these items to make an economical purchase but not so much that you have to walk round them every time you need to go to the toilet. This judgement depends entirely on your available space – and a bit of trial and error.

Clinical waste

Are clinical waste bins and sharps boxes located in the most convenient spots in each clinical area? Do staff regularly change these so that no-one overfills bags or boxes? Where do you keep the clinical waste awaiting uplift? Is this a locked area well out of the way of patients? Do you have a file for the associated paperwork?

General waste 

Where do you keep your rubbish bags before these are collected? Is it shredded and can you guarantee that it still cannot be read? I remember seeing a local firm’s paperwork spread across the main street – it was shredded but the ribbons were so broad they might as well not have bothered. Two lessons here – check the quality of your shredder and whether your general waste bags can be tampered.

…or not to store? 

Most of the above assumes that the practice is a reasonable size with adequate cupboards and shelving, but the reality is often very different. Many practices must continually review what is being held in storage as a necessary process rather than as a part of a good housekeeping routine. This begs the question - what can, and cannot, be cleared out and when this can happen? The guidance below hopefully should help to inform your next cull:

 - Financial information must be kept for at least six years from the end of your accounting year although most practice managers would opt to keep a complete set of financial documentation stretching back to when the practice was first established. 

 - Human resources (HR) paperwork must be regularly reviewed to ensure that information in not held any longer than necessary (Data Protection Act, 1998). The Data Protection Act does not dictate timelines, but good practice suggests that applications for past vacancies should be destroyed after six months and records for previous members of staff after six years.

 - Health and Safety records should be kept for three years from the time the entry was made.

Electronic filing has allowed many practices to reclaim storage space. Others have utilised offsite storage, but this can be costly given the ongoing rental of space and retrieval fees, and add to this the inconvenience of not having instant access to your information. Archiving paper files in the attic might be an alternative, but bear in mind who is likely to be asked to climb into the rafters to find the required file.

Managing storage may not be the most exciting part of a practice manager’s role but it is an area that needs regular attention – as I am sure my mum would agree.