Introduction

Workplace health environmental audit report was prepared by the Health Development Agency of UK to serve as a guide to tools appropriate for primary healthcare facilities in UK. The report outlines the findings of a mapping exercise undertaken by the Health at Work in Primary Care (HAWPC) team over a four-month period in 2001. The exercise was conducted in response to indications from previous projects, and feedback from contacts, with a need for accurate, up-to-date information about environmental audit tools appropriate for general practice, aimed at primary care estates managers and practice managers.

The aims of mapping exercise was to:

a) To identify existing environmental audit tools that might be appropriate for self-administration at small primary care/general practice level.

b) To identify key organizations providing tools, training and consultancy in environmental audits.

c) To identify any major gaps in audit tools that could be usefully provided by primary care trusts, possibly in partnership with other agencies.

The project is also intended to link and support other guidance recently undertaken by the HAWPC team. Some positive impacts of audit in helping to achieve a good working environment are that they can:

• provide information

• form a basis for conducting interventions and upgrading the work environment and facilities

• help to improve standards and environments of care

• highlight discrepancies between perceived standards of practice and measured standards

• be intrinsically rewarding by demonstrating improvements

• aid in bidding for resources

• promote higher standards of care, effectiveness and efficiency

• stimulate education.

Legal Responsibility

There are regulatory and statutory requirements which employers must legally comply with. There are also good practice standards or levels of provision that individual practices may wish to voluntarily adopt that exceed these requirements.

Audit Responsibility

The audit approach is appropriate to ensure compliance with many of the legal requirements and attainment of good practice. Employers must decide whether there is sufficient expertise internally within the practice to undertake the audit, or if external assistance is required, using criteria determined internally or externally by authorities such as Health and Safety officers. Each approach is likely to have advantages and disadvantages.

Audit Structure

The search revealed that many existing examples of audit incorporate a cycle (not dissimilar to the HDA’s Framework for Action Cycle), with a sequence of six steps that usually include variations on the following:

• observing the practice

• setting up support structures, objectives and standards

• gathering information

• comparing performance with the standard

• implementing appropriate change

• monitoring the effects of the change.

Tools for Audit

a) Health and Safety

A fundamental objective for health and safety auditing in general practice is to prevent or control foreseeable workplace hazards through a systematic identification and evaluation process. If there are no legal standard requirements, national or locally agreed standards can be adopted, or they can be internally set as agreed good practice. There have been moves towards adoption of international health and safety standards.

b) Access

Access audits of buildings are a useful starting point for assessing the accessibility and usability of buildings by disabled people. Buildings that are designed or adapted, while bearing in mind the access needs of people with different disabilities, are likely to be more flexible, and more likely to meet the requirements of the Disability Discrimination Act, 1995.

c) Sustainable Development

NHS Estates, in line with central government and the DTI (previously DETR), has five sustainable development target areas:

• energy conservation

• waste reduction

• healthy transport

• water conservation

• procurement/contracts.

Recommendations

a) Health and Safety

Risk assessment

There is much information and guidance available about risk assessment, but a checklist based specifically on health and safety in general practice would be useful for workplace health purposes.

Ergonomics

Several organizations produce information, tools and consultancy to advise on ergonomic workstations. There are also useful websites and interactive tools, but primary care managers probably do not know about them, or how to access them. A guide to resources aimed specifically for primary care employees would be useful, and could cover clinical, administrative and management activities.

Manual handling

The literature has not shown any guidance or audit materials for manual handling in general practice. The HSE has produced general guidance on the Manual Handling Operations Regulations 1992, which can provide guidance on the issue.

Personal safety

Personal safety is partly a managerial and organizational issue, but there are environmental issues for GPs’ surgeries regarding reception layouts, alarms and entrance security systems, car parks, etc. that could be usefully addressed in an audit document.

b) Sustainable Development

Feedback from primary care site visits and case studies undertaken by the HAWPC team during 2000/01 indicates that GP practices would welcome support from primary care trusts in taking a strategic lead on sustainable practices to fit in with Local Agenda 21 strategies. For example, assessing the environmental impact of health facilities through their energy use, transport, waste, purchasing policies and services, both to measure current performance and to determine what (if any) action is deemed necessary. There is a need to integrate environmental sustainability into the fabric of primary care trusts and individual practices.

• Health buildings should not be contributing to the problems of people’s health through pollution, unnecessary or hazardous waste, or risk of accident.

• There are financial savings from reducing waste that could be better spent on health improvements. There is a need to argue the business case for environmental management, and establish targets for improvement.

• Primary care health facilities can be influential in demonstrating to the wider public how to operate at a sustainable level in both small businesses and domestic environments.

• Primary care buildings can encourage sustainability through green features, such as a vegetable plot, a healthy eating cafe,or a bicycle store.