Primary Care Reference Design

1. Heather Chapple A+D Scotland
Primary Care Reference Design

2. Reference Design
Multi-agency project through SFT & Hub
1 real project
2 design teams
3 half day sessions
30+ stakeholders
£2.5m savings
Lessons on design, on process
and on affordability

3. Design Lessons
 Wayfinding for those less familiar with
the facility
 Bookable rooms and central spaces to
be used flexibly over an extended day
 The ’visibility’ of such services in the
experience of all users
 GP areas be calmer, with less through
traffic, and more readily ‘shut down’
while other areas remain open
 Increase privacy in GP consulting areas
 Brings GP areas closer to staff offices,
increasing the viability of shared staff
resources and opportunities for
developing shared experience and
ethos.
The New ‘Front Door’

4. Design Lessons
 Ease of access, especially for people
with impaired mobility
 Minimise transfer time from waiting to
consulting, reducing down-time
between appointments and increasing
opportunities for staff to collect
patients in person, which is valued by
patients
 Minimise patient use of corridors, and
the monotonous experience
 The quality of environment when
waiting, with good visual connection to
receptions to feel secure and not
forgotten, and greater opportunities
for personal choice and visual interest
Efficient Patient Circulation

5.  Give flexibility to accommodate new
and more mobile work patterns
 Provide good quality spaces for
collaboration and retreat spaces for
quick/sensitive conversations
 Offer choice in location, and a range of
space types for personal preferences
 Ensure resources are put into providing
a positive working environment for
staff, rather than an under-used one
 Increase social/impromptu discussions
helping build a shared ethos
 Provide opportunities to allow GP’s etc
to learn/work away from consulting
rooms, freeing up additional consulting
sessions
Design Lessons
Changing Working Modes

6. Design Lessons
 Layout which minimises provision of
dedicated "departments"
 Rooms for general sessional use
grouped and served by a shared
reception with a mix of clinical and
interview rooms and operable in a
range of clinic sizes
 Shared GP waiting areas which allow
peak numbers of patients to sit near to
their practice
 Shared receptions resisted but
adjacent location of receptions was
thought beneficial, making sharing of
resources viable, and also helping long
term flexibility
Flexibility and Space Efficiency

7. Design Lessons
 Electronic records
 Physio, if co-located with consult
X Public spaces; no longer overheads but
venues for health promotion, the social
aspects of well-being, and integration of
the third sector,
• seating groupings within larger space
and smaller more discrete areas.
• public areas with venues for accessing
information through IT etc
• public areas with space for 3rd sector
stalls and flexibility for out of hours use
• external areas designed to provide
additional service opportunities for
physio/children’s services/3rd sector
and promotion events
Room for Reduction?

8. Process Lessons
 Concentrating the Program
 Stakeholder Engagement
Mixing up the groups:
• helped the cross fertilisation of ideas and
practices, encouraging people to reach
beyond their own experience and
braking down preconceptions of what is
possible; when a colleague describes
how they work in one way it becomes
difficult to say it is not possible.
• started to build the relationships that’ll
be needed in the new place.
 Quality Based Selection Process
Construction
Unitary charge

9. www.scottishfuturestrust.org.uk
Area Efficiency Measurement

10. www.scottishfuturestrust.org.uk
Area Efficiency Measurement

11. www.scottishfuturestrust.org.uk
Funding Metric Summary
Metric includes all costs with the exception of the following:
• Land purchase
• VAT
• Group 2 supply and group 3 & 4 supply and install furniture.
• IT hardware
£1,385/m2
£1,395/m2

12. www.scottishfuturestrust.org.uk
VFM Summary
VFM Summary Sheet
• Submitted by Health Board to SGHD
• Summaries cost drivers & performance
• Simple to use.
Eastwood Assessment
0%
20%
40%
60%
80%
100%
120%
Area Per
GP
Ratio
Support
Space
Capex
Life Cycle
Metric
Actual

13. Design Context in Scotland
“Work is in hand to consider how
design quality can be embedded
within the Scottish Government
Health Directorates business case
approval processes through the
further development of the
Scottish Capital Investment
Manual for NHSScotland and the
involvement of appropriate design
experts within the business case
approvals process.”
Nicola Sturgeon: 24 February 2009
Design Quality Policy for NHSScotland
Business cases seen by Government
Design Assessment in the Business
Case

14. Design Assessment in SCIM
 Applies in full to all projects, over
delegated limit, which were pre-IA on
1st July 2010.
 Discretionary use on those pre-OBC on
that date.
 Considered good practice in all other
projects.
 Process supported by HFS and A+DS, who
have role advising Boards & CIG.
 Formal assessments needed in lead up to
business case points, but recommend
engagement sought earlier : ‘no surprises’
principle.
 Assessments are made of developing
project against standards established in
Healthcare Design Guidance and project
specific Design Statement - produced,
assessed and agreed pre-IA.
Capital
Investment Group
Consider Business Case
including level of support
from NDAP
PROJECT TEAM
Develop business case and
Design Proposals
PROJECT BOARD
ensure standards are
established and self
assessment is carried out
HEALTH BOARD
Consider Business Case,
including assessment of
NDAP, and, when ready,
submit to CIG
Design Assessment Process
HFS/A+DS Consider draft business
case and comment prior to
consideration of completed
business case by Health Board.
Outcome verified to CIG on
submission of business case.

15. Map this into
YOUR
processes
Walk through a
‘day in the life’
Capture short
statements on key
attributes
increase
‘bang for the buck’
find views of what
success might look like
Pull out key
Business Objectives
Design Statement

16. Map this into
YOUR
processes
Walk through a
‘day in the life’
Capture short
statements on key
attributes
increase
‘bang for the buck’
find views of what
success might look like
Pull out key
Business Objectives
Design Statement
• Platform for integrated service delivery at a neighbourhood
level.
• Facilitate safe and easy access.
• Support clinical effectiveness and result in improved treatment
outcomes for patients.
• Tackling health inequalities and maximise social and economic
benefits for the area .
• Improve service efficiency by achieving a better joint use of
valuable resources and flexibility to meet the health care
needs arising from demographic change .
• Sustainability - optimise the efficient use of energy, water,
waste management and in so doing reduce lifetime costs
whilst also reducing the carbon footprint by minimising
pollution generation.
• Suitable working environment including promoting patient and
staff wellbeing and confidence .

17. Map this into
YOUR
processes
Walk through a
‘day in the life’
Capture short
statements on key
attributes
increase
‘bang for the buck’
find views of what
success might look like
Pull out key
Business Objectives
Design Statement
Service Users
“Arriving must feel pleasant and safe in daylight and darkness...
The routes and any parking spaces used should allow and
encourage use of other amenities (shops, library etc) whilst in the
area, not separate the use of health services from the normal
experience of the area.”
Staff
“The layout of the facility, and the inclusion of IT services to
support communication, must promote and enable joint working
and efficiency.”
Visitors
“the design of the communal areas must communicate the range
of services available, support for carers , and health promotion
messages to those visiting with others”

18. Map this into
YOUR
processes
Walk through a
‘day in the life’
Capture short
statements on key
attributes
increase
‘bang for the buck’
find views of what
success might look like
Pull out key
Business Objectives
Design Statement
“Arriving must feel pleasant and safe in daylight and darkness...
The routes and any parking spaces used should allow and
encourage use of other amenities (shops, library etc) whilst in the
area, not separate the use of health services from the normal
experience of the area.”

19. Map this into
YOUR
processes
Walk through a
‘day in the life’
Capture short
statements on key
attributes
increase
‘bang for the buck’
find views of what
success might look like
Pull out key
Business Objectives
Design Statement
Staff - “The layout of the facility, and the inclusion of IT services to
support communication, must promote and enable joint working
and efficiency.”
-Shared resources (meeting and rest spaces) close enough to
other working areas to facilitate use (2 mins walk) and attractive
enough to encourage use. Designed flexibly to allow range of
uses over an extended day.
-Staff circulation routes shared by all services, not separated by
discipline.
-Informal spaces at natural meeting points such as circulation
nodes and commonly used facilities (photocopier/printer) to
enable impromptu discussions.

20. Map this into
YOUR
processes
Walk through a
‘day in the life’
Capture short
statements on key
attributes
increase
‘bang for the buck’
find views of what
success might look like
Pull out key
Business Objectives
Design Statement
Visitors
“the design of the communal areas must communicate the range
of services available, support for carers , and health promotion
messages to those visiting with others”

21. Map this into
YOUR
processes
Walk through a
‘day in the life’
Capture short
statements on key
attributes
increase
‘bang for the buck’
find views of what
success might look like
Pull out key
Business Objectives
Design Statement
“the project must make the most of the opportunity to improve
the appearance and experience of an area of multiple
deprivation to aid community perception and regeneration”
“the layout must allow for additional services to be added to the
development as an ‘extension’ without compromising the ‘non-
negotiables’ above”

22. Map this into
YOUR
processes
Walk through a
‘day in the life’
Capture short
statements on key
attributes
increase
‘bang for the buck’
find views of what
success might look like
Pull out key
Business Objectives
Design Statement
What are the key decision points in progressing the project?
Then for each:
•Who will decide if it’s looking on track to deliver?
•Do you need to bring in any additional perspectives to inform
that decision, and if so who?
•How will you assess you’re on track in terms of the statements
and benchmarks (in getting the right skills on board and checking
the developing proposition) and how can you ‘value’ that aspect
in the decision amongst the other criteria that would figure in
that?
•What specific/additional information will you need to make that
evaluation?

23. What are we looking for?
Clear link between business objectives and design objectives
through:
•the key experiences on the patient journey
•supporting behaviours, connections and wellbeing in staff
.....and which address key areas such as:
•benefits of any co-location
•flexibility in use and adaptability over time
.....and that tricky aspects are tackled and direction of travel
established.
Benchmarks that are:
•humane.
•learning from other’s successes
•a clear ‘basis’ for assessment
Objectives and benchmarks that aren't so specific as to be
problematic.
Broad basis of support - “agreed non-negotiables”.
Design Statement

24. ...an estate designed with ‘a level of care and
thought that conveys respect’; buildings that grow
from the local history and landscape, that are
developed in partnership with the local
community - a work of joint learning and joint
responsibility that is particular to that community
and that place; ‘Not off the shelf shoe boxes’...
from an interview with Dr Harry Burns CMO
Vision of Health

25. `
© Architecture and Design Scotland June 2012
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