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Life after a surgery revamp

Was it all worth so much hassle? Dr Kevin Brown recalls times of stress and looks at the benefits.

In case you missed episode one of our medical centre upgrade (GP, 6 April 2007, p56), we knocked down our flat-roofed, one-storey, reception area in between the building's two wings and replaced it with a new structure. In the fullness of time - and I mean after several long and messy months - one storey became two and was topped by a pitched roof.

The administration offices moved upstairs and, downstairs, we have a bigger pharmacy together with consulting rooms for students and foundation year one and two doctors.

The migrating ducks that used to over-winter on the flat roof's 'lake' have moved to new quarters. But now that we have seen the back of the builders I find myself wondering if it was worth all the hassle.

Construction headaches

One obvious uncertainty with construction work in the UK is the weather. I shudder each time I recall this year's wet midsummer.

The rain came in around the edges of the building work. It brought down ceilings in peripheral corridors where we were still working and we lost the use of part of the treatment room, thus adding to our stress.

Delays ensued. A further slowing down resulted from the workmen hiding for hours at a time from our senior nurse and practice manager who were keen to complain (again) about the water damage.

The builders had a large board on which they marked their weekly tasks and progress. Timetable adjustments were required, but there was a slow but gradual evolution towards something resembling the architect's drawing.

Meanwhile, patients were overjoyed to start most consultations with a discussion on progress. Most of mine were kind enough to attribute their doctor's grumpiness to working on a building site.

The new pharmacy opened months before the other bits. Its airy, light design with a consulting room for the pharmacists to use for prescribing reviews cheered the rest of us while we waited for our own new facilities.

Eventually the painters and carpet fitters applied the final touches and we were once again able to use the whole building.

The reception staff were pleased with their office. At last, everyone has a desk they can call their own and the new phone system means better communication.

Longer corridors are making us all fitter and the longer computer cabling does not seem to slow the system down.

Naturally some items were mislaid during the building work. After exchanges along the lines of 'Well, have you seen it?' and 'We never took it down!', and then a lengthy search, the eye room mirror was found in a cupboard.

Moving equipment back in seemed an easier task than moving it out and we disposed of a lot of redundant stuff such as ancient medical tomes.

But, you cannot please all of the people all of the time. A week after moving in, the team met to discuss any problems.

The attached staff are totally happy with their improved accommodation, but some of the receptionists feel the front desk is too high and ergonomically challenging.

The pictures chosen by the younger partners for the waiting area are disliked by the more conservative elements. The callboard with its light-and-bell system to summon patients was too high. Shorter patients apparently need a leg up to hang their number cards on the right hook.

Teething troubles

A wall-mounted heater close to where the patients pass by has been prevented from becoming a possible source of trauma by placing a rubber plant below it. The plant has doubled in size and become menacingly 'triffid'-like'. But looking on the bright side, we are now greener.

The project went over-time and over-budget. The initial £300,000 estimate went up quickly as we decided to spend £10,000 on phones and the same again on increased roof lighting and a similar amount on upgrading the air conditioning.

The old inward-opening automatic front doors could not be adapted to the redesigned entrance. To open them outwards, we needed to hang the old ones upside down or replace them. Throw in VAT and the final figure was a substantial overspend. Our high-street bank funded the project. It won the business after we shopped around - it was the best deal.

Some administrative jobs took longer to accomplish during the six months we lived with the builders. Luckily the staff were happy to do some overtime at weekends summarising notes and scanning letters.

The highlights for me were the big crane and chatting to the builders about summer building site jobs in my pre-clinical days.

The stress for staff and partners overseeing the work was high. The practice manager is still resolving contract difficulties, but the traumas are mostly now a rapidly fading memory. The medical centre seems fit for purpose and we are adapting to a more ordered work and lifestyle.

I just need to work on a new justification for being grumpy.

You can find Dr Brown's earlier article on http://www.healthcarerepublic.com. Search for the term 'building site'

Our major premises upgrade

What went well
- New pitched roof not suitable for ducks.
- Building now fit for purpose.
- Reception staff each have a desk.
- Students and FY1 and FY2 doctors have consulting rooms.
- We disposed of a lot of junk.
- Big crane arriving and chats to the builders were enjoyable.
- Longer corridors are improving GPs' and staff's fitness.
What proved difficult
- Water, water everywhere during rainy summer.
- Other mess, noise, inconvenience, etc.
- The project ran significantly over budget.
- The project seemed to take ages and ran late.
- Stress for the practice team.
- Contractual problems still being resolved.
- Staff's and patients' moans about minor design snags.

Top tips

- Give the partner and other team members leading the project protected time to oversee it.

- Plan for regular site meetings with architect and building contractor.

- The local bank that deals with the practice's business could be the best place to look for a loan.

- Make a note of plasterers', electricians' and other tradespeople's names for other projects - like your house.

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