Renovating a GP Surgery or Dental Practice Without Closing: A Phased Works Strategy

Full closure is the simplest way to renovate a building and almost never the right answer for a GP surgery or dental practice. Patients need continuity of care, staff need continuity of income, and — for GP practices — the GMS contract requires the premises to remain accessible during core hours. A phased works strategy accepts that the building has to keep functioning clinically while it is rebuilt, and designs the construction programme around that constraint rather than around it being convenient for the contractor.

Phasing is not simply a scheduling exercise. It requires the same CDM 2015 duties as a single-phase project — the practice, as client, must appoint a Principal Designer and Principal Contractor where more than one contractor is involved — plus an infection control risk assessment specific to construction dust and vibration in a live clinical building, agreed before work starts on each phase.

Any water system that has been drained, altered, or left unused during a phase of works must be recommissioned under HTM 04-01 — flushed, disinfected where necessary, and tested — before it is used for clinical purposes again. Skipping this step after construction work on plumbing is one of the most common causes of a post-refurbishment Legionella finding.

Why Full Closure Is Rarely the Right Answer

A GP surgery that closes for eight weeks does not just lose eight weeks of appointments — it risks patients registering elsewhere permanently, disrupts continuity of care for patients with long-term conditions, and creates a gap in NHS contract delivery that has to be explained to the ICB. For a dental practice, closure means no income against fixed costs (rent, staff, equipment finance) for the duration. Phased works keep the building trading throughout, even if at reduced capacity during the most disruptive stages.

How Do You Divide the Building Into Workable Phases?

• Phase by wing, floor, or self-contained cluster of rooms, so each phase can be sealed off from the rest of the operational building
• Decant clinical activity from the phase under construction into any spare capacity elsewhere in the building, or into temporarily rented space nearby if none exists
• Use temporary, fire-rated partition walls and hoarding to physically and visually separate the construction zone from patient areas — not just tape or signage

What Construction-Phase Controls Protect Patients and Staff?

• Dust control and negative air extraction within the construction zone, so airborne particulates from cutting, drilling, or demolition do not migrate into clinical areas
• Noisy or high-vibration work — demolition, drilling into structural elements, plant installation — scheduled outside clinical hours wherever the programme allows
• Segregated contractor access and welfare facilities, kept entirely away from patient entrances and circulation routes
• A documented infection control risk assessment for the construction phase, signed off before work begins and reviewed at each phase transition

How Do You Communicate the Programme to Patients and Staff?

1. Clear signage and website updates explaining which parts of the building are affected and for how long
2. Direct letters or messages to patients whose usual clinic or appointment location is temporarily relocated
3. Staff briefings ahead of each phase, covering revised room allocations, temporary workflows, and any changes to decontamination or clinical waste arrangements
4. A single named point of contact for on-site issues during construction, so problems reach someone who can act rather than being reported informally

What Has to Happen Before a Finished Phase Reopens to Patients?

• Contractor snagging completed and signed off against the agreed specification
• A full deep clean of the finished space before any clinical use
• Water system flushing and recommissioning under HTM 04-01 wherever plumbing was disturbed
• Fire alarm and emergency lighting recommissioning tests for the newly completed area
• CDM handover documentation collected and filed before the space returns to clinical use

A phased renovation takes longer overall than a single continuous build, and it costs more per square metre because the contractor is working around live occupancy rather than an empty shell. For most GP surgeries and dental practices, that trade-off is the only realistic way to renovate at all.