PrimaryCare Modernising Primary Care Premises and Services Through Partnership

For ’s Greater Good The new Primary Care Centre, one of many examples of partnership working in the area ‘Greater Glasgow’s Primary Care Strategy – Shaping the Future of Primary Care – aims to revolutionise primary care services in ’s largest city,’ says Ian Reid, Chief Executive, Greater Glasgow Primary Health Care NHS Trust. ‘Put together following consultation with patients, staff, community organisations, local authorities and voluntary organisations, the strategy sets out a future vision for primary care which aims to meet the needs of patients and bring the quality of health in Glasgow and surrounding area up to a level at least equal to the rest of Scotland. Around £38 million has already been invested, with a further £100 million to come over the next five years to improve and develop a wide range of services in line with national, city-wide and local priorities. These plans will only be successful if local premises and facilities are modernised to meet future needs. Funding from the Primary and Community Care Premises Modernisation Programme has made possible a number of projects in Greater Glasgow and a £48 million property plan has additionally been developed to upgrade, extend and replace a number of health centres and clinics in the city. A significant amount of work in improving premises is already underway, with improved facilities up and running in areas such as Rutherglen, Govanhill and Bridgeton. Patients have been extremely positive about the new accommodation and many staff have commented on how improvements have proven to be a genuine boost for services. There is, however, much work still to be done, with future plans for improved or upgraded health centres and clinics in Pollok, Castlemilk, Springburn, Possilpark, Townhead, Maryhill, Gorbals, Parkhead, Shetttleston, and Drumchapel. A different approach is now being taken in the development of new premises. While new accommodation is being purpose- designed and built to meet current needs, taking into account the increasingly closer working across the NHS system and multi-agency approach to the delivery of services, it is also being designed with future needs and services in mind. The requirements of the Disability Discrimination Act are also being taken into consideration when designing and building new accommodation. All these improvements aim to provide modern, purpose-built accommodation to meet the health needs of a changing population. Contact with primary care professionals accounts for 90% of all patient contacts with the health service and the provision of high quality services in accommodation fit for the 21st century is crucial to improving the patient’s experience.’

The third newsletter in the series, looking at improvements in Scotland’s health care provision, turns its attention to a selection of the many developments in the Greater Glasgow area. Kicking off, Carole Gillan (Primary Care Development Manager (Premises) Greater Glasgow Primary Care NHS Trust) provides an overview of the ongoing Primary Care Premises Modernisation Programme. Since the inception of the Scottish Executive’s Premises Modernisation Programme in 2000, Glasgow has had the opportunity to invest some £10.8 million in improving and/or replacing health centres, community health clinics and community pharmacy premises. This has complemented the significant service development programme, as stated in the Trust’s strategy for the modernisation of primary care services. The capital investment can be sub-divided into the following categories:

Community Pharmacies

The Trust, in conjunction with Pharmaceutical Contractors, The Modernisation Programme has helped provide grants to has helped to pilot the model pharmacy scheme. Featuring a three further community pharmacies to help them modernise different style of layout to the traditional pharmacy – with its their premises and upgrading works will be completed emphasis on the display and sale of cosmetics and toiletries shortly. – the new accommodation aims to support the increasing involvement of pharmacists in providing an extended Over the last three years the Scottish Executive has allocated consultation service and the future move towards pharmacist £99,000 each year for premises’ improvements in addition to prescribing. To encourage all parts of the community to use £204,000 in 2002/03 to four schemes. this important facility, confidential consulting space and a generally welcoming environment are required. Additionally, there will be the opportunity for other health and social care providers to make use of these facilities. Health Centres

A total of £10.6 million has been allocated to extend and upgrade eight health centres as part of the programme. Three particular projects are examples of improving patients access to modern primary care facilities, assisting opportunities for joint working with other parts of the health service and partner agencies, and providing primary care contractors with improved facilities.

1. The Rutherglen Primary Care Centre, completed in 2001 at aspects of the town. Aiming to come on stream in 2005, the a cost of £4.5 million, upgraded and significantly extended the facility will provide, on an integrated basis, primary care existing health centre which no longer provided sufficient and services (including two GP practices), community mental suitable accommodation to meet the needs of patients, general health services and social work services. The Centre will be practitioners and other primary care staff. There was a scheme located in the heart of the town, adjacent to a number of aimed at providing significant additional space for all services community pharmacies and general dental contractors. and the opportunity for some practices to develop the practice Provision of a second phase development to incorporate these premises adjacent to the Centre under a cost rent scheme. As and other relevant services is being considered. a result, the Centre has a mixture of GP cost rent and The facility will be built by a development company, set up ‘at traditional health centre rental agreements, allowing each arms length’ by East Council, with practice the scale of accommodation to be leased by each of the occupant accommodation that agencies. In designing the building, great emphasis is being meets their needs, on made on maximising the sharing of accommodation and a financial basis encouraging the appropriate areas for joint working. There will that suits them. The be a single point of entry with a staffed reception area to direct Centre now houses visitors to the correct part of the building. improved facilities for physiotherapy, podiatry and treatment room services with a wide range of secondary health care, voluntary agencies and social care organisations using the improved ‘sessional use’ accommodation on a multi-agency basis. The district nurses and health visitors are now, for the first time, based within each of the practice areas. A general dental contractor continues to offer dental services. 2. Earlier this year, work began to demolish the existing Sandy Road Community Clinic followed by construction of a new-build facility costing £3.05 million.The Clinic no longer provides sufficient accommodation to meet the current needs of a rapidly expanding range of primary care services required for the west end of Glasgow. Previously the site had separate, stand-alone buildings housing community mental General Practitioner health services and a local authority nursery school. Aiming to maximise the development opportunities of the site, the Premises plan is to replace both the primary care facility and the nursery school, with Glasgow District Council contributing Much work has been undertaken to modernise GP premises £200k towards the capital costs. The building will, in addition in Glasgow and significant investment in cost rent and to providing pre-school nursery places for the local improvement grant schemes is continuing. Introduction of community, deliver physiotherapy, podiatry, treatment room the Third Party Developer Scheme has allowed the Trust to and community dental services. A variety of rooms will be help GP practices to take advantage of an additional way to used by many different health and social care organisations, deal with the issue of fewer development sites, potential thereby enhancing the development of joint services locally negative equity in deprived areas and the changing profile of accessible to the community. The building has been designed GPs, many of whom are reulctant to own their buildings. to enable the construction of a phase II in the future, with the There are already examples of high quality schemes having potential involvement of primary care contractors such as been successfully undertaken and, increasingly in these GPs, general dental contractors and community pharmacists schemes, GPs are liaising with their LHCC in providing being considered. accommodation for non attached, health/social care services to operate from GP premises. 3. In partnership with Council, the Trust is involved in developing an Integrated Care Centre in Kirkintilloch, as part of the programme to regenerate all Rutherglen Primary Care Centre

On first sight you could be forgiven for assuming the building is a futuristic shopping mall. But, rising from the ashes of an old maternity hospital and Rutherglen Health Centre, the Stonelaw Road property is Rutherglen Primary Care Centre, one of the first facilities to feature a mix of rental (three) and cost-rent (three) premises.

Ian Mitchell (LHCC Manager)

‘The situation was that each GP practice was looking for more space – a dedicated practice manager, a dedicated practice nurse, computerisation was becoming more of a feature requiring ventilation for IT – and we were saying, ‘we’ve not got enough room for the services we’re trying to run at the moment’. A temporary fix previously had been extensions attached to the end of the existing building – a temporary measure that went on for about 10 years! So it was a great opportunity when the site here was demolished and this new facility constructed.’

David Sweeney (Practice Manager)

‘When I joined the practice of Drs Speir and Bruce as Practice Manager the primary care centre was in its second phase. It was my first practice as manager and it was a great opportunity to liaise with architects in the design and building of this purpose built practice which will enable us to deliver good quality services to our patients. The final results are superb. We have a great open plan administration area and a waiting area for patients which are well lit, warm and friendly. Previously our district nurses and health visitor were based in an office outwith our practice. Now we have been able to base them within our new practice so there is no longer any difficulty in contacting them for patients needing attention or advice. The patients love the new practice. I find if premises are very poor it can lead to poor patient and staff morale. Staff and patient morale is excellent and I know my staff are happy. An example of this was the excellent motivation and performance skills which the practice showed in achieving the Royal College of General Practitioners accreditation award in September 2002.’

Karin Hunter (Podiatrist)

‘We went from the old surgery, where there was no privacy and no room, to the Portakabins which, although better because they were built for us, were very small. But this is absolutely the best – I’ve never had so many facilities. And we’ve not had a single complaint. We’ve got a whole corridor – a sterilisation room then three rooms that interconnect. The sterilisation room is basically the first of its kind, so it’s being used as an example. We don’t need that much equipment so really just wanted a bit more space – it’s always been ‘chiropodists work in a cupboard’, that sort of thing, and now we have all these brilliant sized rooms.’ Dr William Speir

‘Our new facilities are super. Hardly a patient comes through the door who isn’t paying compliments about the place. Now we’ve got everything on tap – we now have the district nurses in a room with the health visitor who is also attached to the practice. We’re not sharing reception space with two other practices, like we were in the past, which is great. We’ve got a physiotherapist, dentist and chiropodist up the stair, we’ve got the maternity people down the corridor. I would be very surprised if anyone had a bad thing to say. The patients are the most important people and everyone has nothing but compliments. The building’s treated with respect so, all in all, I can say I’m very fortunate to be in premises of this quality.’

Elaine Wilson (Health Visitor)

‘I was in the old building attached to this practice and, because I was new and keen to pick things up, I was quite happy to be packed in with my health visitor colleagues at that particular stage. The work facilities were very out of date, especially for bringing young babies into and doing child medical examinations, and the room was very cramped. I was involved with a lot of the initial discussion on the plans for this new building – all the staff were asked what we wanted.’

Christina McCutcheon (Practice Manager)

‘Was the transition straightforward? No, but I think it was bound to be difficult. There were major changes with records storage, for example. Generally it’s all working really well. We would not have been able to provide all of the services that we have today, in the old health centre – there was just no space. We now have a better range of clinic rooms with each practice nurse having their own room. We have the ‘luxury’ of having an extra consulting room, which allows the practice extra space for child health clinics and offers flexibility to run additional clinics for the management of chronic diseases.’

Dr Anne Forrest

‘Because this set-up is so new it’s really going to require a rewriting of the rule book, to get away from the notion of cost- rent practices being completely independent, being in a different category. This is going to involve rethinking the relationship that while, yes, we’re responsible for our premises, we have to work out the sharing of our staff.’

David MacKenzie (Senior Physiotherapist)

‘It’s a great size, a good airy place and better than the Portakabin that was used for the previous ten years. Our Head of Department had input into the layout – the height of the sockets, position of bays and layout of desks – and I really wouldn’t do anything differently. Patients like to be treated in a nice atmosphere, they like to come into a comfortable building.’

Debbie Halliday (Diabetic Nurse Specialist)

‘My job came about as part of the Glasgow diabetes project, where type two diabetics care is moving into primary care. The GPs, practice nurses, podiatrists, dieticians and district nurses have to undergo further diabetic training to enable them to run diabetic clinics in the primary care sites. We have regular meetings with the GPs, consultants, podiatrists and dieticians both in hospital and the community and this is helping to improve communication city wide. The building has a great atmosphere for the patients. We have space to hold open days for patients and training for all levels of staff, including those from nursing homes within the local community.’ Crookston Medical Centre

Positioned just off a busy road, edging on two defined areas of residential development, the Centre has been in operation for over two years, a period which has seen its register of patients rise from 3,000 to nearly 4,500. Built as a third-party project with PMP (now Apollo) builders, the facility houses four GPs, two part-time practice nurses and a practice manager, with space for other visiting staff – the podiatrist, for example – based at the medical centre.

One of the resident GPs, Dr and McDonalds! As a GP there was no William Graham (left), outlines way we could compete with that on a the path that led to Crookston cost-rent basis so we had to approach a and the way ahead for future third-party developer to purchase the land developments for us.

‘We were in brand new cost- The pharmacist is excellent, with a great rent premises in 1996 then, range of services, and we’ve got a very because we had a practice good working relationship. We use a wide range of split, we moved out and pharmacies, however, as the bulk of our population still across the road – ironically doesn’t live on our doorstep. next to the old surgery we’d just left. It had two consulting Since we became a training practice in 2001 we’ve taken on rooms and half a treatment room – which was only half a a registrar, we’ve increased the number of doctors from room in itself, as we only got it for half the week! We doctors three to five, doubled our administrative team and nursing really had to get in and get out again to let the health visitors, staff, and have significantly expanded our practice dietician, chiropodist and so on have some space. And we population, taking on about 1500 +patients. There’s also ended up doing a lot of our paperwork in the car or from been a significant demographic shift with a much younger home. So having a dedicated space to work in here has patient population – our under fives have gone up obviously made a huge difference to us and we’ve been able significantly and the over-75 population to hugely expand our services. has stayed fairly static. At one point, in the old practice, nearly 30% of our practice The pharmacy (next door) was built by population was over 75 – now it’s only the same people and the land purchased 16%, much more in keeping with the by our third party developer. We were national figures. under pressure to leave our current premises and, although this is a better We’ve probably revamped the whole site, much more visible and a perfect management structure since we moved location, it was substantially more here – we didn’t have a practice manager, expensive. In fact the competing simply because we didn’t have room for interests for the site were Brewer’s Fayre one in the old building. So having a manager has made a big difference to us as well. And we’ve also got the attached staff – district nurses, a health visitor on site doing child health surveillance and immunisation clinics, which has been a big boost. We’ve also got community midwives who do a clinic and a counsellor, and our methadone-prescribing clinic is also staffed by a drugs counsellor.

All in all we might be thinking about moving upstairs fairly Patient comments have been very positive – how big it is, quickly! The building was constructed with room for that there’s enough room for mothers to bring their prams expansion above – we would have roughly half of the surface in,and we have our diabetic clinic, which offers podiatry and area upstairs as we’ve got downstairs. If our list continues to dietetic advice, then the chiropody service and a dietician expand in this exponential way…we reckon that we’ll who come in outwith the diabetic clinic. All this extra room probably have around 6000 patients in three to five years.’ has allowed us the scope to provide these different services.’

Erine Don (Practice Manager, below) has been with the practice for eighteen months. Comparing it to the surroundings of the previous health centre where she worked, ‘the differences are vast. There’s more room, it’s much more modern, there’s far more storage space and the patients love it. Granted, it’s a bit further from the previous premises but most of the patients have been willing to come because it’s the doctors they followed.

We haven’t had too many major problems with the building – just the snagging which, two years on, we’re still trying to iron out. I think that’s very much the thing with contractors, though – like building a new house. Once the house is up and you’re in they kick their heels a bit! Issues like our landscaping haven’t been tackled yet. Bannerman’s Pharmacy, Possilpark

Looking not unlike a recent ‘reveal’ from a top-notch TV makeover show, Bannerman’s Pharmacy, Possilpark is a beacon in the field of 21st century facilities. And decades away from the premises’ previous life, as resident pharmacist Gordon Dykes (below left) relates. ‘We purchased this pharmacy from the previous owner about three years ago and, just after that, had a letter from the Director of Pharmacy, Greater Glasgow Primary Care’s office announcing they had an allocation of money to develop a model pharmacy for the future. The grant would be £50,000 and various criteria had to be considered – the premises had to be in an area of multiple deprivation and willing to undergo a refit in the next few months. It had to be on the high street, have doctors in close proximity and we had to be willing to get involved with service development. So we applied and were delighted to be selected. There was quite a lot of interest in the offer but we were picked because we best fitted the criteria. The result is lovely, it’s exactly how I would like this pharmacy built. Major differences from the old premises? We do nothing other than health-related products. No hair dyes or hair baubles, purely medicines. Pharmacies don’t sell the sort of stuff they used to as there are so many supermarkets and other places now. Our speciality is medicines and that’s what we do.’ The almost modular layout of the facility features five distinct levels of engagement for the patients. Level 1 (right) is the long serving area supplying normal, over-the-counter products available in most pharmacies. Based on a more European style, the shape and materials aim to give it a welcoming feel. Level 2 (left) is the area used for supervision of medication – mostly for methadone – where the patient can stand discreetly to consume their medication without attracting the other customers’ attention. Level 3 (below left) provides a little more discretion, with a separate room where people can sit down and have a discussion face to face with the pharmacist. Level 4 (below right) is geared for more privacy as the area has a glass door. Bearing in mind that security could be a concern, occupants can be seen but won’t be overheard. The room also features a computer, accessed to the internet, for healthcare related enquiries. Should a patient have a particular issue with a prescribed medicine, they can be advised on the available information or directed to any available support groups. Level 5 (below left) is a room with a solid door, to the rear of the pharmacy, for use in conjunction with other healthcare providers or social workers, or perhaps where the treatment needed has to be much more discreet. David Thomson (Director of Pharmacy, Greater Glasgow Primary Care NHS Trust, right), explains the ethos of the development, ‘This was a prototype for us. We really had to find a pharmacy that was willing to work with us, give us a blank piece of paper and be brave enough to stick with it. They’re not really competing with supermarkets. Their specialism is health and healthcare. So take away the extras that they get involved in and reward them suitably for concentrating on what they’re good at. By the start of this year we had 15 similar facilities and more are planned. This is a huge opportunity to influence treatment and prevention, and the facilities we’ve been funding have all been targeting different patient groups. Patient feedback has been tremendous. People would come up to you, unprompted, when this facility first opened and say “this is great, smashing”. Compared to the premises here before, it was like coming from the mid 1950s into the 21st century overnight. People noticed that and realised it was much better. Reassuring, from my point of view, is the number of contractors who are now putting in these services themselves without asking – in some cases we’ve made small contributions but not on this scale. The ease of access to pharmacies has been recognised, so our overall aim is to bring a lot more on to the pharmacist side to support the patient.’ Not only a boon for the patients, assistants Tracey Carruthers (below left) and Kelly McDermott (below right) are also highly impressed with their new place of work. ‘It’s a much nicer atmosphere for us to work in. Before it was freezing, dark and we were always having to watch for shoplifters as the layout meant they came in one end, we were at the other end, and they were out the door with stock before you could do anything about it. It’s really nice now, more compact and easier for us to find things. The drawer system is much better than when everything was just kept on the shelf. And customers are always saying how much brighter the place is. At first it was “d’you have deodorant, hair dyes or whatever” but everyone knows what we’re here for now.’

For further information on these and further Primary Health Care premises developments in Greater Glasgow, contact Carole Gillan ISBN 0-7559-0936-4 Astron B31875 12/03 at: [email protected]

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