Open All Hours - Best Value for GP Surgery Buildings

Alex Statham
Recent political focus on improving GP access and responsiveness has highlighted the opportunity for extended surgery opening hours and the role of new technology for consultations.

A pilot scheme in nine areas of England has invited surgeries to bid for funding to extend open hours to 8am - 8pm seven days a week. The Prime Minister said the £50m project would mean doctors "fit in with work and family life". The flexible access plan includes email, Skype and telephone consultations.

The proposals occupy contested ground at present, with funding and staffing issues to be resolved before uptake is likely to become widespread. For practices increasing their opening hours, there are also premises issues to consider. Premises may already be constrained in their suitability, as outlined in 2010 by the British Medical Association (BMA) in their revised guidelines The future of GP practice premises (PDF, 403 KB). Efforts to create welcoming, modern and environmentally sustainable surgery buildings are subject to the challenge of market forces, funding issues, organisational change, physical site constraints, planning restrictions and technology availability.

Longer opening hours will bring a new set of challenges associated with greater strain on buildings.

Longer opening hours will bring a new set of challenges associated with greater strain on buildings. Higher wear and tear costs are to be expected, along with potentially higher operational costs. This is a good opportunity for surgeries to consider their energy efficiency, possibly investing in renewable energy sources – these may have an even more attractive payback period when the additional hours' usage is taken into account.

As an example of how this approach might work, Faithful+Gould is carrying out a two-phase pilot study for an NHS client. The first phase looked at a range of buildings across the client's estate, to examine current energy usage and identify technologies and fabric upgrades to improve overall energy efficiency. The second phase will be to install these technologies and fabric improvements and test them in use, comparing the theoretical data to actual cost savings over a 12 month period. The data and lessons learned will inform a gradual roll-out of a bespoke solution across the client's estate, delivering long-term savings alongside positive social and environmental impacts. This knowledge and experience can be easily transferred to other clients' estates including GP surgeries.

Extending opening hours may also bring planning restrictions and lease restriction challenges.

Where premises are to be extended or renovated, it's important that the accommodation is flexible and adaptable. Health Building Note 11-01 – Facilities for primary and community care services models of care (PDF, 19.7 MB) emphasises this need for flexibility when investing, pointing out that models of care are likely to change every five to ten years, whereas buildings, at least in their basic structure and layout, are expected to last on average for 60 years.

Enhanced hours access arrangements also need consideration. Some facilities may be open to the public when some of the building is closed. These areas will ideally be located together, where possible, to enable the rest of the building to be shut down, easing security arrangements and reducing operating costs. Some remodelling may improve the layout in this respect. Access will need to be well monitored and controlled from a reception point. 

Extending opening hours may also bring planning restrictions and lease restriction challenges. For leased premises, it may be necessary to renegotiate covenants with the landlord and agree an amended lease. However there is also potential for this to complicate dilapidation claims at the end of the term.

We can help GP surgeries find the most creative and cost-effective ways to operate their buildings...

Building performance can be improved in many ways. Before considering extending the use of the premises, it makes sense to assess the building fabric, windows, roof, insulation, heating, lighting and other building services, as well as attending to any maintenance backlog. We can help GP surgeries find the most creative and cost-effective ways to operate their buildings, taking account of current and future patterns of use.

Faithful+Gould has 50 years' health sector experience, spanning all aspects of capital development, estate rationalisation, facilities management, strategic investment planning and environmental support. Our expertise encompasses all procurement models employed in the healthcare environment, including LIFT, Scape, P21+, EMPA and NHS SBS.