Safety in practice

A survey of GP practices showed they are not practising what they preach
when it comes to health and safety.  By Tammie
Daly and Penny Shuttleworth

Like NHS employees, GPs and their practice staff are exposed to occupational
hazards on a daily basis: ranging from mercury spillage to needlestick
injuries, from hepatitis B to disease organisms carried by sick patients.

But a survey carried out by Nottingham Occupational Health highlights a lack
of awareness and commitment surrounding health and safety issues. Nurse
specialist researchers reported that in terms of risk management, GP practices
"could do better". For example, only 12 per cent of practices which
responded to the survey had done a COSHH assessment and none had addressed the
issue of tuberculosis or rubella immunisations.

Since the formation of Primary Care Groups, GPs need better access to
occupational health services. Nottingham Occupational Health was funded to
research the dangers that GPs and their staff are exposed to at work and look
at how the practices comply with current health and safety legislation and NHS management
executive directives.

The study highlighted the areas of occupational health care from which GPs
and their staff could benefit and the importance of OH nurses making the most
of this need.

Free advice

Nottingham Health Authority and the Local Medical Committee offered all GP
practices in the Nottingham area a free visit by Nottingham Occupational Health
to give assistance and advice on health and safety issues.

The visits were conducted as a broad health and safety assessment which
would be non-threatening and non-invasive to gain the support of GPs and their
staff. Information on specific policies and procedures – for example, alcohol,
stress, and sickness absence was not included. Nurse specialists followed up
each visit with an individual report for each surgery including guidelines on
good practice.

Of the 116 GP practices approached, 51 per cent responded. A postal
questionnaire was sent to the 57 non-responding practices to ascertain why the
offer had been declined and 60 per cent replied. Of these, 11 per cent assumed
that health and safety was not their responsibility because they were based in
health authority-owned premises, 11 per cent stated lack of time as the reason,
35 per cent had overlooked the letter of invitation, 20 per cent said they had
already performed assessments, and the remaining practices gave other reasons.

To examine if there was any difference in the standard of health and safety
between responding and non-responding practices further visits were later made
to 6 of the non-responders. No major differences were found between these
practices and those who responded initially.

Comparisons made

Comparisons were made between large and small practices (greater or equal to
and less than a median of 12 staff), and between city (as defined by Nottingham
Health Authority) and non-city GP practices. Out of the numbers responding, 73
per cent were in the GPs’ own premises and not in a health centre. More than
half were in the City East or City West areas.

Under the Health and Safety at Work Act 1974 (HASAW), the Management of
Health and Safety at Work Regulations 1992, and subsequent regulations, all
employers, including GPs, have legal obligations to ensure, so far as is
reasonably practicable, the health, safety and welfare of their employees1, 2.
Our Healthier Nation (1998) states that people with a job spend a lot of time
at their workplace so a healthy workplace is vital to their health.3.

Under the Control of Substances Hazardous to Health Regulations 1994 (COSHH)
GPs must identify and assess the risks to health of microbiological and
chemical hazards in the workplace4.

Ultimate responsibility for health and safety issues lies with the senior
GP. The GP has responsibility for the health and safety of his employees and anyone
else using the premises.

The findings revealed that the majority of the practices, (68 per cent), had
a health and safety policy but only a third (31 per cent) of those were up to
date. Therefore seven out of 10 did not have a proper policy in place.
Practices with greater than 12 staff were significantly more likely to have a
health and safety policy. They were also significantly more aware of the need
to report under Riddor.

The Nottingham Occupational Health survey shows that of the practices visited
85 per cent had an accident book and although most staff were aware of the need
to report accidents over half were not aware of Riddor reporting (Data 1).

1 The Management of health and safety in primary health care practices

Health and safety policy
no 38%                                    yes

Riddor reporting
no 52%                                    yes

The Control of Substances Hazardous to Health (COSHH) Regulations apply to
work involving substances hazardous to health (including micro-organisms) for
example, chemical agents (as may be used by cleaners and nurses) and disease
organisms, brought in by patients, to which staff might be exposed, for
example, an accident with a blood sample.

The research revealed that only 12 per cent of practices had done a COSHH

2 Recording of hepatitis B status of staff and existence of needlestick
policy in general practice within Nottingham Health Authority

B status recorded
            no 71%                                    yes 29%

policy in place
            no 64%                                    yes 36%

Data 2 demonstrates that significantly more city practices and smaller
practices actively monitored the hepatitis B status of staff who are likely to
be occupationally exposed to hepatitis B. Similarly, city practices were more
likely to have a needlestick policy.

The data indicates that notably fewer large practices, (12 per cent) were
aware of hepatitis B and the management of needlestick injuries and only (42
per cent) of smaller practices were aware of the hepatitis B status of relevant

Infection control is an issue of health and safety and comes within the
remit of the Health and Safety at Work Act.

The findings of the research also revealed that, 36 per cent had unsuitably
positioned sharps boxes 24 per cent were incorrectly assembled and 64 per cent
did not have a needlestick policy. However, nine out of 10 practices disposed
of clinical waste properly.

The project showed that only there was little health and safety training
undertaken to comply with relevant legislation.

3 Health and safety training to comply with legislation

handling training
            no 93%                                    yes 7%

Workstation assessment
no 90%                                    yes

Fire training
no 45%                                    yes


The survey revealed a lack of commitment and awareness surrounding some
health and safety issues and in terms of risk management the GP practices could
do better.

Working Together. Securing a Quality Workforce for the NHS states that:
"Each local employer should have in place occupational health services for
all staff by 21 April 2000".

Links with an NHS Occupational Health Service would assist in forming a
collaborative partnership which would permit GPs, and their staff, access to a
confidential service which could supply advice and support on all health, safety
and welfare issues, including immunisations and COSHH.

It would be beneficial to GPs and their practice managers who are already
overworked and find it difficult to allocate enough time to address these

Occupational health professionals are in a unique position to offer a
comprehensive service for GPs and their staff as well as other primary care

This unique opportunity to raise the OH profile within Primary Care Groups
and Trusts and, more importantly, promote the speciality.

This will have the knock-on effect that GPs will come to understand the
support we can provide for their patients whilst in the work situation.

Partnership is the way forward and we either embrace this opportunity or, if
not, expect the role to be taken over by the practice nurses and again OH will
become the poor relation.

Tammie Daly is occupational health nurse specialist, Nottingham Occupational
Health, University Hospital NHS Trust. Penny Shuttleworth is senior nurse,
Occupational Health Service, King’s Mill Centre for Healthcare, Sutton in
Ashfield. Notts. The work was undertaken when they both worked as nurse
specialists at Nottingham.


1 HSC Health and Safety at Work Act 1974 HMSO, London 1990

2 HSC The Management of Health and Safety Regulations 1992. HMSO, London.

3 Dept of Health Our Healthier Nation HMSO 1998

4 HSC 1997 General COSHH ACOP and Carcinogens ACOP and Biological Agents.
Approved codes of practice. HSE Books, London.

Further reading

Chambers,R, Miller, DTweed,P and Campbell, I (1997) Exploring the Need for
an Occupational Health Service for those Working in Primary Care Occupational
Medicine 1997 47,( 8): 485-490

Sen, D and Osborne, K. General Practices and Health and Safety at Work
(1997). British Journal of General Practice 47 p103-107

Parker G. Attitudes of General Practitioners to Occupational; Health
Services. Journal Society of Occupational Medicine 1995 45: 61-62

Jackson, R and Sutton, G Workplace health in primary care premises. BMJ 1995
311: 140-141

HSC 1957. Employer’s Liability Act. HMSO

Croner’s Health and Safety at Work. (1998). Croner publication

HSE (1995). A Guide to the Reporting of Injuries, Diseases and Dangerous
Occurrences Regulations 1995. HMSO London.

Department of Health. 1996. Immunisation against Infectious Disease. HMSO,

HSC 1992 Safe Disposal of Clinical Waste. HMSO

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