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At the heart of general practice since 1960

Cremation form help is at hand

An eight-GP practice in Somerset has just moved into new premises ­

Dr Stephen Gardiner and managing partner Deb Farnworth-Wood give some insight into the lessons learned

Lesson 1 Be prepared to be flexible

Having agreed the need for larger premises, we had been looking for a suitable site to develop for almost six years. As a large town-centre practice our need to remain close to our current site had limited our choice and extensive searches for land were unsuccessful.

But when a 2,000 sq m factory became available in February last year less than half a mile from our original site, we agreed to make an offer for the premises despite only having approval for 1,187 sq m notional rent. The building consisted of two single-storey units, joined by a two-storey office block. Neither of the factory units had internal walls, giving us a blank canvass to work with.

Lesson 2 Never underestimate the planning process

At that stage we foolishly believed the local planners would welcome our new surgery and that the planning application would be a routine matter.

We expected to get outline permission before incurring the costs of an architect, but the planners would not even engage in discussion about our proposals. This meant a commitment of £10,000 without any guarantee of the project proceeding. We then had to attend the planning meeting to state our case but were given only three minutes to do this ­ the same as someone wanting to build an extension on his house.

Despite a convincing explanation of the benefits of our proposals, there was surprising opposition from some of the local councillors. One even claimed that surgeries providing extended services were against current Government policy and that small practices in local neighbourhoods were the future of primary care provision. Planning rules do not allow you to challenge such comments, but in the end we won on appeal.

Lesson 3 Choose local architects

We chose a firm of architects with a wealth of experience who had already designed similar surgeries. We were happy with their references but they were based more than 200 miles away ­ definitely not local. It proved difficult to see them at times and we felt let down in terms of their speed of service delivery and attention to detail.

In the end, managing partner Deb had to produce room furniture plans on graph paper, as the architects were unable to produce these fast enough!

Lesson 4 Chase your solicitors

For the purchase of our building we used one of the larger local firms, but even they managed to jeopardise the purchase in the closing stages. The vendor was pressing for completion but, despite having four weeks' notice of this, our solicitor failed to notice that the searches were out of date. We did eventually complete on time but not without significant stress.

Lesson 5 Employ a good project manager

From the start we agreed that our managing partner would be personally involved in the development but recognised that she needed help in several areas.

We were recommended Paul King, of PMK Ltd, and right from the start developed a good rapport. He is a quantity surveyor with significant project management experience and he was able to deal with the tendering and contractual processes and valued the work for staged payments.

Most importantly he was available on the phone whenever we needed advice and was able to offer effective solutions for problems we encountered during the build. As he is based in Yorkshire he visited the site only when necessary but Deb went nearly every day to check on progress. She already had good knowledge of construction so most of the time was able to speak to the builders in their own language and understand any problems they encountered. Practices that do not have this level of understanding would be advised to bring in a full-time project manager.

Lesson 6 Use specialist consultant to design the mechanical and electrical installation

Due to pressure of time, we opted for 'Contractors Design' on the mechanical and electrical installation and this was tendered separately to specialist companies. This turned out to be the most troublesome area of the whole project. We believed the placing of pipes and electrical sockets, lighting and ventilation would be straightforward, but we are still sorting out problems six weeks after moving in. We have brought in a new contractor for the second phase of our build and would seriously recommend employing a mechanical and electrical consultant to devise and manage specification for any new building.

Lesson 7 Personal involvement is essential ­ stand your ground

After the tender process we appointed Medlock Construction as the main contractors. We quickly built up a good working relationship with them and they were client focused throughout, but there were occasions when we had to stand our ground for what we wanted.

Lesson 8 Involve practice staff

We believed our staff were in the best position to decide the layout of their new rooms. Practice and attached staff were asked to agree room plans and where we could amend layouts for them we did.

We included updates on the progress of the building in our weekly staff newsletter and plans were on display in the staff room throughout. We encouraged staff to visit the site and took small groups around for tours both at the onset and towards the end of the work when finishing touches were being added. They were tremendous when the time came to move. Often with their spouses, they worked extra hours over a long weekend to physically relocate the entire contents of our old building and have continued to be patient while things settle down.

Lesson 9 Involve patients

When our initial planning application was declined we lobbied for patient support and were able to influence some local councillors through their constituents.

One patient who is a keen photographer has even produced a photo diary of the build. We asked for donations of plants for our garden and have been delighted to receive more that enough for our whole planting scheme! The patients even helped to plant them. We continue to ask for advice about how we grow into our new premises.

Lesson 10 Never trust utility companies

Telephones were a huge problem. Apart from them failing to properly transfer many of our dedicated lines, BT managed to lose the order to transfer our ISDN line and at one stage close to our moving date suggested we simply delay moving for 'about eight weeks'. Although they had received very clear instructions about which lines to close and which to transfer, Deb spent hours on the phone trying to remedy their mistakes. Our alarm line wasn't installed until three weeks after our arrival, necessitating the employment of a security guard. Then, a week after it arrived, BT cut it off saying they had received an instruction to move it to new premises.We encountered a similar problem with our electricity supply. Late in the day, our electricity company decided that our supply was inadequate and delayed our build by several weeks while they ordered and installed a new substation.

Lesson 11 Expect the unexpected

This must be the most important lesson of all. We had already asked other practices that had moved what problems they had experienced and made lists of things to check. We hoped we were well-prepared, and even coped when our builders told us they didn't think they would be ready three days before our moving date.

What took us all by surprise was how quickly routine tasks were abandoned. We discovered five days after moving that no one had backed up our clinical computer system. Even the acceptance of deliveries had become a problem with our normal security procedures abandoned.

We found packages that had been delivered in the strangest of places. It was apparent that being in unfamiliar surroundings changed the way people worked and in the end many of our routine procedures needed reinforcement.

Overview

Our move has provided us with 21st century premises. We have incorporated a pharmacy, a large new dental practice and a multitude of allied services from counselling and physiotherapy to chiropody and massage.

Having overcome a number of obstacles, we are delighted with our new premises and the services we can provide for our patients. Importantly, we run our new building with a significant operating profit and would encourage others to be proactive and inventive when considering premises development.

Stephen Gardiner

is a GP and

Deb Farnworth-Wood

is managing partner

at East Quay Medical

Centre, Somerset

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