This document outlines what is required of GPs in order to meet safety requirements for legionella testing and control in practices. The control of legionella is covered in legislation and both the Care Quality Commission (CQC) and Health and Safety Executive (HSE) have produced guidance on these requirements.
Outcome 10 of the essential standards of quality and safety describes what registered providers should be doing to ensure the safety and suitability of premises. Providers must ensure that people who use services and others accessing premises are protected against the risks associated with unsafe or unsuitable premises.
To be able to demonstrate compliance with these standards we would want assurance from practices that they have carried out risk assessments to identify all risks associated with the premises and that the practice is managing these risks. This includes meeting the requirements of the Health and Safety at Work Act (HSaW) 1974 and the Control of Substances Hazardous to Health (COSHH) Act 2002.
This may require a risk assessment to be carried out in relation to legionella. CQC does not make any requirements about who carries out the risk assessment. The risk assessment and the outcome of the risk assessment will always depend on the circumstances of each provider. Risk assessments should always be proportionate and in most cases the risk assessment will identify that there is no risk. If this is the case no further action is required. The Health and Safety Executive (HSE) has produced guidance on this which may be useful.
Health and Safety at Work (HSaW) Act 1974
Paragraph 16 of the Act states the following:
For the purpose of providing practical guidance with respect to the requirements of any provision of sections 2 to 7 or of health and safety regulations or of any of the existing statutory provisions, the Commission may, subject to the following sub-section and except as regards matters relating exclusively to agricultural operations–
(a) approve and issue such codes of practice (whether prepared by it or not) as in its opinion are suitable for that purpose;
(b) approve such codes of practice issued or proposed to be issued otherwise than by the Commission as in its opinion are suitable for that purpose.
It should also be noted that paragraph 17 of the HSaW Act 1974 refers to the possibility of codes of practice being used in criminal proceedings:
A failure on the part of any person to observe any provision of an approved code of practice shall not of itself render him liable to any civil or criminal proceedings; but where in any criminal proceedings a party is alleged to have committed an offence by reason of a contravention of any requirement or prohibition imposed by or under any such provision as is mentioned in section 16(1) being a provision for which there was an approved code of practice at the time of the alleged contravention, the following subsection shall have effect with respect to that code in relation to those proceedings.
Codes of practice, although only guidance, relate to the general duties of the employer, which are listed in paragraph 2 of the HSaW Act 1974. The key part of paragraph 2 is section (e):
the provision and maintenance of a working environment for his employees that is, so far as is reasonably practicable, safe, without risks to health, and adequate as regards facilities and arrangements for their welfare at work.
It would seems, therefore, that failure to ensure legionella control could mean criminal proceedings being brought against a practice if an outbreak of the disease was to occur and the practice had failed to follow the HSE's code of practice.
Health and Safety Executive (HSE)
The HSE was established by the HSaW Act 1974 and was the Executive of The Health and Safety Commission (HSC). The Chairman of the HSC was appointed by the Secretary of State for Health. The HSE and the HSC were merged in 2008 and is now simply known as the Health and Safety Executive.
The HSE's approved code of practice, Legionnaires’ disease: the control of legionella bacteria in water systems Approved Code of Practice and guidance, says the following (page 15):
40 Persons who carry out the assessment and who draw up and implement precautionary measures should have such ability, experience, instruction, information, training and resources to enable them to carry out their tasks competently and safely. In particular, they should know:
(a) potential sources and the risks they present;
(b) measures to be adopted, including precautions to be taken for the protection of people concerned, and their significance; and
(c) measures to be taken to ensure that controls remain effective, and their significance.
If someone is nominated within the practice to take responsibility for legionella control assessments they could consider undertaking certified training, although the above code of practice does provide detailed advice on how to carry out assessments.
Premises Costs Directions 2013
Schedule 1, Part 1, paragraph 5(a) of the Premises Costs Directions 2013 (page 25) states the following:
5. The contractor must comply with any applicable statutory requirements relating to -
(a) the carrying out of a risk assessment and preparation of a management plan with regards to any risk of Legionella
The Management of Health and Safety at Work Regulations (the Management Regulations) 1999
Since GPs are also in control of premises, their liability extends to patients as well as employees. Paragraph 3 of The Management Regulations 1999 states the following:
(1) Every employer shall make a suitable and sufficient assessment of—
(a) the risks to the health and safety of his employees to which they are exposed whilst they are at work; and
(b) the risks to the health and safety of persons not in his employment arising out of or in connection with the conduct by him of his undertaking
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995
RIDDOR also makes it a statutory obligation for employers to report cases of (certain types of) disease. There is guidance on RIDDOR on the HSE website.
Health and Safety at Work Act (HSaW) 1974
Control of Substances Hazardous to Health (COSHH) Act 2002
Health and Safety Executive
Legionnaires’ disease: the control of legionella bacteria in water systems Approved Code of Practice and guidance
Premises Costs Directions 2013
The Management Regulations 1999
Guidance on RIDDOR