Primary care buildings: government policy, implementation and community involvement in facility planning and design

Cavanagh, Susan Deborah (1999) Primary care buildings: government policy, implementation and community involvement in facility planning and design. Doctoral thesis, University of North London.


Between 1979 and 1997, British Conservative governments took the decision to shift the balance of health service delivery away from acute hospitals into an expanded network of primary care services provided from local and community based settings. This had implications for the architecture of primary care, as new and extended facilities were required. Controversially however, instead of developing a centrally planned strategy to provide an equitable distribution of resources supporting comparable services to people in all locations, government policy enabled a disparate range of primary care facilities to be built throughout the country, determined largely by the interests of individual GP practices and the particular health ideologies of district level commissioning authorities.

Against this background, this study sets out to contribute new knowledge and understanding of the development of primary care architecture in two ways. First, through conducting a social analysis of primary care buildings that explores the multiple influences of political and health ideology; implementation processes; key stakeholders; commissioning and design mechanisms; and historical and geographic contexts. Second, through developing and applying a methodology for evaluating how far design and community involvement processes in primary care building projects, built during the 1990s, have been successful in meeting the World Health Organisation's social principles for reducing inequalities in health by increasing inter-sectoral collaboration and community participation.

The findings of this cross-disciplinary study provide new insights into several areas of cultural discourse. For example, through demonstrating the impact of medical and social models of health on primary care centres; exploring political and health professional attitudes to community involvement in health facilities planning; and examining the role of architects in facilitating community involvement during the building design process. The study concludes with a discussion of some of political, organisational and architectural factors, identified during the research, that might support a more consensual approach to primary care buildings and service delivery in the future.

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