Just what the doctor ordered

GP surgeries can leave any patient feeling nauseous, but when they’re designed, developed and built by Guy Greenfield, they can be a real tonic.
By Eleanor Young

Architect, developer and contractor. Few architects get to play such a wide range of roles on any project, let alone a health building. But while practices looking for dependable incomes have courted LIFT (Local Improvement Finance Trust) developers and tried to break into the big time on PFI hospitals, Guy Greenfield has been designing some rather unusual doctors’ surgeries. And most recently, on a £1.7m project in Dulverton on Exmoor, he has also been developing and building them.

Dulverton surgery pulls together many of the strands of Guy Greenfield Architects’ work since the small practice was founded in 1990. Greenfield’s first love is architecture – although he originally trained as an engineer, only converting to architecture after a sandwich year in practice. He spent his early years as a job architect at Sidell Gibson dealing with unpleasant letters from contractors.

Sitting in the office that his five staff share with brick producer Wienerberger and other small practices on the edge of the inns of court around London’s Chancery Lane, Greenfield says his early experience led him to take a less conventional route than many architects.

‘I don’t like arguments and that is not what I went into architecture for,’ he says. ‘Acting as your own contractor removes a tier of anxiety, angst and nasty letters from the builder.’ In the method he has evolved the job architect gets closely involved in buying materials as well as specifying. He has had five to six builders on his books for the past 10 years moving from project to project in the South-west. But the critical team member is the site agent. They work within a similar structure to that of a standard contractor, putting in requests for information and so on. ‘But they are not preoccupied with winning points and winning time,’ says Greenfield.

And after early success converting a house in West London and selling it on the rising property bubble, he went into development. The attraction of pulling a deal together and being his own boss ensured it became a habit. As a developer, his projects have included a set of housing schemes (see RIBAJ June 2005) and, most ambitious yet, a clifftop hotel in Croyde, Devon, which is in planning. Greenfield also has a record in doctors’ surgeries. His numerous small-scale refurbishments and conversions, including a 2050m2 fitout of a health centre in Feltham, west London, with modular GP surgeries, culminated in the Stirling Prizeshortlisted Hammersmith doctors’ surgery most notable for its dramatic white cara pace set against the concrete flyover of the A4.

Dulverton is a little closer to home. Greenfield lives 10 minutes walk from the site, although he practises out of his London office during the week. He met his doctor clients in Dulverton at a party, a couple of years on from the success of his Stirling nomination. A paddock at the end of the garden of the local dentist – whose practice will be based in the new surgery – was secured, complete with southfacing view and a forest of tree protection orders which defined the buildable area. An
oversailing roof, vertical windows overlooking a shallow pool and an Exmoor stone wall will all mark this out as an unusually attractive, light and well thought-through surgery when it is completed this spring.

The economy of GPs’ surgeries has bred only a small number of interesting buildings. Greenfield’s ambitious sort of architecture is rare. ‘There are three issues with building doctors’ surgeries,’ explains Greenfield. The district valuer’s assessment is critical to determining future rents from the primary care trust, and there is also the effective capital value of the project, which in turn defines how much banks are prepared to lend. On such a certain risk they will normally lend 100%, but obviously the price of lending is also critical to the payback on a project. And lastly there is, of course, the cost of building itself.

‘The National Trust planners won’t allow a Travelodge-style surgery,’ was how Greenfield put his case for Dulverton to the district valuer. The valuation was still lower than hoped for but luckily the local primary care trust com- mitted extra funds to design quality – again partly thanks to the backing of the local plan- ner. In fact the design quality was critical to the local GPs, who during the interview process expressed disappointment with the quality of buildings they could expect from a medical developer. It was that which led to Greenfield becoming developer as well as architect of the surgery. For his part, he was attracted by the minimum personal outlay and risk (‘you always have to consider your escape route’) as well as the chance to build an interesting building.

Greenfield reckons on saving 10% on contractors’ costs by building a project himself. But more importantly for him, the way it has been procured has allowed him to retain elements such as the glazing between wall and roof. ‘I like the separation of elements, but I suppose it is an extravagance.’ Even if the project goes 5% or 10% over budget to £1,700/m2, as Greenfield predicts, the development will break even on completion. ‘And in the longer term it is very profitable thanks to the three-year upwards-only rent review,’ he says in typically candid fashion. ‘That is when you start to earn money. And eventually I and the doctors will each own 25% of the building. That is with no investment, just borrowing.’

Certain themes emerge in Greenfield’s designs and more particularly his surgeries: the separation of elements, the importance of the toplit reception, the vertical window device in treatment and consultation rooms to balance light and privacy, the importance of adjacent landscaping. Like many architects, he has an abhorrence of multiple corridors and so designs reception atriums to double as circulation spaces (a canny move with district valuers who don’t count circulation as lettable). ‘I like clarity and efficiency and for all my buildings to have a logic to them so I spend lots of time refining designs,’ he says. ‘I always have a fascination with the plan; a well resolved plan is important to me, along with imagination.’ And, he adds, ‘I like personable things, beautiful things.’ Greenfield sees himself as a modernist whose strength (and planning success) lies in using traditional materials, typically slate and stone, with contemporary forms.

At the other end of the scale are what Greenfield characterises as ‘Travelodge’ surgeries, boxes with a facade of neo-Georgian tat attached. Surgeries as a building type have never had their own architectural language. Polyclinics, many procured under the LIFT initiative, are perhaps starting to set a new design agenda in urban areas where many doctors and other services are gathered in these multipurpose buildings. But from the front room of a Victorian house to the 1960s box attached to a car park, few GP practices outwardly express their civic function or even offer the prospect of care and wellbeing. Instead, dullness and stuffy administrative boredom prevail. Greenfield wants to work at the other end of the spectrum and is open about borrowing elements of Ronchamp at Dulverton, while his Hammersmith surgery has been compared to Richard Meier’s Jubilee Church in Rome. Are churches really his model? ‘Temples,’ is his droll reply.

It is interesting to see how Greenfield’s style of architecture, with its acknowledged extravagances that impart a strong sense of wellbeing to users, fares under different funding regimes. In Hammersmith the health authority-developed project had a design-positive outcome. Greenfield’s next new build surgery is at the centre of an urban extension of 2,000 homes in Waterlooville, Hampshire. Within part of a Feilden Clegg Bradley Studios’ masterplan, the surgery will occupy a prominent site on the boulevard. His joint clients for this project, developer Grainger and the doctors, are both looking for a sculptural building, and the 1,700m2 drum represented by the model in Greenfield’s office looks like it will deliver that. Although it is likely the project will go ahead – even before much of the housing – it is undergoing value engineering while those involved also cast around for better funding.

But doctors’ surgeries are an area where Greenfield feels he can make a mark. Not for him the vagaries and expensive delays of LIFT. Next stop, his local primary care trust to discuss how he can help local doctors as a developer. ‘I look forward to doing a deal,’ he says.

Photos: Paul Tyagi