ESTATE DEVELOPMENT & STRATEGY
A site plan showing the extent of South London Health Partnership’s Cloister Road Surgery in London W3.
The proposed floorplan for the repurposing of a former motorbike showroom into a GP practice in South East London.
1: Modelling Capacity We model the capacity requirements of each PCN based on: a) The space required to meet each practice’s basic primary care demand. This is modelled on an individual practice level. The modelling is tailored to each PCN and locality – what is the projected growth in the area? Are there specific health needs in the local population that would affect the number of visits to the GP etc? b) The space required to accommodate the appointed ARRS. Once we have undertaken the modelling at the individual practice level we can see what space, if any, is available across the PCN to accommodate the ARRS. At the beginning of these studies, the ARRS staff were relatively new, and the accommodation needed to support them had not been tested. Not all the ARRS need a clinical room. Some tasks can be carried out at a workstation, and some in the community. We worked with the ICB, PCNs, and practices, to build a model of what spatial requirements would be needed. c) The space required to accommodate the drive from government to move services from the hospital setting to more accessible community bases (a later addition to the strategy reports). Again, this is layered at PCN level. By ‘consulting
spaces’, we are looking at any space where a clinician can engage with a patient – whether through face-to-face consultations or a virtual setting – and we accept that the estate is not perfect – compliant 16 m2
clinical spaces
across the portfolio are not the ‘norm’. As architects, we are well-versed in developing a
Schedule of Accommodation from the baseline data, which allows us to build a picture of the size of the estate that would be required to meet the needs of the patient population – projected forward to 2040.
2: Clinical Strategy Clearly, the Estates Strategy should be supporting the Clinical Strategy. The discussions with the Clinical directors representing each PCN help form a picture of the challenges experienced by each PCN, the needs of its population, and the aspirations for service delivery. It is the intention that the recommendations in the output would then support the delivery of these aspirations. These discussions are fascinating. We have worked with
nearly 75 PCNs so far, and no two are alike. Each is on its individual journey, with varying degrees of collaboration and different ambitions as to how it would change its service delivery if the estate (and funding) could support it. Of these 75, only two have had a documented Clinical Strategy; this is fine by us – our role is to see how we can manipulate each PCN’s estate to support it.
120 Health Estate Journal October 2024
4: Forward planning With the results of the above assessments, we are then ready to assess how we can make the estate fit for purpose. There is an emotive descriptor in circulation to categorise individual premises, which is intended to assist the right investment decision, use buildings more effectively,
and dispose of estate which is no longer suitable: n Core – those premises that are flexible, fit for purpose, and integral to delivery for the medium to long term.
n Flex – estate that, with sufficient investment, has the potential to become a core site, or with the potential for expansion or better levels of utilisation.
n Tail – sites that are simply not fit for purpose, and should be disposed of in the short to medium term.
This is a sensitive area, as many smaller premises are GP- owned, operating out of a converted residential property, and the ‘tail’ descriptor brings uncertainties. It can be challenging discussing this with individual practices. At a borough level, the outputs are costed, prioritised, and programmed into short-, medium-, and long-term projects to give the ICB an overall picture of the investment required to create that ‘fit for purpose’ estate which will be
3: Site visits The site visits and surveys are an essential part of the process, but can also be the most difficult to navigate. Many GPs are weary of data gathering. Recent years have seen many surveys undertaken – six-facet surveys, GIA checking for rent reviews, and the national Primary Care Data Collection programme which fed into a database of primary care information – all of which takes time away from seeing patients. To be fair, the latter did capture the number of clinical spaces on site. However, premises change with time – for example records are moved off site or digitised, garages are converted, and staff move to work from home, so it is important that we have a current picture of the baseline. Furthermore, we are architects looking for options to address capacity issues – seeing each property helps us to visualise a solution. We capture a huge amount of information on site – condition, accessibility, sustainability, and photographic record, for example, and we sketch floorplans – which perhaps sets us apart from health planning teams. All this allows us to paint a detailed picture of the estate. As architects we are fully conversant with the challenges
of working with listed buildings, in conservation areas, and building liens (a lien is a right to retain possession of another person’s property pending payment of a debt), which makes the options that we present viable.
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