When it comes to realising your vision of a dream dental practice which has been ideally crafted to suit your unique needs, there are several approaches to the construction process that need to be considered at length. Once you’ve embarked on a set path it’s costly and time consuming to suddenly change direction, so you must do your homework, take references and make informed decisions from day one. Once you commit yourself to a construction method you must be sure that the process you have chosen is the one most suited to your requirements.
Dentists have several options open to them.
They can refurbish their current practice, but due to the space available and the necessity to treat existing patients this will always impose limitations.
Alternatively, they can purchase a new site and complete the fit out works before moving their staff and equipment across. This is obviously the best scenario, but finding a new building within your current catchment area may not be possible, indeed you may already own the freehold of your practice or be tied into a long lease.
This is why every project will need a bespoke solution.
The DIY Approach
Think of it as doing a dental procedure on yourself by looking in a mirror; it may look like an easy job in the beginning, but once you start it soon becomes apparent that it’s far from simple.
By designing your own practice and project managing the construction phase using local tradesmen, dentists will undoubtedly save money at the front end. However, on reflection this can be a potential minefield, full of divided responsibility issues and potentially unreliable tradesmen, which can lead to significant project delays. It will require your undivided attention to make sure things are running smoothly on site and that the relevant materials have arrived on time. If they haven’t, or a particular trade has overrun on the project, the tradesmen coming in later in the schedule can be delayed and before you know it your time scales have slipped and your costs are spiralling.
Have you, as a dentist, the experience required to design the building? Are you up to date with the correct commercial fire regulations? Do you have a detailed knowledge of your plumbing and power requirements? Have you worked with the correct spatial requirements required for DDA approvals?
And these considerations are just the tip of the iceberg. You will still need to deal with building control, file correct risk assessments and health and safety information and be responsible for all the CDM’s on the site.
It is not reasonable to expect a dental professional to master the skills of design and construction overnight and the time you spend sat at a drawing board trying to rectifying costly mistakes, could be better spent working on ways to improve patient outcomes and maximise profits for your dental business.
In reality, the sensible decision of which procurement route to take comes down to two very different choices.
Either “The Architectural Route” ie. adopt the traditional Architect, Quantity Surveyor (QS), tender and local builder route
“The Design and Build Route” ie. appoint a one stop shop design and build company – and preferably one with plenty of experience in building new dental practices.
1. The Architectural Route
Dentists may well know an architect or be recommended to one by a friend or colleague. Undoubtedly, they may enjoy the experience of working with an individual who is both creative and passionate about their design. Consider, however, that in most cases the building you are fitting out is already in existence. Therefore, do you need the services of someone who specialises in new building construction, or are you actually employing the services of an interior designer at a qualified architects rates? That said, this tried and tested approach to construction should mean that a dentist can be sure he or she gets the best value for money when the project is sent out to tender.
Or do they ?
A recent survey carried out by a leading London Surveyors stated that, on average, most final accounts on tendered projects end up being 20% higher than the initial contract value. This is because main contractors are often seasoned players in the market and know that to win a project via a tender they must keep their prices low at the outset. There is certainly no advantage to highlight any design issues or omissions in the original scope of works. They are far more likely to seize the opportunity of claiming for extras on every alteration to the original design. Once a contractor is on site it is very difficult for the client to argue over additional fees as they may well be holding up future works and therefore haemorrhaging money at both ends of the project.
Undeniably, working with some architects can be very rewarding if this is your preferred route and is indeed suited to large corporate construction where all parties understand how the process works. Each player will have a full team of experts behind them and play the contractual game until a settlement is reached. This however does not suit the individual practitioner, who neither has the time or money to play this expensive game. It is worth noting at this point that if you decide to appoint an Architect, insist that their fee is not based on a percentage of the project value, as there seems little incentive for the Architect to try to reduce costs on your behalf.
Other issues to consider are who will project manage your job? Will it be the responsibility of your Architect, your QS, or you ? Who will make sure the latest health and safety regulations are adhered to etc?
2. The Design & Build Route
Deciding to use an experienced design and build company to handle the whole project could be a far safer option.
With the dentist working closely with the designers, it is far more likely that a design solution will be found that not only works from the dentist’s logistical movement, but also within his or her budgetary requirements. This is achieved by the design team working alongside their estimating team from conception, building up the design around the dentist’s requirements and budget.
Only when the dentist is happy that all concerns have been satisfied and needs met, will the company begin construction. The dentist knows who is ultimately responsible for producing the approved design within the agreed budget and that all the responsibility for the project is down to one company. This in turn speeds up the whole project, because everyone involved is reading from the same page, making completion of the project on time and within budget much easier.
So, when selecting any contractor try and choose an expert in construction. Many equipment suppliers work very closely with dedicated healthcare build teams, who have extensive knowledge of the market, so it is best to take advice or recommendations from them in the first instance. You will be safe in the knowledge that the equipment suppliers have worked with the contractors previously making project management much simpler and smoother.
It is far more prudent to select your equipment from your chosen supplier and then work with a building company that does not try and sell dental equipment or cabinetry. This way you are safe in the knowledge you are employing an expert and not a “jack of all trades.”