CG10 – Practice environment

The practice environment needs to enable members of the practice team to perform their duties safely and effectively otherwise patient care can be compromised and patient safety may be put at risk.

‘Practice environment’ in this context refers to practices that operate either with or without fixed physical premises.

The practice needs to protect the dignity of each patient by optimising both visual and auditory privacy. If a consultation or examination space itself is not able to guarantee complete audible privacy, reasonable steps need to be taken to maintain privacy during patient consultations.

The practice could consider having:

• the possibility of a spare consulting room or quiet area to provide privacy for patients in distress
• quiet, separate areas where private conversations with or regarding patients can be held
• computer screens that are hidden from the view of patients and other visitors
• a layout, the use of music and other features that protect patient privacy (for example, details such as their phone number, address and medical information) during discussions.

Visual privacy helps ensure that others cannot see the patient during the consultation, and that the patient can undress in private and be covered as much as possible during an examination.

This is achieved by:

• having gowns or sheets to cover patients in each consultation space
• providing curtains around the examination couches.

Auditory privacy helps to ensure that other people cannot overhear a consultation. Where the practice has dedicated consultation rooms, the rooms need to have solid doors. Privacy could also be achieved by:

• using sound-proofing tape around door frames and a draught-excluder at the base of doors, without compromising adequate heating, ventilation and air conditioning
• playing appropriate background music to mask conversations between members of the practice team and patients.

If a physical practice environment has areas where auditory privacy is not possible (for example, a nurses’ treatment bay), there needs to be a private room available for confidential conversations.

The practice needs to maintain patient privacy during consultations regardless of where those consultations occur.

If the practice has physical premises, its layout will ideally provide reception staff with clear sight of the waiting areas, so that they can see and monitor waiting patients.

A practice operating in a physical building can maintain privacy by using dedicated consultation rooms. However, if an outreach service consulting in the community does not have a dedicated space, it may need to employ privacy strategies that suit the setting.

The practice could also consider the cultural requirements of patients in areas such as the waiting room.

The practice could consider ways to keep its premises at a comfortable temperature.

Good ventilation contributes to the reduction of the risk of airborne transmission of microbial infections in enclosed spaces. The practice could:

• conduct a risk assessment to identify the best type of ventilation for the practice, based on factors such as practice layout, patient demographics and cost
• use natural airflow (for example, open windows, provided patient privacy is not compromised)
• engage a ventilation engineer or occupational hygienist to embed good ventilation into the building design
• employ air cleaning by filtration (for example, by using a properly installed HEPA filter)
• use other air-cleaning and disinfection technologies⁽²⁷⁾.

Telephone and video consultations also require physical, audio and visual privacy. Refer to the RACGP’s Guide to providing telephone and video consultations in general practice for guidance on how to maintain privacy and confidentiality when providing telephone and video consultations.

Ideally, a practice has separate toilets for the practice team and for patients. If this is not possible, it may be possible to ensure access to toilets that are very close by (which may be possible, if, for example, the practice is in a shopping centre).

Washbasins need to be in or close to the toilet cubicle to reduce the possible spread of infection.

As per the Infection prevention and control guidelines:

• the use of alcohol-based handrub is now recommended for routine hand hygiene for dry, visibly clean hands
• soap and water are required to be made available after using the toilet, before handling or eating food/drink, and when norovirus or Clostridioides difficile is present or suspected.

Practices need to have a cleaning policy that identifies:

• responsibilities related to the cleaning of the practice
• work health and safety issues
• procedures for routine scheduled cleaning, unscheduled cleaning, and monitoring of the effectiveness of the cleaning.

Refer to section 9 of the Infection prevention and control guidelines for details on what else is required in a practice cleaning policy.

If the practice does not have a physical premises where consultations occur:

• the practice needs to demonstrate how auditory and visual privacy is protected during consultations (for example, via mobile privacy screens, in-home consultation protocols, telehealth privacy workflows)
• a physical waiting area, reception area and patient toilets are not required, however, the practice needs to ensure that:
  • members of the practice team have access to hand hygiene facilities
  • clinical pathways requiring access to toilets (such as urine collection) are appropriately enabled. This could be achieved by referral to pathology or use of onsite facilities.