It’s a common problem – lack of space and funds to develop new primary care premises. So what options are there for practices to improve their current premises and maximise floor space?
There are no golden rules to follow. Each practice will have completely different needs, criteria and existing premises. However there are some common areas for consideration:
- Can the existing surgery layout be changed to maximise space efficiency?
- Can some room uses be re-located to another floor of the building?
- Can some rooms be sub-divided?
- Is there scope to extend?
Assessing your existing space
In the first instance the practice should assess what space it currently has and how that space is used. You then need to assess what space you think they need and what you could change. Is the need for more clinical rooms or more administration space? Or is it to improve accessibility throughout the building?
It might be useful to have a measured survey of the existing premises carried out (if no plans exist), to assist with this.
Firstly, all the space and rooms need to be analysed to ensure maximum efficiency. For example if a room is only used for, say, four hours a day two or three days a week, then that room is not being utilised to its full potential.
Secondly consider what areas or uses could possibly be re-located. One obvious example is the storage of medical records. As more practices become paper-light or even paper-less, patient records may not need to be conveniently located.
Relocating the records away from the rear of reception can free up a lot of space. However a word of caution – medical records are very heavy and have a major impact on floor loading so it is important to consult a structural engineer if you consider relocating them to an upper floor.
Another option is to locate the medical records off site – although costly it can sometimes prove cheaper than building an extension. Some practices have had all the old records scanned and no longer rely on the records themselves.
Sub-dividing rooms and extensions
In some surgeries (usually converted Victorian houses) there are large rooms that might be suitable for sub-division. Always engage the assistance of an architect or building surveyor to advise on the consequences of such work and do not underestimate the cost. Such works will no doubt involve new ceilings, flooring, decoration, light fittings and the movement of electrical sockets and radiators.
It is worth noting that many practices believe they must carry out alterations to comply with Disability and the Equality Act 2010. However it is only necessary to do what is reasonable so again seeking professional advice at an early stage is essential.
A further option might be to use some of the car park area to build an extension. Some local planning authorities (but not all) have relaxed the parking standards to encourage the use of alternative methods of transportation and would not object to the loss of some spaces to build a possible extension.
Providing clinical space on another floor
If your assessment results in a decision to provide clinical space on another floor then the issue of patients moving between floors needs to be addressed.
Firstly are the stairs adequate and safe? Is it possible and necessary to install a lift? How will patients be called and supervised? Is a secondary waiting area required and how will this be supervised?
Although it might be preferable to provide a lift to upper or lower floors it might not actually be necessary to comply with the Disability and the Equality Act or building regulations. It is about the term ‘reasonableness’ and what facilities exist on floors that are accessible to disabled patients – not forgetting staff and visitors. Once again it is recommended professional advice is obtained.
If a practice is fortunate to be given some financial help from the primary care organisation or CCG then this might be subject to improving the building to meet the recommended standards.
The Care Quality Commission (CQC) now expects practices in England to reach certain standards within their premises. In the main this relates to patient care and infection control and not necessarily space standards.
The obvious areas that require attention are floor finishes, sanitary ware and work surfaces. All of these need to be of a specification that allows easy cleaning with appropriate materials.
If you do embark on a programme of work to improve your premises it is better to have a structured and focused plan than carrying out works in a piecemeal fashion. The use of experienced professional help from architects and building surveyors cannot be overstated.
- Neil Niblett is managing director of Niblett Architecrure, an architectural, surveying and project management practice that specialises in the design of primary health care premises. www.niblettarchitecture.co.uk