Barrhead Health and Care Centre A Case Study
Barrhead Health and Care Centre
Overview The Barrhead Health & Social Care Centre was one of NHS Greater Glasgow and Clyde’s (NHSGG&C) earliest developments to address the new ‘model of care’ for health and social care and has formed the basis of briefing for subsequent projects. After two and a half years in operation, the team revisited the facility to discuss its successes and how the community is adapting to the possibilities of the place. The facility integrates a number of local GP practices with primary and community care services into a “onestop-shop” helping to foster new relationships between the NHS, Local Authority and Third Sector partners. As John Donnelly from NHS GG&C Capital Planning suggests, these centres should: The building’s civic presence on Main Street Image credit: Tom de Gay at Avanti Architects Ltd
“Improve access to services, enhance patient care and reduce pressure on acute hospitals” The new health centre is part of a wider masterplan for the regeneration of Barrhead, the primary objectives of which are to: consolidate public amenities, reconnect the area to the Levern Valley and develop a more strategic approach to parking. The site for the new centre was chosen due to its central location within the town and for being close to the existing health centre that had been deemed unfit for purpose. Building the new centre acted as a catalyst for the implementation of the masterplan as the existing health centre site had been identified as part of this wider regeneration. The primary entrance to the facility is located just off Main Street, set back from the road and forms an informal public square to the front of the building. This provides access to the bus stops and main pedestrian routes that the public were already comfortable with. Initial proposals by the architect had indicated an entrance to the west face of the building, linking into a boulevard axis and the wider masterplan. However, the public partnership believed there were too many risks and uncertainties around the proposed town masterplan, particularly the boulevard area, and as a result the west entrance was removed. This has been a beneficial decision in the short term, as the proposed masterplan for the area has developed more slowly than originally anticipated. Fortunately, the building’s character and civic presence has meant the building has not suffered as a result of the delayed masterplan. The masterplan’s proposal for the town centre was to create a strategy of coordinated parking zones to provide a level of parking flexibility for the town centre. The health centre had been expected to accommodate approximately 300 car parking spaces but the flexibility in the masterplan allowed for this number to be halved and the rest to be allocated in the proposed supermarket car park. Reducing this parking demand for the new health centre gave the building more civic space externally and, more importantly, more space internally for patients and staff.
Surrounding built context Image credit: Avanti Architects Ltd
As this was a relatively new type of facility, the team visited a number of similar facilities in Kilmarnock, Inverness, Leith and Belfast to gain some learning from these recently completed examples. In addition to this, the team tried to ensure that the building was embedded into the local community as much as possible and undertook a wide stakeholder and local engagement throughout both the design development and the
Barrhead Health and Care Centre
procurement process. Consequently, a number of community groups were set up to address issues arising within the project. The team believes that this proactive engagement has helped inform the project and has been a key factor to its success. It was believed that getting the correct people on the project team with relevant practical experience, a level of common sense and a passion for the project would be beneficial in helping to galvanise the support of others and make the engagement process more valuable. “One of the things that we emphasised when we were trying to organise people to come in were just laying [it] on the line. ‘You’re going to be working in here, if you don’t attend the meetings, you’re not going to influence it, so unless you actually attend the meetings, you won’t get what you want.’” Angus Hunter, CHCP Business Admin Manager, Barrhead Health and Care Centre
This built enthusiasm within the core group and helped get other people to input into the process and make it work for them. Throughout the process the team met religiously every fortnight throughout design and construction. “Our priority was to get the right team in place, rather than the lowest cost. There was a clear commitment to quality amongst all of the partners including NHS and East Renfrewshire Council” John Donnelly, NHS GG&C Capital Planning
The building has been designed for potential future adaptation. There is a simple steel and concrete structural frame on a regular grid. All internal partitions are independent of this which means that they can be removed if required. Externally, window patterns are regular and frequent, providing flexibility in room layouts should internal partitions need to change. Circulation cores and service distribution within the frame are logical with horizontal routes following corridor routes. These measures allow the building to have a level of flexibility and adaptability should the service need to change in the future.
Cross section through the atrium Image credit: Avanti Architects Ltd
Barrhead Health and Care Centre
Experience The facility has a real presence in the town, forming a bookend to the street with a clock tower that shields the residences beyond. It has been designed to be of a scale and nature that creates a civic identity, similar in some respects to the adjacent East Renfrewshire council offices. Material choices, through the use of colours and tones, have been sympathetically chosen to compliment and reinforce this modern civic quality.
The modern civic character of the public entrance reflects that of the Council offices close by. Image Credit: Tom de Gay at Avanti Architects Ltd
The plaza in front of the building is well used by both patients and visitors. The shared surface finish, predominantly in hard landscaping, has been designed with integrated seating and art. Within this space, parking for disabled persons is discretely located behind a length of boundary wall. This is away from the main traffic thoroughfare and is monitored by the adjacent administration offices making these spaces feel safer for disabled users as well as being closer to the primary entrance. These spaces also share the pedestrian surface material which helps indicate to users that these are not for general use. However, when in use they do not detract too much from the nature of the overall public space. Servicing of the facility is to the rear of the building with the slope of the site serving to conceal the servicing needs of the facility at the lower level. The remainder of the parking is situated to the side and rear of the building, effectively wrapping around the services at lower ground level. Parking has a constant flow of patients and staff which means the car park works almost at full capacity. This is not currently a significant issue, however, it may be something that might become an issue in future.
The Centre looks out over Levern Valley Image Credit: Tom de Gay at Avanti Architects Ltd
The main entrance is clear and visible from Main Street. Routes to the entrance are legible whether arriving by car, bus or on foot. One minor complaint from staff is that the entrance space can sometimes feel draughty as the sliding doors are arranged to be ‘inline’ rather than in a ‘chicane’ format, and with the doors being close together it means that both doors can easily be open at the same time. Once you enter the building though you are immediately greeted with the welcoming atrium space, providing a view through to the landscape beyond. Internally the building arrangement is zoned efficiently with some staff and service accommodation on the lower ground level, clinical accommodation on ground and first floor; and Third Sector and staff accommodation (including social services, speech therapists, community care staff, occupational therapists, adult mental health staff and district nurses) on the second floor. Most of the principle functions of the facility are located off the main atrium space. Clear circulation routes and colour coding of reception areas also aid awareness of the services available to the patient and provides an excellent means of wayfinding. At the base of the atrium the main space acts as an overspill area for people waiting for friends and family where they can get a coffee, read, look at an exhibition or just watch the world go by. This helps to reduce the size of the localised waiting areas.
Colour coding of GP practices and third sector departments for patient wayfinding
The atrium space itself feels welcoming and stimulating, generated by a constant buzz of people moving through the space on all levels. There is a light and airy feel created by the open space and the large double bank of glazed rooflights running the entire length of the space. In developing the atrium space, careful examination of daylighting was undertaken through
Barrhead Health and Care Centre
Ground floor, first floor and second floor plans (bottom to top) Image credit: Avanti Architects Ltd
Barrhead Health and Care Centre
computer modelling to ensure that each room off this space had as much natural light as possible. “It is light and bright and it’s really welcoming. I think for the public, there are negative comments about the size of the space when it is empty, but then they appreciate it when they see things like the choir. I think it’s much better that we’ve got it this way ... it’s flexible and you can use it for lots of other things, it’s really good.” Anne-Marie Kennedy, Public Partnership Representative
Shared waiting areas look out into atrium Image Credit: Tom de Gay at Avanti Architects Ltd
Originally the atrium space was planned as an external court, providing an element of landscape within the heart of the building. However, this was changed during the design development to create more usable internal space. The advantage of this space is that it has the capacity to be used by outside groups such as the Alzheimer’s Groups, choral groups and local artists with travelling art exhibitions. In addition to this, the atrium has been used as a backdrop for filming NHS adverts and by mental health patients for showcasing work, which also raises awareness. Overall the space is seen as very positive from a public-partnership perspective and the use of this space has been increasing since the facility opened. This should continue to increase as the local community becomes more accustomed to it being a usable space. “There should be community activity which builds on the identity of the centre as a community resource ... people then take ownership of it and have a different relationship to it. It’s not like a hospital which is slightly feared, it’s part of their community.” Justin De Syllas, Architect, Avanti
Public terrace overlooking the Levern Valley Image credit: Tom de Gay at Avanti Architects Ltd
One important element of the design was the provision of an area for child’s play that was incorporated into the ground floor waiting area between two GP practices. This space can be monitored well by both GP receptions so that there is an element of supervision and security. Provision of a children’s play area in this location is beneficial as it provides a welcome distraction to both ground and first floor waiting areas viewed from the balcony above. “Kids and toys is a requirement, it’s an absolute necessity… We have a lot of unwell children coming to us, we equally have children every day just getting their vaccines and they need somewhere where they can be comfortable.” Helen Winton, Practice Manager, Levern Medical Group
Children’s play space Image credit: Tom de Gay at Avanti Architects Ltd
Central atrium space from the first floor Image credit: Tom de Gay at Avanti Architects Ltd
Waiting spaces are split over two levels and are located close to reception areas allowing a level of passive monitoring to be undertaken by staff. Between the different services, waiting areas are shared with undefined boundaries, creating an efficient and flexible space for the changing number of patients waiting for each practice. This helps to cater for spikes in patient flow, which are quite commonly associated with this type of facility. Although waiting areas are located within the main space, they are not open and exposed. The design of these spaces ensures that most are tucked away under lowered sections of ceiling, creating a more intimate scale. Acoustics within these spaces are tempered through the installation of acoustic ceiling panels which reduces the overall noise, such as from mobile phones. This
Barrhead Health and Care Centre
Barrhead Health and Care Centre
benefits the patient experience by providing a calming environment suitable for waiting whilst allowing opportunities for private conversations if needed. Most waiting areas also have a view out to the green space beyond and the ground floor has access to an external terrace offering patients ‘a breath of fresh air’ and the distraction of nature.
Staff terrace Image credit: Tom de Gay at Avanti Architects Ltd
Staff accommodation is predominantly located on the second floor level of the building and is designed to cater for a level of flexibility in working arrangements by both NHS staff and partner organisations. Most of the office accommodation is open plan and allows the changes in working patterns of staff to be accommodated easily. Smaller cellular offices and some meeting spaces give staff a variety of accommodation they can use. This mix of space for staff appears to work well, however, storage provision appears to be insufficient to accommodate staff needs meaning there is quite a lot of visible stored items. The staff room and associated external terrace space, with view out over the Levern Valley, offer staff a wonderful, light and relaxed space away from the working environment. One staff member reflected that although this space is good it might have been better linked with a café on the ground floor as part of the atrium space, providing a dual function. This may have benefitted GP staff that, due to their busy schedules, tend use this space less than other staff. The building was required to achieve an ‘excellent’ target through the NHS Environment Assessment Tool (NEAT) and employs a number of active and passive measures in order to make it more energy efficient. It has a wellinsulated envelope to both the fabric and glazing in order to help reduce heat loss and optimise solar gain. Incorporation of a natural ventilation strategy was introduced in certain locations to reduce demand on mechanical means. This was achieved within the atrium space by providing high-level vents to help cool the space and with opening windows to each external room. The strategy was only partly successful as window restrictors inhibit the cross flow of air to many of the external facing rooms. With privacy an issue in GP consulting rooms, this quite often means that these rooms overheat during summer months. Heating provision is targeted through a number of sources: a ground source heat pump provides energy for mechanical cooling, underfloor heating in the atrium and preheating for hot water; air handling units provide air conditioning to some of the more highly serviced rooms; and ceiling mounted heating panels provide an extra source of heat when necessary, although some feel these are too inefficient.
Art in the staff corridors on the second floor Looking through the atrium to the Levern Valley Image credit: Tom de Gay at Avanti Architects Ltd
Throughout the facility there are a series of large and small art installations, some within the clinical areas, but mostly in the public areas. An art coordinator was appointed to the project to help develop the vision and prepare a series of proposals for the new centre. Included within their remit was to find the necessary funding to deliver these works. Unfortunately, unlike the community engagement process, which was open and collaborative, there was a lack of shared vision between the coordinator and the group, which was never fully resolved. In addition, the art coordinator was unable to secure the necessary funding for the works meaning the initial vision could not be completed. This put strain on the process and ultimately the end result.
Reaction The facility appears to have gained wide acceptance within the community. For example, early engagement with the community allowed any significant issues to be explored and resolved within the process. The result of this can be evidenced by the fact that when the planning application was lodged with East Renfrewshire Council, there were no objections from the local community. This is mirrored by the lack of vandalism to the building. “Externally, there is not one single bit of graffiti and, to me, that shows that the whole community outside have accepted the building.” Angus Hunter, CHCP Business Admin Manager Public forecourt and primary entrance Image credit: Tom de Gay at Avanti Architects Ltd
In general, patients are now organising multiple appointments around a single visit, which illustrates that the efficiencies of co-location are becoming more appreciated. This will hopefully increase over time as the model gains wider acceptance and suggests that co-location of primary care health provision and social care has been beneficial. “We’re finding now a lot of people are linking their GP appointments with going to the physiotherapist or going to the podiatrist or going to the dentist, so it’s not just one person coming to see one appointment, they can do two or three.” Angus Hunter, CHCP Business Admin Manager
With external groups beginning to use the building more, the identity as a community resource is becoming better known. There have been a number of community events organised within the facility, suggesting to the wider community that Barrhead Health and Care Centre is more than just a healthcare building. At the beginning of the process there was a significant amount of staff apathy about the project due to a large level of stakeholder fatigue. This was the result of many years of consultation without a positive result leading many to believe that the development would be unlikely to happen. One of the significant challenges the team had to address was to change this ‘scepticism’ into ‘optimism’. This was largely achieved as staff felt empowered to make changes and provide input to the project, which is testament to the leadership of the key staff members who were placed within these groups. “It’s not just being involved but we were allowed to be involved and I felt that it was one of the most incredible periods of my working life…you felt you were changing the future. To allow practices or staff to get that part of it, you then get them being very proud of the building.” Helen Winton, Practice Manager, Levern Medical Group
The consultation process included construction of a sample consultation examination room, complete with all required finishes and equipment, in the middle of the building site during early construction. As this was the most common room module, it was felt necessary to allow stakeholders (such as infection control, GPs, moving and handling staff, equipment staff and the contractor) to critique the layout and specification of the room to ensure it 10
was correct. Over a two-week period around 40 people viewed the room, and although the room data sheet information had been signed off prior to this, several changes were requested. One example of this was that the desk position against the window was moved to avoid stretching over to open a window. This room also allowed the contractor to use the sample room as a quality benchmark of the finish expected by the client, and was itself used as a finished room in the completed building. The staff canteen (and associated terrace) located on the second floor is well used by NHS staff. Some staff use this area as an extension to the working environment, using the café as a break out zone for informal meetings. NHS GG&C have expressed delight with the completed facility and view it as a good example to showcase to others when looking to build a similar facility.
Consulting examination room Image credit: Tom de Gay at Avanti Architects Ltd
“This building is highly successful and owes a lot to getting the design principles right at the outset. We use this building when briefing other newbuilds because there are fundamental lessons here on zoning, structure and process.” John Donnelly, NHS GG&C Capital Planning
This success of this building can be partly attributed to the flexibility of the procurement route. NHS GG&C were quite familiar with using this form of procurement and understood how it could be used to their advantage. Since completion, the lessons learned from this project have been taken forward into other facilities being developed by NHS GG&C including the Primary Care Reference Design project, ‘Quality and Efficiency’ for the Eastwood Health Care Centre. “In Glasgow the health centre programme has historically been delivered using traditional construction routes. We think that this building is a good example of the output where the client has control over the design, the design team, the budget and the contractor. The move towards contractorled processes has still to be demonstrated as producing better quality buildings.” John Donnelly, NHS GG&C Capital Planning
Current forms of public sector procurement can restrict the level of flexibility at later stages in the process due to the pressure of locking down the financial spend early. It is therefore crucial that key requirements of the physical environment are considered at an earlier stage in the development process in order to be more effective. Elements that may influence the physical layout include: •
Allowing GP practices to be better integrated gives opportunities for future flexibility and possible combination, if required. This helps to ensure that changes in working patterns of these practices can be accommodated more easily. Similarly, integration of GP rest areas will support better cohesion of the overall facility.
Integrating a level of spatial efficiency within the plan to allow a number of areas of shared use to be incorporated for both staff and patients. These spaces are beneficial to the design as they provide opportunities for a reduction in the overall floor area of the building, generating savings for the project. Additionally, they have the added benefit of providing opportunities for interaction, particularly within the staff environment, supporting better integration of the service.
Providing a level of future flexibility to extend the longevity of the building. This was particularly apparent at Barrhead where the accommodation requirement for the Third Sector services increased soon after opening. Due to the flexibility of the layout these changes could be incorporated without too much trouble.
The project has been considered a success. This is in no small part due to the extensive stakeholder and community engagement that helped to shape and influence a number of aspects of the environment for patients, staff and the community. The evidence from this project indicates that consultation and engagement can really help inform good decision making processes and, ultimately, create a building that people are proud of. “It was the fact that the process was to involve people, listen to people and to put people, like me, on the design and accommodation group. That was absolutely incredible.” Anne-Marie Kennedy, Public Partnership Representative
Shared waiting areas off the main atrium Image credit: Tom de Gay at Avanti Architects Ltd
Project Information Client body: NHS Greater Glasgow and Clyde Location: Main Street, Barrhead, Renfrewshire Architect: Avanti Architects Principal Contractor: Graham Construction Value: ÂŁ18 million Area: 5750m2 Opening Date: April 2011 Procurement Type: Traditional
A+DS would like to thank the following for their time and candour: John Donnelly, Capital Planning, NHS Greater Glasgow & Clyde Angus Hunter, Community Health and Care Partnership, Business Admin Manager, Barrhead Health & Care Centre Helen Winton, Practice Manager, Levern Medical Group Anne-Marie Kennedy, Representative from the Public Partnership Forum Justin De Syllas, Architect and Lead Consultant, Avanti Architects
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