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How our new building helped us broaden the scope of our service

7 July 2010

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Business Partner
The Ridge Medical Practice
Bradford, West Yorkshire

Nick is fairly new to the NHS, having joined the Ridge Medical Practice in January 2007. He previously worked in recruitment and facilities management for Orange. Nick lives in Leeds with his wife Bridget and her two teenage sons. He is a keen SCUBA diver and diving instructor. He loves to spend weekends cooking and entertaining friends, and keeps fit by swimming and running regularly

Designing and constructing our new building was a significant challenge, with a huge workload, but this was only part of the process. The new environment may be a significant improvement and the building a great enabler, but it will not in itself solve many of the challenges we face in practice at the moment!

The transition to the new building required a cultural shift as well as a logistical one, and we needed time to settle in and adapt. Having done that, we now have a great platform from which to improve our current services and develop new ones.

Change management
Key to a successful transition into the new building has been an extensive change management programme, both with our own staff and the patient participation group (PPG). We used our existing staff consultation group, which represents all staff teams, to act as “move champions”.

The team met in each of the six months leading up to the move and played a key part in all the decisions and choices relating to the new building, including desk layouts, furniture choice, changes to working practices, clear desk policies, staff security, building facilities, etc.

This culminated in the production of a 24-page handbook for the new building, which we gave to all occupants. This liaison with staff representatives and the practice management team helped all staff to feel engaged and involved in the process, and was key to a smooth transition into a new environment.

In the last four months leading up to the move, I set up a series of regular project meetings every three weeks. The purpose of these was to bring together all the various people involved in the move to update on their progress and to make sure that everyone was co-ordinating as required.

Invited to these meetings were all the various suppliers involved in fitting out the building (IT, furniture, phone system, clinical furniture, AV systems, PR company, printers, etc), the constructor’s site manager, the architect and a pharmacy representative. Also invited were a selection of practice staff members who were most involved with the move, plus a couple of “open seats” for any staff who wanted to know what was
going on.

This proved very useful in helping staff to understand the complexity of the move and relay this to their colleagues. Most staff were still busy seeing patients and conducting their normal duties. Sometimes they felt left out and even put upon, believing that some people were spending too much time away sorting the building, which impacted on them. These meetings were a great counter to this feeling.

The transition and handover of the building from the contractor to us, and the co-ordination of deliveries from various suppliers, worked very smoothly. The suppliers had already met each other and worked out in advance how they would dovetail together in those very busy few weeks.

This process allowed everyone to feel that they were part of the bigger project and take ownership of their part of delivering the whole, and also led to them all taking pride in making sure they did not let the team down. As more suppliers and contractors (eg, cleaning and maintenance) were appointed, so the group grew.

A week after we had moved in, we held a thank-you lunch for all the contractors, subcontractors and suppliers who had been involved in the project, including staff from the primary care trust (PCT). Many of these people had not seen the finished building, and in some cases (for instance, our solicitors who are not local) had never seen it at all, despite doing a lot of work for us. This lunch event was a great success, with nearly 70 in attendance to share in the celebration of the project completion.

Don’t underestimate the impact on the practice team that such a move will have. Even with all our planning and engagement, we had a very tough month after moving in and it took a while for the teams to re-establish effective lines of communication and work together in the new environment. By communicating openly and honestly, however, we have been able to address this and have come through stronger.

Also, don’t fall into the trap of thinking a new building will solve all your problems. While the environment might be a huge step forward and a significant improvement, the building itself will not solve the access challenges we face and will not create extra appointments or more capacity on the phone lines. Patients will still present with the same issues they had in the old building, and provide the same challenges!

Patient and community involvement
Our PPG was instrumental in helping to plan changes to the way we operate. In the latter stages leading up to the move, the group spent a whole morning in the new building “trial running” it with us the week before we opened.

In our first week of operation, PPG representatives were present in reception during surgery times to act as building guides for our patients. They were also willing models for a photo session for a library of shots to use in publicity surrounding our move in our building handbook and other materials. They really felt involved by doing this, and it has given them a sense of ownership over their new surgery building.

Communicating with our wider patient community about the changes has not been easy. We sent a letter to all patients providing details of the move, but this is expensive and many patients don’t read letters sent to them, so this can’t be relied upon as effective. We enclosed with the letter a handy card (kindly sponsored by our pharmacy) containing new contact details for patients to keep for easy future reference.

We also used the local press to publicise our move. We took out a full page in local monthly “community pages” books delivered in local postcodes, which proved very cheap (about £100), to let people know we were moving. We also took out a two-page spread in the local evening paper; they also sold advertising to various local companies who had worked with us, and in the end this cost us just £200.

Both these methods proved excellent ways of raising awareness of the practice without directly advertising, and have certainly led to an influx of registrations (which we have welcomed) since we have opened.

New patient services
Now we are settled in and have space, we are developing a range of new services for our patients. With a large number of GPs with Special Interests within the team, we have had a number of practice-based commissioning (PBC) business cases approved by the PCT. Within the surgery, we are now running: a muscular skeletal service; joint injections; a level 3 diabetic service; a warfarin clinic; a full sexual health service; an H Pylori clinic; minor surgery; electrocardiograms; 24-hour blood-pressure monitoring and spirometry.

Patients greatly appreciate having these services provided in their own surgery. It is part of our vision to provide as much of their healthcare as possible from their own surgery building with staff they know and trust. We also have a number of outside agencies – including physiotherapists, benefits advisers, the local police and health trainers – who use our premises for drop-in or pre-bookable clinics so that we meet as many of the social, as well as medical, needs of our local community as possible. We are also in the process of preparing business cases for neurology and dermatology services.

Beyond core primary care
The newly renovated listed building we have on site is scheduled to become a key part of the practice strategy to strengthen our links with the local community and deliver innovative services that take our role far beyond core primary care.

Our patient population is among the most deprived in the UK, with significant health inequalities, a high level of chronic disease (particularly diabetes and heart disease, with a high percentage of South Asian patients), and high rates of teenage pregnancy and infant mortality.

Working in conjunction with our local PCT and commissioning alliance, we are using freed-up resources from previous years to complete the internal fit of this space to create a community health education centre. This will create an environment less clinical than the main health centre, but one that is still clearly associated with the practice.

The community building has four main areas; three of which are spaces that will comfortably accommodate groups of up to 10 people. We intend to furnish one of these as a “lounge”. This will be available both for use by our PPG to meet with the patients they represent and as a meeting point for groups of patients doing guided walks in the local park.

The second area will be set out as a classroom/education area that can be used by the practice team for group smoking cessation and weight-loss groups. The third area will be furnished in a “teenage-friendly” way as a base and social area for those coming to our popular teenage drop-in sessions. The final area is slightly larger. We intend to run this as a community café that will provide a lunch facility for employees in the building, an area for patients and the public using the surgery to socialise around, and also a facility for us to conduct cooking education and healthy eating promotion for our local  population.

Future development
Our vision is to see the local community treat this facility as their own and for our patients to have a say in the services we provide there. We plan for it to be an ideal resource for local community groups, youth organisations, schools and third-sector organisations to use and work more closely with us in delivering health improvements to the community and education, so that people can manage their own conditions better, leading to measurable improvements in the health of our community.

Other future plans including letting some of the under-utilised consultation rooms within the building to the local secondary care provider, which is looking to move a number of their outpatient services into the community. This will help us to work more closely with some of the hospital consultants, with whom we would normally only communicate with via letter and the occasional phone call.

We believe that this will provide the opportunity for secondary-care clinicians to see and discuss issues with patients informally. It will also enable us to be seen to be working together with local hospitals and will help us develop clinical skill, as well improving the quality of care for patients, again helping to deliver care closer to home.