Barbara Weiss Architects’ unclinical GP surgery provides ambience as well as ingeniously compact spaces, writes Felix Mara
Although it’s sometimes reported as being in terminal decline or patronisingly dismissed as a quaint, naive vestige of post-war altruism, the British are on the whole justifiably proud of their National Health Service. Bad press, however shocking, reflects expectations that it should be accountable and reformist, and the original NHS ethos is still very much alive. In the case of GP surgeries, while some give the impression they want to limit their registers to the bare minimum, others, like Wokingham Medical Centre, radiate optimism and appear keen to expand. When I visited the centre’s new home with its designer Barbara Weiss, three months after welcoming its first patients in February, it was like walking into a house party.
Anticipating a sharp rise in registrees generated by 4,000 new homes planned for the former market town, and mindful that the floor space of its existing premises in two separate historic buildings was 50 per cent adrift of Department of Health recommendations and therefore likely to raise Care Quality Commission eyebrows, Wokingham Medical Centre commissioned Barbara Weiss Architects to design a new purpose-built home, saying goodbye to converted residence surgery culture and potentially making it Britain’s largest single-site GP practice.
Chancing upon its north-west frontage in the town centre conservation area backlands, you’d never guess this is a makeover of a horrific, long-vacant 1980s PoMo spec office block. Barbara Weiss Architects gutted this L-shaped structure, removed two of its mini-pedimented facades along with some incongruous curved stair-tower glazing, infilled the space between its two legs and persuaded the planners a rooftop pavilion would rarely be visible, topping up the total floorplate increase to 400m².
Without an expansion of this magnitude, it would have been impossible to meet the Clinical Commissioning Group’s ambitions to make life easier for the public, reduce costs by decanting secondary health services from hospitals to GP surgeries, or for it to facilitate NHS strategy to amalgamate medical centres with other primary services such as dentistry.
With services such as paediatrics, psychiatry, physiotherapy, audiology and even acupuncture either already in place or on the practice’s horizons – along with phlebotomy facilities, a pharmacy and provision for minor surgery – it’s not surprising visitors refer to the well-appointed but compact centre as the Tardis. Director Barbara Weiss, a self-confessed storage obsessive and author of a book on the subject, has packed a lexicon of healthcare facilities into this project. She has drawn on experience gained on over 200 residential projects completed by her practice as well as previous healthcare experience to devise an ingenious, highly practical plan. Waiting areas, relieved by a triage system in which nurses assess patients over the phone, are spread across three floors rather than concentrated in one pool, and a separate, vertical back-of-house zone for staff and tenants enables them to mix informally and take essential respite from the pressures of public service.
A row of new bollards separates the 1.8m-wide approach leading to the centre from an adjacent area with an existing right of way for servicing vehicles. Because of the project’s financial constraints, plans for rationalised access, with visitors using an existing supermarket car park, never materialised. Nevertheless, the centre’s white-rendered frontage and glazed ground floor, capped by an oak-framed curtain wall, radiates order and calm as you approach the entrance, which is sheltered by a projecting stair tower and a canopy, its level dictated by truck heights.
Intensively used facilities, such as phlebotomy, flu immunisation and administration, are concentrated at ground level, along with the pharmacy, which has eye-catching, shiny bright plastic displays, anthropomorphic arms and dispensing robot shoots spiralling down from the ceiling. ‘The pharmacy, owned by us but run by others, is an income generator without which we couldn’t have done the project,’ says lead client GP Vipan Bhardwaj. A sliding gate enables it to be separated from the surgery reception and operate at different times.
Taking exception to the irregularly spaced existing columns, Weiss concealed most behind new walls and clad others with colourful circular casings. New ceiling levels and bulkheads were fine-tuned and co-ordinated with old and new downstand beams to optimise headroom: ‘I fought for every centimetre,’ says Weiss. The existing staircases and lift shaft stayed, enhanced by elegant handrails and a new car. Declaring war on banal institutional details and finishes, Weiss avoided deadly stainless steel lift car surfaces and coved skirtings, and specified domestic basins in consulting rooms.
Despite mandatory requirements covering mixer taps and traps, medical centres enjoy much more independence from design guidelines, regulation and inspection than hospitals, provided authorities are convinced that the installation and maintenance of unconventional features, such as the inset sinks at Wokingham, don’t compromise hygiene. In fact, the centre’s mixer taps achieve enhanced standards.
As Barbara Weiss Architects director Nicholas Jamieson explains, in the wake of the Health and Social Care Act 2012 funding for medical centres has been fiendishly difficult to unlock. ‘Five partners each took out huge bank loans instead,’ says the centre’s Dr Ishac Jalisi. Although the lender’s valuers commented on features they considered expensive and the partners had to convince them the centre would generate sufficient revenue, they were not hemmed in by government cost-benchmarking.
A new accommodation staircase links the ground- and first-floor waiting areas, which have mounted rows of stylish Italian chairs. ‘I spent days and days looking for the cheapest of the cheap on the internet,’ Weiss reflects. The surrounding consulting rooms hark back to a traditional model that separates the GP’s desk and the examination area, with a dividing screen, bespoke cherry-lipped cabinetry, and handy recesses and containers designed to be hard for children to break. They’re much more interested in the curtain wall, which can be switched from clear to opaque for privacy. Its expense will be partly offset against savings on curtains and blinds, which have to be thrown away every six months as part of the hygiene regime. Weiss forewarned the partners that the consulting rooms would overheat in the summer and suggests awnings or solar control film as possible remedies.
The waiting area on the floor above has a long skylight and feels like a traditional residential atrium. As elsewhere, there are ventilation slots rather than cumbersome grilles; cupboard, access and fire panels are regular and discreetly flushed into walls. Natural carpet and timber finishes complete the ambience, along with halogen lighting in waiting areas negotiated with building control. The contrasting world of the treatment rooms has high-performance lighting and 10 air changes per minute.
‘Slightly “woman’s touch”, there are dishwashers and tea points on every floor,’ says Weiss. ‘It’s been designed so things work, with storage for sugar and coffee.’ Staff are especially pleased with the convivial, echoy common room with its long bespoke table, and they’re delighted with the glassy conference room and roof terrace overhead. Bhardwaj jests that the fine views of the skyline and the countryside beyond make it difficult to work.
Looking back across the backland car parking, I realise Weiss is more of an internalising Soane than an externalising Nash. At Wokingham, her interiors fit more comfortably into the modern architect mould than in earlier projects where, despite having worked for Richard Meier and Stirling Wilford& Associates, she sympathetically reworked period buildings. The centre’s exterior seems closer to Adolf Loos, apart from the fussy, quirky steps at the parapet corners, like vestigial acroteria or abstracted giant’s hands.
The centre’s exterior never really looks of its time in daylight, and this is how Weiss seems to want it. Nevertheless, the conscientious work of the interior and its clean but colourist Minimalism is let down by blemishes such as a vertical fold line in the render, which only extends as far as the budget, abruptly exposing the brickwork and corbelling of the original structure, with its mocking tiled roofs. But despite its frontality, the centre, which is well insulated and sealed, is no Regency facade. Its treasures lie within, and may one day be matched by enhancements to its exterior.