BREEAM is a sustainability rating and it relates not just to the structure, but to everything from the building's concept to its location, local transport facilities and its operation.
The NHS grabbed on to BREEAM when it launched, announcing all new buildings had to gain 'excellent' status. The district valuers (DVs) office undertook a policing role and for all new surgery premises to gain approval as good value for money, it required an 'excellent' rating for new build, or 'very good' for refurbishments.
This was initially applied despite BREEAM requirements not applying to buildings where the total cost (with all fees, VAT and so on) did not exceed £2m.
BREEAM on small premises is problematical as the basic cost of accreditation can be expensive - disproportionately with small projects where additional rents or capital contributions will be required.
Now everyone is a lot more cost conscious, PCTs and DVs are more willing to accept that a full BREEAM assessment is unnecessary. My own firm, when acting as project monitoring surveyors, normally expects the building element to meet BREEAM sustainability standards. However, we do not look at transportation and location elements and do not require the full accreditation process.
Try to persuade your PCT to adopt a similar approach.