A suitable case for treatment
One of Campbell and Arnott's fortes is the design of medical centres, providing a snapshot of this moving target. One trend is the increasing variety of services that centres accommodate. Of the two we look at here, Penicuik primarily accommodates a doctors' practice and a mental-health team, while Arbroath houses two doctors' practices, one dental practice and a community health team. This diversity is further illustrated by the table (page 36), which indicates the prime accommodation mix of five of Campbell and Arnott's other medical centres.
Another trend Murray Fleming of Campbell and Arnott identifies is an increase in size.
Not inexorably; small can be beautiful. But there is an appetite to try more extensive mixes of services. Another Campbell and Arnott centre in the pipeline, at Pitlochry, incorporates plans for a doctors' practice, a nine-bed ward serving the local hospital, a seven-bed dementia ward and care-home facilities - some 5,000m 2 in total (compared with 1,500m 2 at Penicuik and 2,400m 2 at Arbroath).
The limit on growing in size may not be the number of services that can be brought together beneficially so much as the maximum number of parties that can join in a briefing meeting and come to mutual agreement before the health service changes direction again. Fleming continues to wonder at the length of time that these projects take, particularly in the brief-development phase.
Pitlochry, Penicuik and Arbroath are by the same PPP developer, Medical Centres (Scotland), which typically leases back centres to user clients for 25 years. While budgets and accommodation schedules are tight, there are signs in the quality of space and construction of the developer's commitment for the long term. Fleming is pleasantly surprised that the practice can create a significant amount of double-height entrance space within the budget, and that the developer is open to suggestions about where to focus the balance of spending; for example, spending more on the stone fin wall and roofscape at Arbroath.
There are, of course, similarities between these medical centres, born of the architect's common authorship and its experience of what works. Both Arbroath and Penicuik give primacy to the pedestrian approach, leading to a light, double-height entrance space. They both provide separate zones for each medical group, with their own waiting areas, and both concentrate patient services on the ground floor with in-house and community-care staff on a smaller floor above.
ARBROATH This former gasworks site in the town centre sets the Eastfield Medical Centre end-on to the road, with the building broadening to create a highly visible entrance sequence.
Two GP practices occupy the west side, with a dental practice to move in to the east. By investing in the entrance volume and daylight penetration, the architect is not just seeking more drama in this tightly proscribed building, it is also deliberately using light, spaciousness and indoor-outdoor visual connection to help reduce stress among waiting patients. Coloured reception desks and WC enclosures, plus big graphic games played with signage, lighten the atmosphere and divert the eye from the clinical white.
Beyond these opening areas, the construction changes from exposed steel to hidden timber frame, and the strictures of the accommodation schedules kick in, with rooms double-banked along corridors. The architect has invested in corridor width and bright lighting, with glazed doors at corridor ends that reduce claustrophobia. On the upper, staff level, rooflights are set into the corridor ceiling. A bridge over the entrance provides a private route for staff between the east and west of the building.
There is some spare space, more than anticipated, as the dental practice is smaller than the third GP practice initially planned for, but the developer remains confident it can let this to a variety of medical service organisations.
Letting the intermittently used community health rooms to other community groups too is part of the original financial model.
At Springfield Medical Centre, while one arm of the L-plan aligns with the suburban street, the layout still focuses on pedestrian access to the heart of the plan. Red render is used to light-hearted effect, against medical tradition - it is a colour health buildings traditionally avoid. The double-height reception - light and naturally ventilated - is organised to lead GP patients into a waiting area with views out. The nature of mental health treatment means patients are taken to a more private waiting area at the heart of that wing. At Penicuik too there is great attention to corridor detail.
In both these centres, Campbell and Arnott has built appropriately to the scale of medical services offered, using massing, materials and colour to limit the institutional feel.
The main reservation is about longerterm flexibility. The method of briefing appears to lead to buildings relatively tightly fitted to each of the major medical services accommodated. These two buildings would not have been completed like this, say, five years ago, yet there is an unpredictable 25 years to go on the PPP. You might argue that this a problem for the owner/developer.
But, of course, in a world of PPP, we all share the risk.