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How to approach surgery redevelopment

Architect Neil Niblett has ten top tips for making any building project run smoothly.

Make sure all contracts are signed before work begins (Image: iStock)
Make sure all contracts are signed before work begins (Image: iStock)

Funding for new premises or improvement grants to improve existing premises are difficult to obtain.

To be successful practices must demonstrate clearly that improving your building will result in improved patient care. Start by contacting your PCO or CCG to arrange a meeting to discuss your premises.

Set out clearly the practice’s issues and problems and how they can be overcome with some form of redevelopment. This should at least get your premises difficulties acknowledged.   

Develop a business case

Developing a business case is the next step in accessing limited funds. Whether you want a new building or a small extension, a robust business case, which is factual and shows that all possible options have been considered, is essential.

A lot of the initial work on this can and should be done by the practice, including a detailed assessment of the existing accommodation including how the practice uses it and its shortcomings.

If you anticipate the list size will increase, show how this relates to housing developments or other developments in the practice’s catchment area. The local planning authority may be able to assist with this. List the range of services currently provided and those that could be added if adequate space was available. 

Get expert help

To have the best chance of securing funding, you need to be prepared to commit some expenditure to obtaining expert advice. There are a number of architects, project managers and surveyors who specialise in primary care premises.

If the practice succeeds in obtaining funding, your business case can later be used as a briefing document to the architect and other design team members you appoint to take the project forward.

Even if your scheme is not dependent on NHS funding the practice business case should still be prepared so that you can work out that the expenditure is indeed justified.

Depending on the size of the scheme the design team will consist of some or all of the design team professionals below.

Design team professionals
  • Architect
  • Quantity surveyor
  • Health and safety: construction design and management (CDM) co-ordinator
  • Electrical and mechanical consultant
  • Structural engineer
  • Planning consultant
  • Landscape architect
  • Energy and Building Research Establishment Environmental Assessment Method (BREEAM) assessment consultant
  • Project manager

What design help will your project need?

A modest extension with a building contract value of around £250,000 should require only an architect, quantity surveyor and CDM co-ordinator as the project management role should be carried out by the architect.

New build projects with a contract build value of over £1.5m almost certainly will require most of the consultants listed mentioned above. However some architectural practices have in-house electrical and mechanical consultants and may be competent enough to handle the planning and landscape works. The architect may also take on the role of project manager.

It is strongly recommended that an architect with expertise in primary care design is engaged as this will save time, avoid mistakes and ensure the project stays within budget.

Ten tips for a successful upgrade

1. Make sure all design team members have adequate professional indemnity insurance and are prepared to provide, if applicable, a suitable ‘collateral warranty’ in favour of funders and tenants. (A collateral warranty is a contract under which an architect or a contractor/sub-contractor promises to a third party that they comply with their professional duties under a building contract).

2. Obtain a fee proposal and schedule of service clearly setting out what ‘is’ and what ‘is not’ included.

3. Ensure each design team member provides a form of contract with terms and conditions and check that it covers all services required.

4. Check fee proposals for additional services such as surveys, interior design, planning appeals, model-making and so on. Also check if the fee quote includes expenses such as design prints and mileage.

5. If a project manager is appointed (or the architect assumes the role) allow them to lead and be responsible for the other design team members.

6. Make sure the architect keeps to the design brief and the project budget is understood. The budget must clearly show land cost with stamp duty and VAT if applicable, the building cost including VAT, professional fees including VAT, and all other associated costs. Rental projections must also state if VAT is included or not.

7. If you are not happy with or do not understand the design, do not allow the architect to proceed. The architect should be able to explain the design philosophy and how the building will function. Also make sure you understand the materials specification and you are provided with options in terms of quality and cost.

8. Allow the design team to arrange building tenders and avoid direct contact with contractors tendering for the works.

9. Do not accept a tender until you fully understand its content.

10. Make sure all contractual documentation is signed and in place before work commences on site.

  • Neil Niblett is managing director of Niblett Architecture, an architectural, surveying and project management practice that specialises in the design of primary health care premises.

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