Designing Your Surgery
As a child In the 1950’s I remember attending a sit and wait Surgery in what really was a large house in my home town of Stafford. There was no appointments system in those days.nPatients waited in the sitting room whilst the doctor eventually called patients in to what was his dining room. The receptionist kept drawers of records in an under stairs cupboard and handed records to patients through a stable door which led to the kitchen. The doctor’s desk was a roll top bureaux, cluttered with record folders, instruments and paperwork. The Practice moved to new purpose built premises in the sixties a few streets away. It was a single storey building with three consulting rooms. At the time I was still at Secondary School and had no idea that my career path would involve helping design new surgeries and that I would work in such surgeries for around 25 years.
Internal garden becomes records store
My first venture into the world of modern surgery design was managing improvement grants and visiting health centres in central London in the early 1970’s. The first health centres were built in London and where supposed to house all four Family Practitioner Services along with Community Nursing. It would however have been unusual to find a GP, dentist, optician, chemists and community nurse base in a health centre. Over the years the design of health centres has proved problematic with an excess of doors, flat roofs and internal garden quadrangles. The excess doors provided access to examination rooms which tended to be locked or walled up with a cupboard. There was also a preponderance of long corridors and sub-waiting rooms.
Development Tip – At one flat roofed Surgery in Leeds a central quadrangle with no useful purpose was covered with a new roof and converted to a records storage room with skylights bringing day light in to a relatively dark area. The records were stored in a roll store thereby maximising the space.
Inspection teams assess the quality of GP surgeries
Later in the 1980’s I was part of an inspection team that visited surgeries in the Black Country, West Midlands. The team included a GP and lay member of the Family Practitioner Committee and took with it the Standards of Accommodation set out the the Red Book, Statement of Fees and allowances. The inspections concentrated on the décor, screened couches and the provision of hot water. Nowadays of course the CQC look for evidence of curtains being washed. The inspections probably helped create a trend to modernise or replace buildings that had been in use since 1948 and before.
Cost Rent Scheme abounds
In the 1980’’s improvement grants were overtaken by the cost rent scheme and I was involved in approving the design of some 30 new building projects in West Yorkshire. The buildings varied in size, and some had an upper floor. The doctors involved all accepted the need to build a future proof surgery with sufficient rooms to develop into. Depending on the amount of space available on the site would determine whether additional floors were needed and whether the common room and administrative rooms would be on the upper floor. One doctor who wanted to construct a three storey building insisted that all the clinical rooms should be accessible by those wheelchair bound. The cost rent scheme originally only encouraged accessibility on the ground floor but these days new premises providing health care will require a lift and/or stairlift to provide ease of movement throughout a building. It has always intrigued me as to why many dental surgeries are found on a first floor without provision for the wheelchair bound.
Private funding takes a hold
Surgery premises design took another leap forward with the advent of private funding, PFI and LIFT projects. My experience of these buildings has been more as a patient and Locum Manager in the last 12 years. Inevitably, these buildings are built on more central sites with more than one floor often sharing facilities with more than one Practice as well as community services. In Leeds for instance, such premises have become extended hours or out of hours hubs.
Development Tip – I found that where a Practice was delegated a first floor suite rather than ground floor rooms, patient registration was effected negatively. Added to that it was necessary to take part in a management committee with other occupiers and argue about service charges and maintenance costs. My view at the time was never the twain shall meet and basically they didn’t.
Voice of experience
In my final few years as a full time manager, I had the opportunity to help design, plan and manage a major surgery extension costing over £1.4 million, which virtually doubled the size of the premises.. I was involved in the conception, design and decision making throughout the whole project. I had picked up many design principles over the years, which helped me work with the architect.. The reception counter was much to my regret open, but nevertheless deep so that violent patients could not reach the staff. Interestingly many surgeries have enclosed their reception counters during the Pandemic only to remove them again. I just wonder why as episodes of violence increase and adequate screening helps prevent the airborne transmission of disease. The reception became a room shielded from the main office which provided for privacy fitted with panic alarms and a live video camera. The main entrance had controlled locking introduced as well as automated opening. A serious incident with a violent patient subsequently confirmed the need to control entry and exit from the building. Extra rooms were provided for visiting clinicians, a physiotherapist and counsellor as well as extra consulting rooms as we could see the patient list rising. One potential problem was with door closers which all needed adjustment to provide for gentle closing.
As big turns into small
It’s strange to me how the Covid Pandemic has driven Practices to take a different approach to how they use their premises. Counter screens were installed in many surgeries only to be taken down as the Pandemic subsides. I think that Practices too have tended to use their more spacious rooms for face to face consultations. The seating arrangements for those waiting has changed as fewer seats are laid out for use. Posters and Notice Boards were cleared and new technology with apps galore have developed new ways of working. On reflection I wonder whether the ever changing state of general practice has reached the stage where large more recently surgery buildings will become white elephants as the new ways of working promote the idea of smaller premises not centrally located. Just a thought!