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Primary Health Care Design Briefs

Volume I: Generic Services Facilities

Contents

1.0       The Primary Care Services Network         
2.0       Health Centre Services           
3.0       District Health Facility Services          
4.0       Health Centre Services & Operational Policies
5.0       District Health Facility Services & Operational Policies

1.0  The Primary Care Services Network

1.1 The strategy for reform will develop a strengthened capacity in the MOH for sponsorship and regulation of both public and private sectors.  As described, national policy and priorities based on health needs will shift expenditure towards high quality primary care including preventive services.  The influence on the public sector provider function will be through a system of contractual arrangements combined with awards commensurate with performance.  The private sector will be influenced by improved regulation and standards for accreditation, and encouraged and regulated through competition with a more effective and efficient public sector.  The public sector will also be encouraged to act as an informed purchaser of private sector and NGO services through the RHAs.

1.2  RHAs will therefore be responsible for improving the health status of their populations and ensuring the right balance of service delivery within the available budget.  National policy will drive the shift of resources to primary care but it will be the responsibility of the RHAs to determine the right mix of provision for its population.  Primary care services will be delivered by the RHA's directly managed units (health centres, outreach centres and district health facilities) and/or through private sector units (GPs, NGOs and private health clinics).

1.3  The health centre will remain the cornerstone of the public primary care service for the local population who choose to seek care in the public sector.  The rationalisation process detailed in the National Health Services Plan will result in a smaller number of centres but each will be staffed by a full-time team of health professionals including a general practitioner.  The health centre team will have responsibility for their clients and the clients' health record will be maintained at that health centre.  Continuity of care and management of complete episodes of care is critical and these clients will be actively encouraged to seek primary care from the centre responsible for maintaining their health records.  Clients turning up indiscriminately at other centres will not be seen except in emergencies.  Attention at district health facilities and hospitals will be dependent on referral from the health centre — except for emergencies. The infrastructure development programme is timed to actively support this process by coordinating the availability of improved health centre services with district health facility provision in all specific locations.

1.4  The health centre will provide primary clinical care for a local population of up to 30,000 in some places and between 10,000 and 15,000 in others, the size being dependent on local geography and demography (see HSRP Final Report, October 1994, Annex 3.0: National Health Services Plan for details).  Services will be provided in an accessible and coordinated way, will be appropriate and responsive to local health needs, and will reflect policies set by the Ministry and the RHA.

1.5  Where it is necessary to improve access of services to smaller populations, regular services will be provided at outreach centres using some of the existing health centre buildings.  Depending on the population's health needs and the resources available, including the actual rate at which training can supply the full primary care teams, the RHA will determine the range of services to be provided at these outreach centres.  Initial projections for this are provided in the HSRP Final Report, October 1994, Annex 3.0: National Health Services Plan.  For the most part, it is expected that preventive or wellness clinics will be given priority at outreach centres, for example antenatal and child welfare clinics.  For the two relatively rural RHAs, Eastern and Tobago, outreach centres will be crucial to maintaining cost-effective access and equity for the more remote areas where travel distances and conditions are difficult.  In the more urban RHAs, where distances between health centres are small, and there are greater numbers of GPs, the outreach centres will have a less prominent role.  As primary care develops, including the increased involvement of private sector providers, the role of the outreach centres will decline.

1.6  The district health facility is a primary care centre which provides not only primary clinical care for its local population (20,000 to 30,000) but additionally provides out-of-hours primary care and access to therapies and consultations on-site with hospital specialists for a wider population (80,000+).  The precise range and volume of district health facility services required at any time will be dictated by local health needs and by MOH and RHA policies set to effect changes in health status and behaviours.  The additional services are intended to support the primary care work of both public and private sectors — the latter selectively at first.  Initial projections for this are provided in the HSRP Main Report, October 1994, Annex 3.0: National Health Services Plan.

1.7  For those 5 health centres located in close proximity to the hospitals, the designation of enhanced health centre has been applied.  They will not duplicate the out-of-house emergency care, diagnostic services or specialist outpatient clinics that will be available in the nearby hospital, but will provide those additional primary care services which will be centred in the district health facility e.g. dental and school health services as determined by the needs of the local population.  In the 3 larger RHAs, they are in fact "urban health centres"; and in the case of Tobago and Eastern RHA centres, which serve small communities, special relationships will be required, as well as the integration of these district health facility type services with the hospital ambulatory services.

1.8 The provision of effective health care requires a multi-disciplinary health team in which all health workers understand each other's roles and work in partnership.  Within the health centre the multidisciplinary team will bring together the skills required to meet all aspects of primary health care — prevention, treatment, health promotion and rehabilitation.

2.0  Health Centre Services

Summary of Health Centre Services and Staff

Services to be provided to the local population: 

General Practitioner (medical)       
Chronic Disease 
Health Promotion 
Maternal & Child Health 
Antenatal, Postnatal, Child Health (immunisation, Growth/development monitoring, parenting etc.) 
Family Planning 
Women's Health (Cytology) 
Mental Health 
Men's Health  (screening) 
Home Nursing Service 

The full-time primary care team consists of:

General Practitioner 
Health Visitor 
District Nurse (home nursing) 
Treatment Room RN 
Midwife 
Nursing Assistant 
Pharmacist 
Public Health Inspector 
Clerk 
Cleaner 

Details of Health Centre Services and Staff

2.1 Doctors will be available for consultations twice daily, Monday to Friday.  Arrangements will be in place for advising the patients registered with the health centre of "out of hours" services at other times.  Some sessions will be held in the evenings and/or on Saturday mornings to meet the needs of the working population.

2.2 Consultations will be arranged by an appointment system which will be sufficiently flexible to accommodate emergencies at each clinic.

2.3 Other members of the core primary care team providing services throughout the working day will include:

a) The treatment room nurse who will carry out clinical procedures during clinic hours and manage chronic disease clinics, for example diabetes, hypertension and venous ulcers etc. at other times.

b) The health visitor who will take referrals relating to infants, pre-school children and families needing support, advice and health education in learning to effectively manage their health and well being.  The health visitor will play a significant part in the early detection and prevention of child physical and sexual abuse.  This work will be undertaken both in the centre and in the family's home.  In addition, the health visitor will be responsible for health surveillance within a caseload of families with children under 5 years and for health promotion activities with other groups — preconception  counselling for men and women, healthy lifestyles for adolescents, women's health screening and, together with the midwife, care of pregnant women.

c) The psychiatric nurse who will provide advice and take referrals of patients manifesting symptoms or suffering from mental illness.  In addition, the psychiatric nurse will manage a caseload of patients with chronic and continuing mental health problems, preventing avoidable breakdown or unnecessary admissions to secondary services for either the chronically ill or those suffering from episodes of acute illness. This will include preventive programmes/group work, e.g. with depressed mothers.

d) The district nurse and team who will care for patients in their own homes, at same time providing advice and emotional support for relatives.  Nurses will assess and co-ordinate changes in the patient's treatment in consultation with the doctor, and make  referral to other services the patient or family may need.

The home nursing service is a new service development which will be available 7 days a week, daytimes only at first.  The nurses will manage the care of patients discharged from hospital and those with episodes of acute illness who do not need to be admitted to secondary care. In addition to the caseload arising from the centre's catchment area, the district nurse will liaise with local doctors in private practice and provide their patients with the same home care services available in the public sector.

e) The midwife will manage the antenatal and postnatal care of women who attend the centre and, in partnership with the health visitor, follow up women who do not attend clinic or hospital sessions — these women most frequently represent the more vulnerable groups in need of careful monitoring and support.  The midwife will also work closely with the clinic doctor and the obstetrician responsible for the management of high-risk pregnancies.  She will manage the liaison and communications between the maternity unit and the health centre.

f) The social worker will support and advise the other team members on the social problems they encounter, will take referrals and manage a caseload of families in need of support and supervision, particularly where there are children at risk of abuse and where there is a history of violence.  She will be the advocate for the more vulnerable — the disabled and the chronically ill — ensuring that they receive the benefits and services to which they are entitled.  She will provide counsel for special groups —  very young females in the throes of unplanned pregnancies, the abused and the abusers.

g) The public health inspector will provide advice for other team members and the local population on matters relating to the environment.  She will be responsible for monitoring the locality including safety and accident prevention, supervising food handling, outbreaks of food poisoning, water safety, vector control and other areas to help to achieve a healthy non-contaminated environment.

h) The pharmacist will be responsible for the pharmacy services provided at the health centre.  This team member will provide dispensing advice and support to the primary providers in the team while ensuring the rational and efficient use of this valuable resource.  The pharmacist will be able to play a greater role in the management of patients on long-term drug regimes aimed at increasing their understanding and compliance.  Further, the pharmacist is a resource for advice and supervision for the staff in nursing homes and residential homes and for general practitioners in the area.

i) The centre manager will be responsible for the smooth running of the centre.  He/she will manage the appointment systems, the records systems and the systems in place for referring patients to the district health facility or to the hospital.  It will be the responsibility of the centre manager to arrange centre meetings, to ensure that all staff are informed of the arrangements about the running of the clinics etc., of procedures to deal with problems relating to the public, security or other issues which may interfere with internal or external relationships.

Regular Clinics

2.4 Regular clinics will be held for child health surveillance, immunisation, family planning, chronic disease management and men's and women's health for the local catchment population.  The frequency and range will be determined by local circumstances.

2.5 Health promotion sessions will be held regularly to promote healthy lifestyles.  These will be targeted towards the prevention of illness and associated complications through informing and motivating the population.

2.6 This model of primary care organisation is appropriate for the public services or the private sector — the numbers working in the primary care team will be dependent on the population served, the mix of skills will be dependent on the health profile for the locality.

Table 2 (1) shows a sample health care schedule.

2.7 Outreach Centres

The services to be provided at outreach centres will be primarily preventive and promotive in nature.  This is to facilitate access by the local population to those services which are critical to maintaining and improving their health status.  These are:

* Antenatal and postnatal supervision/care and advice

* Child health — immunisation, growth & development monitoring, management of simple illnesses

* Family planning and general health advice

Equipment will not be needed as a separate supply item for the outreach centres.

3.0 District Health Facility Services

Summary of DHF Services and Staff

Services to be provided to the local population:

Routine primary care services for the local catchment population as those provided at health centres 

* 24-hour ambulatory care emergencies
* Radiological and basic laboratory services 
* Dental services 
* Nutrition services 
* Specialist clinics — dermatology, paediatrics, ophthalmology, psychiatry, medicine, obstetrics & gynaecology 
* Physiotherapy 
* School health services to local primary schools 
* Community mental health services

Core Staffing Summary:

Primary Care Physician 
Health Visitor 
District Nurse (Home Nursing) 
Nurse (Treatment Room) 
Nursing Assistant 
Midwife 
School Nurse 
Pharmacist 
Dentist 
Dental Nurse 
Dental Assistant 
Social Worker 
Public Health Inspector 
Centre Manager 
Clerk 
Receptionist 
Security Personnel 
Cleaner 
Driver 

Details of DHF Services:

3.1 District health facilities will provide the routine primary care services as described for a health centre for its local catchment population.  Development of the district health facility must aim to support the surrounding health centres and private primary care and not undermine their importance to the local populations for routine primary care.  Additional services will be available on-site throughout the week to a larger district health facility catchment population.  These include pharmacy, physiotherapy, laboratory services, X-ray, electrocardiology, audiology screening and dental services for school children.  It is through these services that access to diagnosis and treatment will be improved as will the quality of service the patients receive.  A further benefit will be the prevention of inappropriate referral to and overload of hospital emergency services.

3.2 Doctors will be available to a wider population for primary care emergencies over the 24-hour period, 7 days a week.

3.3 Consultations will be arranged by an appointment system sufficiently flexible to accommodate emergencies, sudden  illnesses or accidents during clinic hours as well as during "out of hours" day and night.  Victims of major accidents will usually be taken directly by ambulance service to the nearest major accident centre, but some patients may be stabilised at the district health facility en route to hospital.

3.4 Suspected fractures will be diagnosed by X-ray and those that are not complicated will be plastered on-site.

3.5 Dietetic clinics will provide expert advice for a range of conditions, and will focus particularly on those at risk for diabetes and hypertension.

3.6 The physiotherapy department will treat acute conditions in addition to providing rehabilitation and maintenance programmes for stroke patients and patients with other disabling physical conditions.

3.7 Specialist consultant services will be available. The number and frequency of sessions will be determined by need and demand in practice. Referrals to the specialists will be made by the doctors working in the district health facility, doctors working in adjacent centres and by general practitioners working in the private sector. Such sessions will include general medicine, surgery, orthopaedics, obstetrics, paediatrics and psychiatry and others as needs indicate.  This new development will improve access for patients to specialist services, lessen the waiting time for secondary referral and reduce the overload on hospital out-patient departments.

3.8 The district health facility will be the RHA's audiology centre for secondary screening of infants and young children including school children whose first screening at the health centre or school indicates the need for further investigation.

3.9 The community paediatrician will hold regular clinics, seeing infants and young children referred for further investigation by other health centres and will have a major role in teaching and training primary care staff.

Table 3(1) shows a sample district health facility schedule.

4.0 Health Centre Services and Operational Policies

4.1 Purpose

4.1.1 Health centres will provide primary care for catchment populations of between 10,000 and 30,000 who will self refer for injuries, diagnosis and treatment of illnesses and diseases normally managed by family practitioners.

4.1.2 Doctors and the team will provide the traditional family health care, including prevention and health promotion for a local population in the immediate catchment area of the polyclinic.

4.2 Staffing

4.2.1 There will be a full range of primary care staff: doctors, nurses, including health visitors, home nurses and psychiatric nurses, who will work in the treatment room and at clinic sessions.

4.2.2 As part of the primary care services, antenatal and postnatal services will be provided for the local population by midwives from the centres.

4.2.3 The centre manager and staff will provide reception and support services.

4.3 Normal Hours of Work

4.3.1 The centre will be open for regular services — for example between 8 am and 6 pm Mondays to Fridays, and between 8 am and 12 noon on Saturdays.

4.3.2 Out-of-hours primary care services will be available by local arrangements or at the Region's polyclinic.

4.4 Schedule of Accommodation

Access to clinic areas should be on a single level, with facilities to accommodate people with physical disabilities.

4.4.1 Reception area with counter and space for clerks, designed to allow for  confidential discussion.

4.4.2 Centre manager's office adjacent to reception area.

4.4.3 Waiting area with seating for 30 people at any one time, with a play area for children.

4.4.4 Three soundproof consulting suites consisting of the consulting office and 2 examination rooms which will be shared by the doctors.

4.4.5 A treatment room with couch and lighting for minor surgery

4.4.6 A preparation room adjacent to the treatment room

4.4.7 A specimen lavatory facility adjacent to the treatment room

4.4.8 A sub-waiting area/bench outside the treatment room.

4.4.9 Two interview rooms to accommodate social work, mental health, visiting therapists etc.

4.4.10 A health education room adjacent to the clinic room with black-out facility to accommodate 30 people.

4.4.11 Two interview rooms adjacent to the health education room for interviewing parents and seeing clients during clinic sessions.

4.4.12 Office accommodation for the following staff:

4 full-time doctors 
12 DNs including treatment room and home nurses.
5 full time DHVs 
2.5 full time CPNs 

4.4.13 Seminar room for 30 people

4.4.14 Staff room, adjacent to staff kitchen.

4.4.15 Storage, cleaning, portering rooms.

4.5 Organisational Structure

4.5.1 The centre will be managed for its day-to-day functions by a centre manager who will support the clinical staff and be responsible for ancillary staff.

4.5.2 A house committee will set standards of service and delivery.  This will have membership from all disciplines working in the centre, including local users and will be chaired in the first instance by a senior clinician.

4.6 Budgets

A budget will be delegated to the centre manager, who will regularly inform staff of costs and expenditure.  The house committee will be held responsible for containing costs within the budget.

4.7 Relationship with Other Parts of the Region

4.7.1 Records for referral to and from the polyclinic and hospital consultant will be managed between the centre manager and referring clinician.

4.7.2 Local authority, schools and private sector arrangements will be agreed to by the primary care general manager and managed from the health centre.

4.8 Patient Services Organisation

4.8.1 The patients will be directed by sign or porter to report to the reception desk. A notice board will be in place to assist patients with directions.  The receptionist will allocate a number to patients who have appointments and to those without appointments but who require urgent attention.  The patients will then remain in the waiting area until called to see the doctor or nurse.  Patients who do not need urgent attention will be given an appointment for another time.

4.8.2 If the patient has not been seen before the receptionist will start a record. If the patient has been treated previously, the receptionist will retrieve the patient's record and have it transferred to the doctor's consulting room.

4.8.3 Patients needing attention from the treatment room nurse and who do not need to see the doctor will be given a number and will wait to be called by the nurse.

4.8.4 There will be an intercom or buzz call system between the receptionist, the doctors' consulting rooms and the treatment room by which patients will be called for consultation or treatment.

4.8.5 Patients requiring examination will be directed by the doctor to one of the adjacent rooms. The doctor may see the next patient in the consulting room during the time a patient undresses and dresses.  A chaperon will assist female patients during physical examination by male doctors.

4.8.6 Patients who, having seen the doctor, require immediate treatment, will be directed to a sub-waiting area outside the treatment room, taking with them a note about the treatment required.

4.8.7 Patients who need to be seen again will report to the receptionist after seeing the doctor and will be given an appointment to see either the visiting consultant or the centre doctor and nurse.

4.8.8 Patients who require drugs will take their prescriptions to the pharmacist.  When the pharmacist is not available the doctor will dispense and fill the prescription or provide a "holding dose" and arrange for the prescription to be filled next day.

4.8.9 The pharmacy will normally be open during the hours of doctors' consultation. When it is closed a representative range of drugs will be available for the doctors to dispense.  This supply will be kept in a safe place and will be replenished regularly.

4.8.10 Patients needing emergency treatment who require admission will be transferred immediately to the hospital by ambulance with trained para-medical ambulance staff.

4.9 Treatment Room

4.9.1 Patients will go to the treatment room either as emergencies or for planned treatments, examinations or tests.  These will include dressings, suturing, blood pressure readings, vaccinations, other injections, urine tests etc., or for self treatment teaching.

4.9.2 The treatment room and the adjacent preparation room will be clean areas, with adjacent areas for disposing contaminated or soiled dressings.

4.9.3 Sterile supplies for all dressings, etc. will be available from a central supplier.

4.9.4 Soiled trays and equipment will be placed in the container marked "soiled equipment", to be returned to the Sterile Supplies Department and removed at the end of the shift or before, if necessary, to a collection point.

4.9.5Soiled linen will be placed in the appropriate soiled linen container, secured and removed to the disposal area.

4.9.6 Soiled dressings will be placed in a garbage bag marked "clinical waste" and disposed of by agreed procedure.

4.9.7 Syringes and needles will be placed in a "sharps box" and disposed of by agreed procedure.

4.10 Child Health, Antenatal, Family Planning, Other Screening Sessions

4.10.1 There will be agreed protocols for all regular clinic sessions which will describe the activities and responsibilities of each professional.

4.10.2 The doctor, health visitor, midwife and nurse will provide regular sessions throughout the week for the population requiring these clinic services.

4.10.3 Individuals and families attending clinic sessions will be directed to the area marked "Health Education Room".

4.10.4 The sessions will be by appointment but will, in addition, accommodate self-referrals.

4.10.5 There will be a private area for interviews, access to records for regular attendees and equipment available appropriate to the session.

4.10.6 Individuals and families will be interviewed by the health visitor, the midwife or nurse, depending on the session, and will see the appropriate doctor.

4.10.7 Advice and support for parents will be a priority for the health visitor, who will arrange to visit families in their homes.

4.10.8 All attendances at the clinics will be recorded by the clerk who will be responsible for arranging further appointments and for maintaining the records system in collaboration with the professional staff.

4.10.9 Health promotion and health teaching sessions will be provided in the health education room, separate from the clinic sessions.  Home nursing care will be provided 7 days a week for patients in the catchment area of the primary care team.

4.11 Operational Management

4.11.1 A senior and experienced nurse or health visitor will be appointed centre co-ordinator for nursing and health visiting, to be responsible for ensuring that the team leaders work together in managing their teams providing services either in the centre or by home visiting.

4.11.2 A senior doctor will be appointed/nominated who will be the overall clinical lead for the health centre.

4.11.3 A health centre manager will be appointed who, with his/her support staff, will provide the full range of administrative and clerical support and domestic and security services for the health centre.

4.11.4 The health centre manager will be responsible for managing the accuracy and timeliness of the information provided by manual/computer systems.  These will be audited by the house committee, ensuring that the appropriate data systems are in place and that the data is forwarded as outlined by the RHA.  This information will in addition be used by the house committee in setting targets and in the efficient management of services.

4.11.5 The health centre manager will be responsible overall for the timely, efficient and effective running of the centre.  This manager will be the first contact for patient problems and will be the secretary to the house committee, which will meet regularly.

4.11.6 The health centre manager will investigate or ensure that investigations take place when complaints occur. There will be a regular internal review of complaints and compliments and a regular reporting to the primary care general manager.

4.12 Communication

4.12.1 An intercom system will be in place for directing patients and providing and receiving information from doctors and nurses.

4.12.2 A staff-to-staff call system for emergency use will be in place. It will be operated via reception.

4.12.3 Each consulting room, treatment room, interview room, clinic room as well as managers' offices and staff rooms will have telephones.

4.13 Supplies

4.13.1 A system of requisitioning and inventory management will be in place to maintain safe levels of drugs, sterile supplies and equipment.  Clean linen will be supplied weekly, stationery and domestic supplies will be supplied regularly with monthly requisitioning.

4.14 Housekeeping

4.14.1 The health centre manager will implement a programme for cleaning the centre within agreed cost limits.

4.14.2 The centre will be cleaned regularly in accordance with an agreed and costed programme.  A planned programme of cleaning patient areas after clinic activities will be in place.  Standards will be monitored and all members of the centre will be expected to participate in maintaining and monitoring these.

4.15 Disposal

4.15.1 Items for disposal will be placed in appropriate colour-coded bags.

4.15.2 Soiled linen will be transported to a central laundry area regularly.

4.15.3 Contaminated waste, including sharps, will be sealed and removed for incineration regularly.

4.16 Transport

4.16.1 Pool cars will be required for nurses, health visitors and therapists carrying out home visits and who do not have their own transport.

4.17 Security

4.17.1 There will be a security guard on site at all times.

4.18 Recruitment and Performance Appraisal

4.18.1 The primary care general manager will authorise the filling of all appointments.

4.18.2 The interviews will be co-ordinated by the general manager's human resource officer and conducted by the appropriate senior professional.

4.18.3 Disciplinary action will remain the responsibility of the primary care general manager or the manager's designated officer for matters relating to contract of employment.  For matters relating to professional practice the manager will support the senior professional adviser in carrying out the investigation, and taking further action, such as dismissal or referral to the registering body.

4.18.4 Staff working at the health centre will be subject to the same terms and conditions as other RHA employees.  These include leave, remuneration, training development performance, review and reward.

 

5.0 District Health Facility Services & Operational Policies

5.1 Purpose

5.1.1 District health facilities will provide primary care for  catchment populations of between 20,000 and 30,000 who will self refer for injuries, diagnosis and treatment of illnesses and diseases normally managed by family practitioners.   In addition, they will provide certain services for wider populations of up to around 135,000.  These include primary care services over a 24-hour period, 7 days a week; diagnostic facilities, such as X-ray, ultrasound and ECG; and specialist outpatient services provided by visiting specialists.

5.1.2 Doctors and team will provide the more traditional family health care, including prevention and health promotion for a local population in the immediate catchment area of the district health facility.

5.2 Staffing

5.2.1 There will be a full range of primary care staff: doctors, nurses, including health visitors, home nurses and psychiatric nurses, who will work in the treatment room and at clinic sessions.

5.2.2 As part of the primary care services, antenatal and postnatal services will be provided for the local population by midwives from the centres.

5.2.3 The centre manager and staff will provide reception and support services.

5.2.4 Physiotherapy and dietetic advice will be available for regular planned clinics, as will social work and other support services appropriate to local needs, e.g. psychology, speech therapy, audiology.

5.2.5 Visiting hospital specialists will provide regular planned consultations for the catchment population.  Other primary care doctors who are not based at the district health facility will refer their patients to these consultant sessions.

5.3 Normal Hours of Work

5.3.1 The centre will be open for regular services — for example between 8 am and 8 pm Monday to Saturday, and between 8 am and 12 noon on Sundays.

5.3.2 Out-of-hours primary care services currently available from health centres will be provided over a 24-hour period, 7 days a week.  On-call staff will staff will advise, treat or refer to hospital during "unsocial hours", 8 pm-8 am.

5.4 Specialised Equipment: Summary

* Portable ventilator 
* X-ray facilities including diagnostic equipment and viewing screen 
* Ultrasound 
* Lab equipment for bloods/urine analysis 
* ECG measurement 
* Minor surgery facilities 
* Diathermy equipment 

5.5 Key Space Needs & Functional Relationships

Access to clinic areas should be on a single level, with facilities to accommodate people with physical disabilities.

5.5.1 Reception area with counter and space for up to 3 clerks, designed to allow for confidential discussion.

5.5.2 Centre manager's office adjacent to reception area.

5.5.3 Waiting area with seating for 30 people at any one time, with a play area for children.

5.5.4 Three soundproof consulting suites consisting of the consulting office and 2 examination rooms which will be shared by the doctors.

5.5.5 A treatment room with couch and overhead theatre light for minor surgery; space for laboratory testing. 

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