Practice made perfect

It's blindingly obvious as soon as it's suggested, yet until recently it had never actually been tried. If health centres were sited in town centres, fronted by a shop window and open all hours, then people would have no inhibitions about walking straight off the street for treatment.

This revolutionary concept has led to a new type of healthcare building called, appropriately, the walk-in centre. Within the last four years, a total of 43 walk-in centres have been opened by the NHS across England, and a further 22 are under development.

Set-up costs range from £500,000 to £2m, depending on site, size and design.

Luton NHS Walk-in Centre sets an impressive standard for this building type. Located on Chapel Street, just off Luton's main shopping street, the four-storey 943 m² building is larger than most, and its set-up cost came to £2.3m, including a £1.6m contract.

The centre has a smart, efficient-looking, modern shop front incorporating a clear-glazed, double-storey "shop window". It was designed by a practice with an all-too-rare reputation for bringing architectural distinction to healthcare buildings, David Morley Architects. "The building has a modern look because it provides a modern service," explains partner Jonathan Wilson.

The shop window rises straight up from the pavement edge in the form of five large single-storey panels of clear glazing, one of which is the main entrance. For good measure, the glazing is repeated on the first floor directly overhead. The shop window does exactly what it is supposed to – it displays what's on offer to all passers-by. Not, admittedly, the actual medical treatments, as these thankfully take place in more private rooms at the back, but a large, airy, welcoming waiting room with a reception desk at one side. A street sign juts out from above the entrance, proclaiming the new service on offer.

Open all hours
Marie Simon, who set up and now runs the walk-in centre on behalf of the local NHS primary care trust, says that people have been, well, walking in in their droves from day one. "We've been very, very busy from the day we opened in February. We're in a very convenient location in the town centre. And we're open every day till 10pm, including weekends, bank holidays and Christmas day. So people just walk off the street. People working or shopping in the town centre and commuters all use it. But it could be anybody from anywhere. They can be registered with the NHS or not – that's not an issue – and you don't need an appointment. We've had as many as 250 new unregistered patients in one month."

The fact that Luton is a deprived area is central to the project. "Part of the population has no access to healthcare," says Simon. "There are not enough GPs here, and those there are have long waiting lists. The Luton & Dunstable Hospital is four miles away and has a very busy accident and emergency department. We are run by nurses and a few healthcare assistants, who deal with minor injuries and illnesses, such as twisted ankles, ear, nose and throat complaints and skin rashes. So we take pressure off the GPs and A&E. And because we cater for unregistered patients, we reflect the ethnic mix of the town and attract people who are new to the area."

As well as providing minor medical treatment, the centre caters for Luton's underprivileged, ethnically mixed community in other ways. The reception desk has access to an instant telephone translation service. And the third floor is dedicated to "partners" or voluntary agencies providing a range of welfare services, from the Relate counselling service to a health promotion drop-in centre specifically aimed at the women of the town's Asian population.

The medical and counselling services are all helped in their mission to attract new customers by the crisp, modern, transparent appearance of the building. Yet what looks like a brand-new, up-market infill building was in fact converted from a particularly off-putting, system-built 1960s block entirely clad in heavy, grey concrete panels. A former job centre, instead of addressing the street, it had a gloomy, recessed shop-front at pavement level.

Morley's reworking of the street frontage has made it more inviting and accessible in several ways. For a start, the shop window at street level was brought forward to the edge of the pavement and the floor-to-ceiling, clear-glazed panels were introduced. Second, the whole building has been unified into a single use. Whereas before, the ground floor and the stairs to the upper floors were served by separate front entrances, these have been combined into a single entrance located between the waiting room and the stairwell.

In the extra space gained in front of the stairwell, a lift has been added for the convenience of patients. The front of the lift shaft and the lift cabin have both been glazed to continue the theme. As well as adding a touch of dynamism to the streetscape, the exposed lift shows passers-by that the walk-in centre's public service extends to upper floors too. On the top two floors, the raw concrete cladding has been retained, but it has been brought up to date by being screened behind see-through grilles of galvanized steel.

The main entrance leads straight into the waiting room, which is made more light and airy by its double-height space and clear-glazed facade. White-painted walls and seats in cast aluminium add a reassuringly efficient ambience, though an absence of plants, artwork, children's toys and other distractions make it appear more clinical than it need be. Marie Simon regrets that earlier attempts to enliven the waiting room in this way had suffered at the hands of a few unruly patients.

Satisfied customers
Behind the front waiting room, assessment and treatment rooms are arranged along either side of a central corridor. The medical services on the first floor have their own waiting area. Counselling and meeting rooms on the second floor are likewise fronted by their own dedicated waiting room. The top floor is given over to staff offices and changing rooms and the local NHS Direct telephone advice service.

Behind the shop window, there appear to have been plenty of satisfied customers. "The biggest compliment we've had is someone saying: 'You're not telling me it's on the NHS. It looks like a private clinic,'" says Simon. Her only regret is that the narrow floor plan forced the medical services to be split over two floors. "It led to the additional cost of the new lift, and it can cause difficulties in escorting patients to and from the upper floor," she says.

As for the services on offer, the new walk-in centre not only reaches the parts of the population that other NHS facilities cannot, it also provides services not available elsewhere. "Our nurses typically spend 15 minutes with the patient," explains Simon. "People don't feel awkward about coming in and asking about some health issue or other. With a GP, you would be lucky if he looked at you. So when I go shopping in the town centre, people stop me to say the service is wonderful. The Asian women love it here because we offer something different, and they come in great numbers. They're now saying they want to bring their husbands for advice too."