The take-over of NHS commissioning by local GPs and the need to comply with strict regulatory demands is prompting a wave of refurbishment projects at primary care facilities across England.
Architects, interior designers and construction firms are reporting an increase in the number of refit projects being planned at a time when the market for large hospital schemes is drying up across the UK.
Peter Leach, director of Eos Interiors, told BBH in an interview this week: “There is an awful lot of old primary care stock out there and nearly every practice we go to that is not a new-build facility has had no significant investment for 25 years.”
But, as control of NHS budgets shifts to primary care professionals from April this year, and community services are increased in an effort to keep people out of hospitals, the onus is on doctors’ practices to ensure they comply with strict regulatory policies, particularly around issues such as infection control.
Leach explains: “Practices at the moment are clearly focused on the Care Quality Commission inspections and that is a big driver for improvements to the primary care estate. The up-coming dispansion of primary care trusts and the formation of GP clinical commissioning groups means doctors are now much more aware of their responsibilities and they feel under increasing pressure to make sure their practices comply. The long and short of it is that often they do not comply.”
Not only is this investment in the primary care estate driven by regulatory pressures, it can also prove profit-making for GPs.
Leach said: “GPs see improving their buildings as an opportunity to increase revenue. The more fee-earning procedures doctors can carry out, the better for the practice, but in order to do that it needs to go from a building with an old couch and old-fashion décor to a more modern and more relevant environment.”
The up-coming dispansion of primary care trusts and the formation of GP clinical commissioning groups means doctors are now much more aware of their responsibilities and they feel under increasing pressure to make sure their practices comply. The long and short of it is that often they do not comply
Key problems Eos consultants find when asked to work with practices are inadequate furniture and wall coverings and old-fashioned fixtures and fittings that no longer comply with infection prevention standards.
“We see all sorts of things, but in the main it is about refurbishment, redecoration and new furniture,” he said.
“The first thing you often notice when you walk into these facilities is the welcome. You enter straight into a carpeted, badly-decorated building with very old dim lighting. The treatment and consulting rooms are often carpeted or have carpet tiles and are packed with shelves full of reference books with curtains at the windows; in other words loads of nooks and crannies where dust can gather. This is all hard to keep clean and inevitably that means it is not clean.”
The decision to call in specialists often comes following the publication of reports by local infection prevention teams.
After being refurbished, Northbrook Health Centre is now a much more welcoming place for patients and meets strict regulatory demands covering issues such as infection prevention
Leach explains: “They will carry out an audit that covers cleanliness, through from cleaning regimes and procedures for taking and dealing with samples, to cleaning equipment and handwashing procedures. These reports give practices a score and make a set of recommendations to achieve compliance. These invariably cover things like handwashing facilities as many practices still work with traditional sinks with plugs and that is a no-no. They also cover things like chair, floor and wall coverings, for example recommending the removal of anaglypta wall coverings and replacement with washable surfaces. They may also be told they do not meet the standards because the room sizes are too small or they do not have individual sluice rooms or patient toilets.
“While these reports are advisory and not mandatory, it is in the interests of the practice to comply.”
And grants are often available to help meet the costs of improvements to facilities, he added.
We predict that because of the changes to the healthcare system, the primary care estate will keep us busy for the next couple of years. There is so much stock out there and so much is old and in need of modernisation and refurbishment
“We have worked closely with a number of practices, including several in Solihull where we have a framework agreement with the primary care trust,” he said. “We predict that because of the changes to the healthcare system, the primary care estate will keep us busy for the next couple of years. There is so much stock out there and so much is old and in need of modernisation and refurbishment.”
When choosing who will do the work, Leach recommends choosing a company with experience of working within the healthcare marketplace.
“You need to ensure your contractor has experience of what’s required in terms of making sure the end result is of high quality, compliant with infection prevention, and works well for staff and patients,” he adds.
“They also need to ensure a fast-track schedule of works is developed and adhered to that enables the surgery to offer an uninterrupted and safe service to patients.”
Richard Whitehouse, head of estates at NHS Solihull, has worked with Eos on several improvements to surgeries in the area and said having one key partner in overall control was crucial. He told BBH: “From my experience it is far better to employ one experienced company rather than trying to liaise with a lot of different consultants and tradesmen. They will manage the whole process, ensuring the work gets done to schedule and the risk is with them.”
Also important for practices is to get a works plan that is fully costed, with no hidden extras. And Leach urges practice managers to think outside the box in order to come up with innovative ideas such as space-saving solutions.
“Space is always at a premium, so we advise the use of lockable, floor-to-ceiling cupboards that, not only provide increased storage, but are excellent for hygiene as there is no area on top for dust to gather.”
Eos provides a free health check for GP premises and appoints a project manager to run each scheme.
Leach concludes: “Refurbishment increases the hygiene level of a surgery and brings cleaning benefits and cost savings. Replacing out-dated heating and lighting, for example, could save money. In a recent project, we replaced traditional gas-fired heating with the latest low-energy heating and cooling, which resulted in an estimated energy saving of 25%. Making a surgery more up-to-date and welcoming, better designed and with more compliant treatment rooms could also attract more patients and help to increase revenue.”