Practice makes perfect

With the evolution of doctors’ surgeries into multi-purpose medical centres has come a new design brief, which has led to big improvements, finds Nicky Churchill

Anyone who has been to their doctor lately may well have visited one of a spate of new medical centres that are appearing up and down the country. Thanks to the NHS Primary Care Bill, your family doctor is no longer just a provider of pills, potions and prescriptions, and in many areas the GP (or the consultants) no longer have to refer you to a hospital for further treatment – it can now be provided in-house.

The past few years have seen health authorities (read Government) actively encouraging GPs to improve and expand their services, in order to relieve the pressure on hospitals. Money has been pumped into primary health care and doctors have been given generous incentives to come together to form group practices. New consulting rooms have been created within those practices to house visiting external consultants and treatment areas provided to deal with minor ailments. This change in space requirements has resulted in a spate of both new-build and refurbishment projects.

In terms of design, the medical centre is a specialist area, with the architect required to create not just a suitable building, but, more importantly, the right environment for the patient. The first example of this blend of design and medicine goes back 60 years to the now classic (and listed) Finsbury Health Centre built in 1938 by Berthold Lubetkin and Tecton. It moved away from the institutional feel of past buildings, instead providing a welcoming community environment with logical circulation and colourful, clean finishes. Avanti Architects is refurbishing the building, which has become something of a “milestone” for future projects, with a design that could, and has been, adapted to the changes in medical requirements over the years.

More recently, health buildings have evolved because of the need to provide the community with additional (and better) services and, as such, now provide a broad range of facilities from health education and speech therapy through to dental and chiropody clinics. New and larger doctors’ surgeries or group practices now include treatment areas, X-ray rooms and even minor surgery facilities. And if they are linked to a hospital, they may have to accommodate teaching space in the form of seminar rooms. As a result, the interior planning of such buildings has become all important.

Architect and health care advisor Ann Noble believes that these buildings should be designed with health in mind and sees the architect’s main role as “creating a building that works for the patient”. This involves designing a welcoming yet soothing interior scheme in recognition of the fact that most people entering the building will have some form of ailment. Natural light and plants go a long way towards providing a calm and peaceful atmosphere, as does the use of colour and clean finishes.

Generally there are three main areas: the public area (waiting room, reception); the clinical zone where patients and staff interact (consulting rooms and treatment areas); and the staff facilities (offices). Circulation between these areas is function-related and access needs to be well lit and clearly signed – many patients will have poor eyesight and/or language problems.

The public space will include both the waiting area and the reception desk and this is where the “comfort” factor is perhaps most important. In many of the newer health care buildings, the entrance area is a double-height space with daylight flooding in through large rooflights. The finishes are usually bright and cheerful, to get away from the clinical feel. Security and safety also need to be considered – the need to protect staff from both distressed patients and intruders – and privacy is important: patients don’t want to be overlooked or overheard, particularly at the reception desk.

The waiting room seating is also crucial and usually supplied in one of three ways: it can be purpose-made and fitted by the contractor as part of the overall package; specified through the hospital suppliers; or provided by the doctors – in which case, it is often brought from the previous premises. Whatever the route, it should be chosen carefully and be robust enough to cope with young children clambering over it, while at the same time being suitable for older people and those with mobility problems.

Peerless & Noble Architects

The Fairfield Centre, Charlton, London (left)

This new centre combines facilities for a local GP practice and a range of community health services. As such, it houses a range of facilities from treatment rooms to teaching spaces. The client specified that the building should emphasise the unity of this partnership, while being flexible enough to allow for future changes in the organisational structure.

Emphasis is on levels of lighting within the building, with a double-height atrium providing the central focus. Here, a built-in, curved reception desk links both sides of the centre providing staff with clear views of the waiting area, and allowing patients to view the gallery levels above. Pitched rooflights allow daylight into the single-storey surgery wing with the consulting rooms located around the core.

The finishes throughout are simple yet durable (stainless steel handrails, beech veneer doors and laminate worktops) with great attention to detail – from the specially devised bolts on child barriers to the development of a built-in desk system for the office and consulting room desks. The project was also fortunate enough to receive a budget for fittings which has avoided the problem of re-using existing or inappropriate furniture.

Penoyre & Prasad

Rushton Street Surgeries, Hackney, London

Although presently unoccupied, the building has been designed to accommodate four GP practices, three on the ground floor and one on the first floor, each of which has its own separate entrance. The brief required that the design should allow for the building to be opened up in the future, and as a result the interior planning is uniform throughout.

Each practice has its own curved reception desk which backs on to the record storage area with built-in seating provided in the waiting areas. Brightly coloured surfaces lead to the consulting rooms and offices.

The use of daylight throughout adds to the general welcoming atmosphere with the central lightwell/rooflight allowing light right into the heart of the building and large runs of windows providing views out across Shoreditch Park. The treatment rooms at the rear of the building have not been forgotten, either benefiting from both a bold colour scheme and natural light entering through the side windows in the projecting bays.

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