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Building a new GP surgery premises

Dr Vipan Bhardwaj's partnership recently created one of the largest single-site GP practices in the UK. He offers advice for other practices considering building new premises.

Wokingham Medical Centre was created by converting an office building
Wokingham Medical Centre was created by converting an office building

Wokingham Medical Centre, in Berkshire, is a 1,600 sq m NHS building, providing new facilities for up to 16 GPs and five nurses, along with a new pharmacy and flexible medical suite. It was created from the redevelopment of a redundant 1990s office block in the town centre.


Dr Vipan Bhardwaj

The decision to create a new premises was not one we took lightly, but the demands of modern medicine and a significant increase in patient numbers left us with no choice.

After a rigorous selection process Barbara Weiss Architects were appointed as project architects and work commenced on the design in early 2011.

We funded the development by securing lending from a high street bank. PCT approval for the development was secured in December 2010 and the medical centre opened for patients in February 2014. The contract sum was just under £2.6m with site purchase costs, consultants’ fees and VAT on top. The overall cost was just over £5m.

Challenges of the building project

The GP partners of the practice were actively involved in the design and development of the project and we faced a number of challenges.

Financial
Well-designed and well-built premises aren’t cheap. A further setback included the then PCT’s application of an arbitrary and punitive notional rent cap. This meant that many banks simply refused to consider our proposal, as the indicative notional rent was too low for their underwriters.

We overcame this by renting space to a pharmacy and having an ISTC outreach clinic. To their credit, our NHS area team also managed to secure a fair notional rent which has helped considerably.

Time constraints
Overseeing a project such as this, in addition to being a full-time GP, has obviously been difficult. As the lead for the development I was given one day per week by the practice as protected time.

Design
Our old surgeries were so far adrift of modern standards that trying to think about future requirements was very difficult. We didn’t just want to provide sufficient capacity for the present but we wanted to be ambitious and enable the practice to flourish long in to the future. We visited many practices to get a feel for good design and facilities.

Communication
Communicating with patients and staff was essential. We had regular meetings with our staff and provided updates for our patients. Prior to the planning application we held two ‘roadshows’ for patients to enable them to see and comment on our proposals.

Learning about property development
I am not a propertydeveloper. This meant I had to juggle many hats, and conduct lots of research to ensure I had a clear and practical vision as to what needed to be done.

Whilst admittedly, this area may have been unfamiliar at first, I would certainly do it again as the outcome has outweighed all of the effort.

As well as the clear benefits to patients, consideration has been given to staff with features such as the common room, which helps to bring all medical centre personnel together. It also provides a more sociable environment leading to increased morale and team spirit amongst those who work there.

Top tips for other practices
  • Be committed: Before you take on the responsibility of working on such a project, consider how important the new development is to you - you will have to work very hard and dedicate a lot of time to the project.
  • Be bold: One can’t design by committee. If you are the lead GP for the development, be brave, follow your instincts and take responsibility for your decisions. Keep the wants and needs of your practice and staff at the forefront of your mind when making decisions.
  • Good architects: It is not necessary to have ‘medical architects’. A good architect is the key. They might not have NHS premises guidance at their fingertips, but they learn fast, as in the case of our architects.
  • Store project-related correspondence: Archive every single email regarding the development. You never know when you might need them.
  • Have a plan B: Make sure you have a healthy budget contingency – you are bound to need it.
  • Be vigilant: Main contractors, but especially sub-contractors, will try to get away with short cuts, for example putting on one coat of paint instead of two. Keep an eye on them. You also need to keep an eye on your professional team to ensure they are carrying out what needs to be done. 
  • Plan ahead: Obtain specialist advice early on regarding capital allowances and how to incorporate energy saving fixtures and fittings into your design. This means you can claim the majority of the money spent from HMRC.
  • Make time: You will need protected time if you are taking on a project of this scale. At least one day per week, but preferably two. To put it in context, a professional project manager costs £500-£600 per day, and even then they need as much input as possible from the client.
  • Be flexible: The development might stimulate other changes and this can be beneficial too.
  • Try to enjoy the process.
  • Dr Vipan Bhardwaj is partner at Wokingham Medical Centre, Berkshire

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