24 Primary health care CI/Sfb: 423 UDC: 725.512
Ann Noble Ann Noble, after many years with the Medical Architecture Research Unit (MARU), is now an architect and health planner in the all-important field of health facilities
KEY POINTS: We are in a period of major change, with more being provided at primary level and community level rather than in hospitals The NHS is supporting the development of large primary and community care centres where a wide range of services will take place
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Contents 1 Introduction 2 New building types 3 GP premises 4 The brief 5 Functional content 6 Design principles 7 Spaces 8 Bibliography
1 INTRODUCTION 1.01 Health sector overview From the 1990s onwards, there has been a very substantial investment in buildings in the UK health care sector. While these buildings are a result of Central Government policies, the design and management of each project is in the hands of a local client project team, most of whose members have little experience of briefing for, or procuring health buildings and have demanding jobs within the health service. Their task is not helped by frequent policy changed from the Government, introducing new and different initiatives, nor by the continuing uncertainly of how the health service will be delivered in the future. The intention that services will move from being hospital based to community based, that hospitals will reduce in size, that elective procedures will be separated from acute procedures and that a limited number of specialist (tertiary) hospitals will exist, have been voiced for many years. In addition, decisions to increase the number of health buildings for specific groups of patients have created hospices, mental health units, day centres and specialised care centres such as those for cancer patients. With these developments, the traditional classification of health buildings such as hospitals or primary care has become less relevant as differentiating between health buildings has become inconsistent and unclear. The terminology of different types of buildings no longer provides a clear definition of the services that will be delivered from them. Each General Hospital, District Hospital, Health Centre, Medical Centre, Community Centre, Community Care and Treatment Centre, Women and Childrens’ Centre, Walk In Centre, Cancer Centre, Diagnostic Centre, Rehabilitation Centre and Mental Health Unit will offer different services and require different facilities. This situation emphasises the importance and the need for client project teams and design teams to clarify the scope and scale of the services to be provided and the operational policies before developing and finalising the brief for a new building. It is generally acknowledged that, currently, insufficient time, wisdom and experience is allocated to this critical stage for a project. Initial programmes and resources may need to be modified to ensure that this is achieved. It is also
generally acknowledged that many problems are due to inexperienced health client teams, inadequate importance and time given to site selection, site appraisals and feasibility studies. The NHS publishes a wide range of valuable guidance. This includes: Technical Memoranda (HTMs) – 73 in number, which • Health cover most aspects of technical engineering systems. Building Notes (HBNs) – 38 in number, mostly based on • Health the departments of a District General Hospital. Component Series – 16 in number. • Building Electrical Engineering Specifications – 24 in number. • MechanicalModel Engineering Specifications – 23 in number. • Health Facility (HFNs) – There are 41 covering a wide • range of topics.Notes These notes contain interesting and useful information but HFNs have not been through the rigorous reviews and processes as HBNs and do not have the same status. The scope and scale of the Guidance Documents is vast. It is not possible for them to be continually reviewed and updated to take account of changes in practice, policies, external circumstances (such as climate or procurements routes), of relevant new legislation, new developments and improvements in available equipment, materials, finishes and systems. There are discrepancies within the guidance and there are requirements which are generic and cover a wide range of activities resulting in an over-specification for some activities, for example, requiring the same environmental requirements for modest surgery as for very major interventional surgical procedures. Design Guidance was developed to provide guidance for those who found it useful, not to be prescriptive nor to prevent innovation, not to be inflexible in responding to project circumstances and needs. Currently, the guidance is being used by clients to be taken as standard requirements which must be met, often to the detriment of the project. Private sector providers of public sector buildings also use compliance with the guidance as a means of risk reduction for them. Most of the guidance is not freely available to people not employed by the NHS. In common with many sectors, NHS buildings are mostly procured by the Government approved routes: Public Finance Initiative, Procure 21 – a regionally based Public Private framework agreement, and Local Initiative Finance Trusts – a public private partnership between the NHS Primary Care Trusts (PCTs) and Private Sector Providers. Sometimes Local Authorities are also included in the Partnership. The Private Sector is also constructing and owning health buildings from which they are providing services to the NHS. 1.02 Until recently, primary health care has been delivered from one of four building types: centres. • Health General • Clinics. medical practicioners’ (GPs’) premises. • Dental practitioner premises. • located conveniently for the population served. Now the distinctions between acute and primary health care services and between GP and health authority community services 24-1
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are becoming increasingly blurred; as are the distinctions between the different types of primary health care buildings.
1.03 Health centres A health centre was a building provided, equipped, maintained and staffed (with the exception of family doctors and dentists who were licensed tenants) by the local health authority. The purpose of the health centre was to draw together a combination of traditionally separate health services. Many health centres have been successful, some have been unpopular, some have become overcrowded as the activities and numbers of staff have expanded beyond the intended use, some have suffered from poor management and some from a lack of investment in building maintenance. When in 1974, the responsibility for health centres was transferred from local to health authorities, it was anticipated that 80% of GPs would be working from within them by 1980. The concept of primary health care teams gained acceptance but, as a result of changes in national policy, health authorities were subsequently discouraged from building more health centres, and by 1984, only 28% of GPs were practising from them. Family doctors and dentists have been licensed tenants in health centres; but after 1995 the NHS Trust owners were looking to change the lease arrangements.
1.04 General practice premises GP premises have been provided by the practitioners for their own use as a surgery, and they are reimbursed by the NHS for providing these facilities for NHS patients. As an alternative to NHS investment in health centres, GPs were encouraged to raise the capital to develop their own premises, and given financial incentives to do so by means of a ‘cost rent reimbursement’ scheme. The standards set for cost rent schemes represented substantial improvements over many existing premises: they required minimum space standards, facilities for a practice nurse, access for disabled patients and the possibility of offices for attached community nurses and health visitors. However, the range of services they could accommodate was generally fewer than for a health centre but there have been exceptions. For practices who did not wish to invest in buildings, third parties have developed premises for the practices to lease.
1.05 Clinics Clinics offer community health services such as antenatal and baby clinics or chiropody and speech therapy where there is not a local health centre offering these. Many clinic buildings have of poor quality and under-used.
1.06 New directions In some ways, the primary health care needs of a local population have not changed significantly over the years: Finsbury Health Centre was built in 1932 and continues in use in 2007. However, recent trends are affecting the ways in which services are organised and financed and, consequently, the buildings from which they are provided. is an increasing emphasis on a wide range of primary and • There community-based health care and associated social service pro-
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fessionals working as teams and being based in one building, which benefit both staff and patients. Changes in GP practice have led to many GPs offering an increased range of services, such as immunisation, child development, antenatal care, family planning and minor surgery: activities which have been traditionally carried out in health centres and clinics, and for which many GP premises are not suitable. Some GPs work closely with other health care professionals such as acupuncturists and osteopaths, not normally associated with NHS primary health care, as well as with chiropodists, physiotherapists
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and dentists. These trends have been developing for many years, usually with the GP practice providing the accommodation. There is an increasing pressure to move consultant out-patient clinics, diagnostic and therapeutic activities out of acute hospitals into less costly, community settings. As with other health buildings, increasing emphasis is being placed on obtaining maximum and efficient use of all facilities, on the sharing of resources and on reducing running costs. Information technology, theoretically, if not yet operationally, makes information instantly available between primary, community, and acute health care locations, meaning that physical proximity to sources of information (such as test results, X-ray pictures, specialist opinion or medical records) is no longer a determinant of accessibility to the information. More education at all levels of most health care professionals is taking place in primary and community settings. In some cases, educational centres are integrated into health buildings. In common with other buildings in the public sector, and the NHS in particular, there is the stated intention that development should be of high quality, appropriate to their location, provide easy access for the elderly, and people with disabilities, and be attractive and pleasant for users. From 2002 onwards, the public sector has been taking a more proactive role in the procurement of primary and community health care facilities by forming partnerships with the private sector to provide new and upgrade existing premises to meet the local service needs of their population. This reduces the need for investment in property by GPs and facilitates the provision of buildings which can house a wider group of services. Implementation of the local investments finance trust (LIFT) programme for procuring primary and community premises was introduced as a means of creating much needed healthcare buildings across the country. The LIFT programme enables selected PCTs to invite several consortia to submit designs, facilities management proposals and costs for several (sample) buildings which meet the PCT’s briefs. On the basis of this, one consortium is selected to be the Private Sector Partner with the Public Sector to create a LIFT Company which builds the sample schemes and all future buildings commissioned by the PCTs and, where relevant, Local Authorities. The Public Sector takes a head lease(s) and sublets, as appropriate, to GP practices, other service providers or other users of the building. Commercial activities such as chemists usually have a direct lease with the LIFTCo. The health sector rent is paid to the LIFTCo by The Trust for both Trust areas and GP areas. Rent for any Local Authority services located in a building is paid by the Local Authority. The LIFTCo is responsible for designing, fitting out and maintaining the building for an agreed number of years, at the end of which the building passes to the public sector. The tenants pay maintenance costs for the building and the facilities management services provided by the LIFTCo. This comes directly or indirectly from the public sector. The LIFT process enables partnering and team relationships to develop between the public and private sector participants and should enable the company to benefit from the lessons learnt from each project and continually improve every aspect of their performance including the design of the buildings.
2 NEW BUILDING TYPES 2.01 The strategic health authorities produce service development plans for their area. New and refurbished projects have to be compatible with the strategic plans to obtain the support of the local PCT. It is also essential to confirm that there are available financial resources within the PCT to cover rental or improvement grant costs.
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2.02 As a result of new directions, wider ranges of services, activities and staff are being grouped together in different and larger configurations, often in buildings undertaken as joint ventures by different providers, with funding which reflects this. In addition to health centres and GP premises, terms such as primary health care centres, medical centres, resource centres and polyclinics are coming into use. There is no standard definition of services, staff, management, ownership or funding for any of these but the term resource centre implies some specialised facilities which are available for use by various practitioners and the term polyclinic implies a grouping of specialist consultant facilities with some diagnostic and treatment support. 2.03 Any of these building types could include general medical practitioners (GPs), dental, ophthalmic and pharmaceutical practitioners, community nursing services, specialist out-patient services, community services, such as chiropody, physiotherapy and speech therapy, non-acute beds, resource centres, educational facilities, out-of-hours services for GPs, ‘walk-in treatment’ and minor surgery facilities, social services and voluntary bodies.
3 GP PREMISES 3.01 Notwithstanding the new building types, GP premises continue to comprise the largest number of primary health care buildings. GPs themselves may have limited experience and understanding of their current and future needs and may need guidance to achieve high standards of space and design. Without experienced financial advice, they may limit themselves unnecessarily. 3.02 GPs are reimbursed for the use of their premises by the NHS PCTs. This enables them either to raise capital to invest in premises themselves or to pay rent. It is imperative that the PCT is involved in any development proposal, as its support is crucial. Some PCTs offer better advice than others but the following points should be borne in mind: space required for both the delivery of health care and for • The administrative support is frequently under-estimated by GPs. is no limit to the size of premises for which a PCT can • There reimburse GPs a current market rent (actual or as assessed by the
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District Valuer); provided the PCT agrees that the space is both needed and used. The ‘cost-rent scheme’ was introduced in the 1960s as a basis for paying GP practices an enhanced reimbursement to encourage new purpose-built developments. The area on which the enhanced reimbursement was made reflected the pattern of GP practice at that time and so did not include any allowance for additional services. The virtual withdrawal of the ‘cost rent reimbursements’ raised serious problems for the financial affordability of premises developments for GPs.
4 THE BRIEF 4.01 Decisions about which services are to be delivered from a particular building have to be made within the overall strategy for primary care provision for each locality, enabling the various facilities within the area to support and complement each other. For this reason, establishing a precise brief can be complicated, particularly when the building is seen as a means of enabling changes and developments in the delivery of services to take place.
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4.02 The brief should be expressed in the following terms: 1 A list of services to be delivered (the functional content). 2 The scope and scale of the specific activities and the number of staff required for each of the services (e.g. the requirement for physiotherapy could range from a staff team and a fully equipped gymnasium to one physiotherapist using one treatment table for two sessions a week). 3 The number of staff to be based in the building. 4 The number of staff working in the building on a sessional basis. 5 The number of patients per session. 6 Operational policies that affect the organisation and management of the whole building or individual services (e.g. having one shared or several separate reception points, or requiring to close some areas while others remain open).
4.03 This information enables schedules of accommodation to be developed and decisions about sharing or multiuse spaces to be made.
5 FUNCTIONAL CONTENT 5.01 Content will vary considerably including combinations of the following.
5.02 General practices
medical practice (varies between one and 30 GPs), in • General one or more practice partnerships. dental practice. • General pharmaceutical practice. • General ophthalmic practice. • General Others such as osteopath, acupuncturist. • 5.03 Community and school health and dental services
and child welfare • Maternity Ophthalmic services • Child guidance • Speech therapy • Physiotherapy • Community nursing services • Community health visiting services • Chiropody • Health education • Social services •
5.04 Services traditionally hospital-based Hospital out-patient services. Hospital diagnostic services. X-ray services and other imaging. Minor surgical procedures. Drop in centre (drug addiction centre), walk-in centre. Walk-in treatment facilities. Beds – intermediate and day care beds.
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5.05 Education Post-graduate education centres. Teaching facilities for medical students. or any of the allied professions GP Registrar training.
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5.06 Types of spaces The activities generated by the range of services listed above do not all need different types of spaces. Their activities will require one or more of the following types of space: amenity • Entrance/waiting/reception/patient storage/administration • Record rooms/interview rooms • Consulting/examination Treatment rooms (general specialised) • Diagnostic rooms (general and specialised) • Large spaces with associatedandstorage for group activities (baby • clinics, health education, relaxation classes) office bases • Staff rooms/meeting rooms/library • Seminar facilities • Staff facilities (clean and dirty utility rooms, storage, dispo• Support sal, cleaners’ rooms) in-patient wards with support • Non-acute rooms • Plant • Car parking/drop off points 5.07 To facilitate the multiuse of spaces, the provision of adequate and secure equipment storage is needed; and size rooms need to be sized so that their function can be flexible. Where rooms are tailored too tightly to a specific function, it limits their flexibility.
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Relationship and zoning diagram for a health centre
reception desk, where one side of a telephone call can be • The overheard by people waiting, seating close to, or facing reception desks should be avoided and
rooms during consultations and treatments, where per• Clinical sonal topics must be discussed freely and in confidence without fear of being seen or overheard. There should be no waiting outside patient rooms.
6 DESIGN PRINCIPLES 6.01 Location The location of the building in relation to the people, it serves, is crucial. If it serves a wider public than can walk to the building, it should be adequately served by public transport and have appropriate facilities for those using private transport. 6.02 Circulation The entrance to the building and the circulation within it should be designed with due consideration for wheelchair users, parents with small children, people with visual, audio or ambulatory disabilities, and the physically frail who constitute a large proportion of the users of primary care. Everyone should be able to arrive at, move around and leave the building without unnecessary effort, anxiety or embarrassment. The pattern of circulation should be obvious to the visitor and should not rely on complicated signs. Staff also need to work efficiently, moving easily from one place and activity to another. The translation of these broad requirements into details is imperative for example, doors should not be too heavy for frail, elderly to open, door ironmongery and taps should be suitable for people with limited manual dexterity. 6.03 Zoning To facilitate the translation of planning principles into the design, group activities within the building into the following three zones: zone: where callers are received and wait • Public zone: where patients meet clinical staff • Clinical • Staff zone: where staff meet each other and work in private Grouping spaces into these zones controls contact between staff and clients, ensures privacy, minimises unnecessary movement and increases security, 24.1. 6.04 Privacy Privacy and confidentiality are important aspects of the relationship between a patient and staff members. Two places where these aspects suffer from poor design are:
6.05 Security and supervision Movement of the public about the premises should be supervised by reception staff without disrupting their work. Supervision also promotes security within the building. Sub-waiting areas should be avoided unless they will be managed and supervised by staff. Staff need security against personal assault; the equipment and facilities need security against theft and vandalism. The degree and types of security needed depends on the location and on the nature of the services being provided. 6.06 Environment The building should be comfortable, welcoming, with good natural lighting and ventilation; and it should be easy to maintain and keep clean. It should also include sound absorbent finishes. A combination of increased external temperatures, revised building regulation thermal requirements, the inappropriate selection of windows, concerns for security and fire requirements, is too often resulting in unsatisfactory environmental conditions for staff and patients in many new primary care buildings. Design of a total system is essential and diligence may be required to ensure that the elements are not eliminated when there is a pressure to reduce capital costs. 6.07 Infection Control A serious number of hospital associated infections (HAIs) has raised concern leading to more stringent requirements across the whole health sector. There is no history of HAIs in primary care buildings but there is a policy to reduce risks in all health buildings. The most important design factor is to facilitate good, hygienic practice by staff. Buildings should avoid creating any potential reservoirs of infections and promote easy cleaning. Finishes, fabrics and materials which have anti-microbiological properties are now on the market. All NHS Trusts now have Infection Control Officers who have a strong role in accepting or rejecting design elements of a project. Their knowledge of buildings, environmental systems, materials and detailing is generally limited in the primary care sector so there is a tendency for them to focus on standard solutions rather than on performance specifications.
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6.08 Running costs Staff salaries are the largest component of the running costs so the design should facilitate efficient staffing. Energy-efficient, longlife and low-maintenance approaches should be adopted for the building. 6.09 Flexibility and growth Designs should provide for the flexible use of some spaces from day to day; and for the inevitable changes in the demand for services and the pattern of delivery during the life of the building. Provision for extending it should be considered, as should the installation of hard standings and temporary building services connections for special, mobile diagnostic units.
7 SPACES 7.01 Car parking Car parking needs to be provided for staff and patients. The number of places required will depend upon the functional content of the building and on local circumstances. For traditional primary health care buildings, an approximate guide would be four parking spaces per consulting room (1.5 for staff, 2.5 for patients). Provision for disabled parking must be made adjacent to all buildings, and for patient transport by ambulance for some buildings.
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7.02 Main entrance The main entrance should be clearly visible, identifiable and easily accessible, preferably with a covered setting-down point from cars. 7.03 Reception The reception area should be visible from the main entrance. Receptionists need to oversee the waiting area and the main circulation routes 24.2. Allow 1.5 m counter length for each receptionist, and space in front of the counter for patients to stand without encroaching on circulation routes or waiting space. Counter design should be open but should provide some protection for staff. Provision for people with disabilities should be incorporated, for example, a lower section for wheelchair users and incorporating aids to hearing. 7.04 Record storage Record storage needs to be close to the reception area, but ideally not part of it. Records should be out of sight of patients and secure. The use of electronic records and information systems is increasing within GP practices and some of the other services. GP practices need to keep the paper records for reference but in many practices, they no longer need to be near the reception counter and are archived elsewhere in the building. Where there are paper records, the space required needs to be calculated for the selected storage system.
24.2 Primary Care Centre with all patient activities on the ground floor. Note that the receptions have visual control of movements. Also note the confidentiality zone in front of the reception counter
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7.05 Administration and office bases Offices are required for administrative functions. Some staff require offices for full-time use. Others, such as health visitors, district nurses and midwives, need to return to an office base once or twice a day. Consideration should be given to flexible arrangements which meet this requirement. This can be done by providing work stations for use by anyone, with mobile personal storage units, rather than personal desks. 7.06 Waiting areas Waiting areas should be visible from reception but sufficiently separated to provide some privacy and confidentiality for patients at the reception desk. Pram storage and WCs need to be near the reception and waiting area. Part of the waiting area can be designed and furnished for children. Some seating suitable for the elders should be provided. Assessment of the number of seats required is important as this is often provided, either too large or too small. Patients should not wait in corridors nor outside consulting or treatment room doors. Sub-waiting areas should usually be avoided. 7.07 Consulting/examination rooms Consulting rooms are usually provided for each practitioner on a personal basis. Where this results in under-use, they can be scheduled for the use by other staff or for other purposes. Combined consulting/examination rooms are more economical of space than having separate examination rooms but patterns of practice vary and separate rooms may be required. If the desk is a built-in work surface and access is provided to the foot and one side of the couch only, allow 14–15 m2, 24.3. If the desk is free-standing and access is provided to both sides of the couch, allow 17 m2 as a general rule, 24.4. When the rooms are used for teaching medical students, the area increases to 18 m2. 7.08 Treatment rooms The increase in practice nurses, in addition to district and school nurses, has resulted in enhanced requirements for treatment facilities. Some GPs also use treatment rooms for some clinical procedures, for example, fitting contraceptive coils. In addition, GPs now undertake minor surgery. As a result, the conventional provision of a treatment room of 17 m2 for use by one nurse, 24.5, is being replaced by treatment suites comprising several treatment rooms, with separate clean and dirty utility rooms, a specimen WC (sometimes with a hatch to the dirty utility room) and a nurse base, 24.6. A mix of treatment chairs and
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Consulting/examination room used for teaching, 18 m2
couches may be provided. Couches in treatment areas must be accessible from both sides and one end, 24.7. Leg ulcer clinics can now be fitted out with fixed seating, in situ running water and drainage relieving nurses of the need to fill and empty buckets in sluices. 7.09 Minor surgery Treatment spaces used for surgical procedures need to be equipped and finished to standards appropriate for the proposed procedures. There may be requirements for general anaesthetic (not for GPs), additional ventilation and a recovery space. Minor surgery facilities can be provided as separate suites with their own clean and dirty utility areas or as part of a larger treatment suite, sharing support spaces. 7.10 Chiropody treatment rooms Allow 11 m2 for a one-chair room plus changing facilities. Many chiropody patients will be in wheelchairs, 24.8 and 24.9. 7.11 Speech therapy rooms Requirements can range from rooms where individuals can be assessed and treated to larger spaces for groups of adults and children sometimes with viewing facilities. Noise levels need to be low, 40 dBA is recommended and must not exceed 45 dBA. 7.12 Dental suites Most dental room layouts are developed with specialist suppliers of dental equipment and units, and all dimensions should be checked with them. Allow 16.5 m2 for each surgery, 24.10, and 28 m2 for a laboratory if required. If the throughput of patients warrants it, separate waiting, reception and record storage may be required; but dental staff should not be isolated from other staff. Community dentists in particular need provision for wheelchair patients. An arrangement is now available which enables dental treatments to take place without a client leaving their wheelchair.
24.3 Standard consulting/examination room, 14 m2. 15 m2 is better for wheelchairs and provides a more flexible space. The clinical wash hand basin can be inset in work surface if properly detailed. Some infection control advisors prefer it to be located inside the cubicle.
7.13 Multipurpose rooms Large rooms will be required for health education, baby clinics, relaxation classes, physiotherapy and other group activities. Associated storage is essential for chairs, relaxation mats, baby scales, etc. Hand-washing facilities are needed for some of the activities. Tea-making facilities are desirable. Ideally, this room should be accessible when the rest of the building is closed for evening activities. Allow 40 m2 for eight relaxation mats. Sufficient storage for equipment is essential if the room is going to be available for a wide range of activities.
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24.5 Treatment room Key to 24.3, 24.4, 24.5 and 16.11 1 Bracket for sphygmomanometer 2 Ceiling mounted curtain track 3 Coat hooks 4 High level storage 5 Worktop 6 Low level storage 7 Wash hand basin 8 Writing shelf 9 Mirror 10 Paper towel dispenser 11 Chair 12 Disposal bin 13 Instrument/equipment trolley 14 Examination couch 15 Mobile examination lamp 16 Swivel chair 17 Desk 18 Couch steps 19 Waste paper bin 20 Scales 21 Couch cover dispenser 22 Built-in work surface with storage under 23 Shelving 24 Sink and drainer 25 DDA cupboard 26 Refrigerator 27 Stool 28 Warning light 29 Lockable cupboard for scheduled poisons 30 Pedal waste bin 31 Dental equipment cabinet 32 Space for anaesthetic machine 33 Dental chair 34 Dental unit 7.14 Interview rooms These are small rooms for two to four people to speak privately in a relaxed atmosphere. It is ideal if these are located near the reception counter so that they can also be used by receptionists. 7.15 WCs for patients These must include at least one WC for wheelchair users; and facilities for baby changing. Patients may be required to produce urine specimens. A hatch can be provided between a WC and the dirty utility room (or treatment room if there is no separate dirty utility room). Patients should not be required to walk through
24.6
Plan of a treatment suite
24.7
Space requirements for treating a patient on a couch
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public areas with specimens. The number and location of WCs required will depend on the design. 7.16 WCs for staff These should be conveniently near working areas and common rooms. 7.17 Staff amenities Kitchen and beverage facilities are usually provided. A shower is desirable. Lockers are needed for staff with no secure office base. 7.18 Out-patient consulting and diagnostic facilities These should be to the same standards as in hospital out-patient departments (see Chapter 17).
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24.8 Space requirements for chiropody
Chiropody couch Operator’s chair Unit with lamp and drill Instrument trolley Handwash Instrument wash Knee hole under Cupboard under mirror on wall Storage cupboards above and below worktop (including lockable pharmacy cupboard) 10 Chair 11 Curtain 12 Grab rail 1 2 3 4 5 6 7 8 9
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Plan of a chiropody suite with two rooms
7.19 Beds Ward provision should usually be to community hospital standards with appropriate support facilities.
7.21 Storage Requirements for storage must be established and quantified for each of the services.
7.20 Educational facilities Seminar and other teaching spaces should be to normal education standards. A student or students in a clinical area requires the room to be enlarged so that the clinical activity is not compromised.
7.22 Building service requirements Space requirements for heating, ventilation, electricity, telephone, security, computer, intercom and call systems will be determined by the operational policies.
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the waiting/multipurpose, consulting/examination and treatment rooms. Parts of the building may be in use when the rest is closed; for example, GP Saturday and evening surgeries, educational facilities, drop-in treatment facilities, health education or community groups in a multipurpose room.
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Plan of a dental surgery
7.23 Grouping of spaces In grouping rooms within the building, consider the activities that spread across several spaces, for example, a baby clinic may use
8 BIBLIOGRAPHY R. Cammock, Primary Health Care Buildings – Briefing and Design Guides for Architects and their Clients, The Architectural Press, London, 1981 R. Cammock, Health Centres Handbook, MARU 1/73 Evaluating designs for GP premises (Information Sheet 2) MARU 5/89, Medical Architecture Research Unit, School of Architecture & Civil Engineering, Faculty of Environmental Studies, South Bank University, Borough Road, London SE1 HBN 36 (Draft), Health Centres, October, DHSS, HMSO, 1987 HBN, Community Hospitals, HMSO NHS GMS, Statement of Fees and Allowances for Standards of Practice Accommodation and Procedural Requirements for GP cost-rent schemes and improvement grants (only available through GPs or FHSAs) Scottish Out-patient Building Note