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Standards for general practices (4th edition)

including Interpretive guide for Aboriginal and Torres Strait Islander health services

Standard 4.1 Practice systems

Our practice demonstrates effective human resource management.

Criterion 4.1.2

Occupational health and safety

Our practice implements strate - gies to ensure the occupational health and safety of our GPs and other members of the practice team.

Indicators

► A. At least two members of the practice team are present during normal opening hours.

► B. Our practice team can describe how our practice supports their safety, health and wellbeing.

Explanation

Key points

  • Safety and wellbeing of practice teams is an occupational health and safety requirement
  • Safety after hours requires special attention
  • Access to support services for practice staff is important
  • Design and set up of general practices have an impact on staff safety
  • This criterion cross references to Criterion 5.3.3 Healthcare associated infections.

OH&S is a legal obligation

The occupational health and safety of the practice team is governed by occupational health and safety (OH&S) state/territory and federal legislation, which may vary from state to state. Practices need to consider how they ensure the practice is a safe working environment for the practice team.

Safety during normal opening hours

Normal practice hours are the hours the practice advertises as being its regular hours of opening for routine consultations during which patients can see a GP.

A GP cannot be both a receptionist and a medical practitioner at the same time. During normal practice hours, practices need to be staffed by at least one additional person who is trained to take telephone calls, make appointments, assess the urgency of requests for appointments and assist with medical emergencies.

Practices are encouraged to consider setting up a duress alarm system as a mechanism for protecting the safety of practice staff.

Safety after hours

The requirement for two members of staff to be present in the practice need not apply to consultations conducted within the practice outside normal opening hours. However, where a GP is providing consultations in the practice without another member of the practice team present, extra attention needs to be applied to safety and security issues.

Staff health and wellbeing

Practices can support the health and wellbeing of GPs and other practice staff in many ways. For example, scheduling regular breaks in consulting time may reduce fatigue and support the health and wellbeing of the GP, as well as enhancing the quality of patient care, since fatigue and related factors (sometimes called ‘human factors’) are associated with increased risks of harm to patients.

It is helpful to have a plan for reallocating patient appointments if a GP is unexpectedly absent from the practice, to minimise the burden on other GPs in the practice.

Practices can make information available to their GPs and other practice staff about relevant support services in their state or territory. Providing support for GPs and other practice staff is important in all areas of Australia, but perhaps even more important in areas of workforce shortage where GPs face additional pressures and workloads.

Violence in general practice

Concerns about violence in general practice continue to be raised by the profession, especially following the deaths of several GPs and assaults and threats to general practice staff. In order to deal with these uncommon but distressing situations, the practice should have a risk management strategy which details the steps to be taken to protect doctors and staff of the practice.

Where a GP no longer considers it appropriate to treat a patient who has behaved in a violent or threatening manner, the GP has the right to discontinue the care of that patient (see Criterion 2.1.1 Respectful and culturally appropriate care). The GP may choose to end the therapeutic relationship during a consultation or, depending on the circumstances, by letter or telephone. Safety should dictate the method chosen. It is advisable for the practice to document a process to be followed by practice staff if the patient makes any subsequent contact with the practice.

The RACGP has published a useful tool to assist practices to deal with these distressing situations. Entitled General practice: a safe place, it is available at www.racgp.org.au/your-practice/business/tools/safetyprivacy/gpsafeplace/.

RACGP GP Support Program

The RACGP provides counselling for GPs facing crises in their professional or personal lives.

Appointments for face-to-face or telephone counselling can be made by calling 1300 366 789 during business hours (prebooking is essential).

For traumatic incidents or crisis counselling call 1800 451 138 (24 hours/7 days).

RACGP self care guidebook

The RACGP acknowledges the pressures of working in general practice and has developed a special self care guide for GPs. Keeping the doctor alive: A self care guidebook for medical practitioners provides strategies to deal with stress and is available at www.racgp.org.au/publications/ordering/tools/.

Doctors’ Health Advisory Service

Contact details for doctors’ health advisory services in each state and territory are available at www.dhas.org.au/content/view/1/21.

Other OH&S resources

Other organisations providing resources include:

Safety and practice design

The RACGP guide Rebirth of a clinic describes building and layout designs for safety and is available at www.racgp.org.au/publications/ordering/tools/.

Services providing care outside normal opening hours

Indicator A is only applicable to services providing care outside normal opening hours that provide clinic based services.

Standard 4.1 Practice systems

Our practice demonstrates effective human resource management.

Criterion 4.1.2

Occupational health and safety

Our practice implements strategies to ensure the occupational health and safety of our GPs and other members of the practice team.

In a nutshell

Occupational or workplace health and safety is a legal obligation to ensure a safe working environment for staff. It requires your health service to follow relevant state/territory and federal laws, which may vary between states. Health and safety extends to staff wellbeing, so your health service is advised to have systems in place that protect both the physical safety and general wellbeing of your staff, both in and outside of normal opening hours. Additionally, your service could encourage health and wellbeing through healthy practices such as taking breaks to reduce fatigue and its associated risks to patient safety.

Key team members

  • CEO/director
  • Health service manager
  • Human resources manager
  • OH&S officer
  • All staff members

Key organisational functions

  • Occupational/workplace health and safety policies and protocols
  • Staff rostering
  • Risk management and control
  • Staff wellbeing and safety

Indicators and what they mean

Table 4.2 explains each of the indicators for this criterion. Refer to Criterion 4.1.2 Occupational health and safety of the Standards for general practices for more information and explanations of some of the concepts referred to in this criterion. 

Table 4.2 Criterion 4.1.2 Occupational health and safety
IndicatorWhat this means and handy hints
▶ A. At least two members of the practice team are present during normal opening hours.  Your health service needs to have at least two members of staff present during normal opening hours so that health professionals can concentrate on their clinical work. This means that when there is a health professional seeing patients, there is at least one other staff member present who has the skills to take telephone calls, make appointments, assess the urgency of appointment requests and assist with medical emergencies.
▶ B. Our practice team can describe how our practice supports their safety, health and wellbeing.     The safety, health and wellbeing of your staff is important, not only in its own right but because this contributes to the level of care and service they are able to provide to patients.

Having processes to support safety, health and wellbeing contributes to a supportive workplace culture and can enhance staff retention. It is also important because of concerns about violence in general practice, where there have been deaths of, and assaults on, clinical staff. Your health service can support staff safety, health and wellbeing in many ways, such as:
  • scheduling regular breaks in consulting time to reduce fatigue
  • having plans or protocols for re-allocating patient appointments when a doctor is unexpectedly absent
  • providing readily available information for doctors and other staff about support services in the area (for example, counselling services or crisis counselling) and providing access to these services
  • providing a risk-management strategy, known to all staff, with details of steps to be taken in situations of violence, or the threat of violence or distress to any staff member
  • having a discontinuance of care policy and process for doctors who wish to end a doctor–patient relationship in any circumstance, and particularly in circumstances of violence or threat of violence
  • having building and layout designs that support safety.

Case study

Below is a description of the ways in which an Aboriginal community controlled health service can ensure that it has effective OH&S processes for its staff. Not all of these good practices are required by the Standards, but they illustrate the many practical and creative things that ACCHSs can do to ensure they deliver services of high safety and quality to their community.

There is a specific OH&S policy and procedure manual that is updated at least every 3 years or if a change in legislation occurs. Each updated version is dated and staff are notified if an update has occurred.

The health service has an OH&S committee that meets regularly. Copies of the minutes are emailed to all staff members as well as a hard copy being placed in a file in the staff tearoom.

The service obtains rebates for health service equipment relating to occupational health and safety through its state jurisdiction where applicable. Through the state WorkSafe website it also obtains guidance material – including codes of practice, guidance notes and alerts on specific hazards, and solutions as well as advice on processes and actions required to meet legal obligations or prevent injuries.

The appointment book ensures that regular breaks for clinicians are scheduled. The service is receptive to proposals for part-time or job sharing where it is possible.

Many processes are in place to support staff and to recognise their contribution. For instance, specific achievements (such as promotions) and routine occurrences (such as birthdays) are regularly celebrated. Staff participate in leisure activities and competitions after hours. A culture of mutual trust and caring is encouraged by leadership example. Staff have ready access to support services as required.

The layout of consulting rooms is designed so that staff members are not trapped behind desks and unable to get to the door in case of emergency.

All consulting rooms have a duress alarm in place.

In the smaller remote clinic the service has included a safe room for staff members, which is a secure, lockable room that contains a toilet, telephone for emergency calls and access to water.

Showing how you meet Criterion 4.1.2

Below are some of the ways in which an Aboriginal community controlled health service might choose to demonstrate how it meets the requirements of this criterion for accreditation against the Standards. Please use the following as examples only, because your service may choose other, better-suited, forms of evidence to show how you meet the criterion.

  • Maintain a policy and procedure manual.
  • Show that you cover occupational health and safety in staff interviews and inductions.
  • Ensure appropriate use of staff rosters.
  • Maintain an OH&S policy and procedure.
  • Cover OH&S in staff interviews.
  • Maintain an appointment book showing scheduled breaks.
  • Ensure the service has suitable building and layout designs.
  • Show that staff have access to support services.

Related RACGP criteria

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Search Interpretive guide Advanced Search

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