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The Alders

'My dentist and all their staff are caring, welcoming and kind. My husband and I husband cannot fault this practice. I am disabled and access is excellent. My dentist has made sure the practice has access for all. I do not think there is a dentist here who would not look after their patient as their first priority. I am (or have been) a very nervous patient, and have been reassured during every step of my treatment. We have been using this practice for many years and do not think you could find a more caring, attitude to NHS patients. From the frontline at reception to sitting in the dentist chair, you are a priority. We cannot praise this practice highly enough.'

Dentist Duncan Caldwell's practice employs four dentists and 10 additional staff. Here, he talks about its transformation – from its origins in the 1940s to the 21st century practice it is today

I purchased The Alders in May 2008 after nearly 20 years in the practice working as an associate. The practice was established in the early 1940s and, therefore, has a very well established, broad patient list with generations of the same families attending. It's worth noting that 95% of our patient base is NHS.

An opportunity arose to re-evaluate and reconfigure our working space as the    upstairs of the property (which is rented as a separate flat and accessed from a rear external staircase) became available. Originally, the practice was entirely on the ground floor and made up of three surgeries, an X-ray room, a waiting room and a reception area. There was a single-storey annexe that housed a kitchen area, staff and patient toilets and an office. The disabled access was via portable ramps placed to help wheelchairs enter via the two steps at the back door.

When the separate upstairs flat became vacant, a decision was needed as to whether to rent it out again or to incorporate it into the practice. By rebuilding the internal staircase and incorporating the upstairs into the practice: a kitchen, a staff room, an office, a staff toilet/shower room and, more importantly, a large decontamination room could be developed which has helped us achieve best practice in line with HTM-01-05. This also meant that the single-storey annexe could be reconfigured with a fourth surgery which was much more wheelchair friendly, incorporating a disabled toilet and an auxillary waiting area.

The garden was landscaped to allow mobility-impaired patients to access the building without any assistance. The development work improved access for disabled patients, provided us with a decontamination room, vastly improved the layout of the staff areas of the practice and provided a state-of-the-art fourth surgery with garden views through a double patio door – something much appreciated by dentists and patients!

I had always wanted to improve the access to the building for our wheelchair patients and my dream was to have a surgery in which the dental chair faced a patio door with a view to a garden. We have a very productive vegetable garden here at The Alders which the patients have always very much enjoyed viewing.

The project took nine months and McKillop were excellent at advising on equipment - they didn’t disappoint at any stage of the project.  We had previously equipped one of our surgeries with a Cleo chair from Takara Belmont, therefore I was aware of the reliability and ease of use of their units.  The knee break action of their Cleo chair allows easier access for patients. As we’d worked at improving the approach into the practice, it was logical to do whatever possible to also improve access into the chair itself! 

The Cleo also allows the dentist to be better positioned for access to the patient’s oral cavity for some aspects of prosthetic and oral surgery work.  I believe in the old adage that if it’s not broken, don’t fix it and, as my old chair had been a loyal servant, I went for the same make again. 

I wanted to base the colour scheme around parrot green chair upholstery and the dark wood floors. Architect Keith Summers [of Munro Summers Architects] proved an enormous help in translating our ideas into reality. I am very much enjoying the end result but continuing to provide an uninterrupted service whilst major development work was taking place did prove to be a challenge. However, with the great team we have at The Alders, no problem was insurmountable!

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W1 Dental

Kamran Rostam Yazdi reveals how a desire to declutter his Wimpole Street practice created a clever use of space much marvelled by patients and staff alike.
When I began considering locations for my practice, I knew that I wanted to practise somewhere with a reputation for a high standard of care - both Wimpole and Harley Street are well known as the heart of medical care in London. I purchased W1 Dental two years ago in March 2011.

I was always interested in medicine and wanted a job where I could work with my hands; dentistry combined the two.

Our patients at W1 come from a wide range of backgrounds and are a variety of ages. What they all have in common is that they are looking for a high standard of care and someone they can trust to do what’s in their best interest. Our practice aims to provide a welcoming, relaxing atmosphere where the staff are always friendly and provide the highest standard of care and service but on a personable level. The patients' needs and interests are always put first.

We have five staff members employed at the practice; a practice manager, a dental nurse, two hygienists and an aesthetic practitioner who can provide facial rejuvenation treatments such as Botox and fillers.

We not long ago completely renovated the surgeries, office and reception area of W1 Dental. Our first priority in the redesign was to comply with the CQC regulations for best practice with the addition of a separate decontamination area. We also wanted to create more space for a second area, a staff room with kitchenette and more storage space.

We wanted to create the feeling of uncluttered space, calm and cleanliness. We have three dental surgeries, an office, a reception area, a staff room, a decontamination room, private toilet, and stock room. Our focus was to provide a practical space that was easy to maintain a high standard of cleanliness and in line with CQC regulations such as capped and coved flooring and no areas to collect dust. We wanted to create all this without a cold, clinical feeling and this has definitely has been achieved.

We chose Anglian Dental to supply the dental equipment and cabinetry as they came highly recommended by a colleague. We were impressed by their excellent customer service, attention to detail and very helpful team. We also viewed a surgery nearby they had refurbished and were impressed by the design. They were excellent at advising on dental equipment and were able to point us in the right direction on which compressors and suction pump to purchase that would have the right capacity for our surgeries. We didn't even need to visit the Takara Belmont showroom as a nearby colleague had just installed the same Belmont chair we were interested in purchasing.

We chose the Belmont chair because of its comfort and design and because Belmont also has a good reputation for features and durability. The model we have has a foot rest that completely folds away on the seating position so it is easily accessible to elderly and disabled patients. Colours were also very important to the new look of the practice as we were keen to create the right kind of mood. We went for bright splashes of colours on the dental and nursing chairs but kept the walls and floor quite muted so there is a bright and positive atmosphere but it's not too overwhelming.

We were able to condense our cabinetry quite a bit, too, as with proper design, we realised we had a lot of space which was just not used well. This allowed us to create a lot more room. All in all, the refurbishment took around four months to complete. The initial stages of design and planning were surprisingly enjoyable, and the actual refurbishment was quite painless as Anglian and their contracting team, Apollo, were organised and efficient. We have had extremely positive feedback from patients -  the usual comment is it looks a lot more spacious and light and the staff and the patients continue to enjoy the new look and space.

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Queen's Gate Orthodontics

Based in Queen's Gate, in the Royal Borough of Kensington, there is something distinctively regal, yet unequivocally homely about Queen's Gate Orthodontics, established in 1989. The premises have undergone a major overhaul, which has not been without its challenges; a basement building, an active caseload and a limited budget all added to the complexity and challenge of the project. Claire Nightingale, owner and lead orthodontist takes up the story. 

Royal Restoration

Based in Queen's Gate, in the Royal Borough of Kensington, there is something distinctively regal, yet unequivocally homely about Queen's Gate Orthodontics, established in 1989. The premises have undergone a major overhaul, which has not been without its challenges; a basement building, an active caseload and a limited budget all added to the complexity and challenge of the project. Claire Nightingale, owner and lead orthodontist takes up the story.

“I purchased the practice just over four years ago and I knew from the outset that there was something special about it. I'd looked at 5 other business purchases before this opportunity came my way, all of which were inherently flawed, such as poor leases and over valued Goodwill. However, the moment I stepped through the door, I knew this was the opportunity for me. It just had a good ‘feel’ to it and the retiring dentist was delightful. This was important, as I was not only acquiring a building, but also a patient base, who needed uninterrupted care and a smooth hand over that inspired their confidence in me."

Cutting Your Cloth According To Your Purse

“Despite the ambience of the practice, I knew that it did need to be updated in order to reflect my personality and commitment to excellent patient care. I had very clear ideas about what I wanted to achieve, but obviously had to keep my vision in check with my budget not to mention logistical restraints. The first I did was to move the back office into the reception area as it made sense for the receptionist/secretary to be based in a patient-centred area.”

“I felt that the décor of the reception and waiting room needed to reflect the architectural beauty of central London. I chose two very bold designs for the wallpaper in these areas. The reception depicts a bright modern landscape of London, and the waiting room shows audience members seated in theatre boxes, a discreet reminder of the nearby Royal Albert Hall. Our wallpaper has instigated as much conversation as our orthodontic work!”

Upcycling

“Inspired by the regal provenance, I wanted to create a rather grand seating area for fun. My budget, however, did not allow me to purchase new chairs, so I took three dull dining chairs home over Christmas and (in between two rain storms) spray painted them gold. I then found a loud and proud, purple and red striped velvet remnant, which I used to upholster them. My "thrones" look much better than even I dared to imagine and my accountant loves the fact that my efforts at upcycling only cost the business £20!”

Updating Equipment

“The three surgeries are all small and only one has natural light so I have kept them white to maximize the illusion of space and light. For this reason I also opted for white Corian worktops. The equipment also needed updating, as it wasn’t functional. The dental chairs did not move vertically so I could not get patients into the appropriate position, which had the potential to compromise my work as well as my posture and long-term health.”

“Whilst I drew on my own ideas for décor, I knew that I could not afford to make any mistakes when it came to purchasing equipment so I appointed Hague Dental to advise and manage the project. They had a reputation for being reliable and good value; I can vouch that they were both. They also had a great sense of humour and a positive attitude, for which I was grateful on many an occasion.”

The Patients’ Throne

“For the chairs, Hague recommended the Cleo from Belmont with its folding leg rest. We are fortunate enough to have these at the Watford General Hospital where I work as a Consultant Orthodontist two days a week, so I was already familiar with their versatility and reliability. Their small footprint was ideal for the size of my three surgeries. I also like the fact that it functions as a chair so that when I present clinical images I can discuss these with patients whilst they are relaxed and in an upright position. The ‘below-the-patient’ delivery system is also ideal as all the clean and prep can be done out of the patients sight.“

Challenges and Opportunities

“The biggest challenge whilst renovating the practice was to keep it open at all times. For this we’ve had to stagger the work (which has taken over four years) and utilize times when I’ve been away on holiday for any of the really messy work to be done. Huge credit must be given to my staff, who have endured the upheaval and have never moaned or berated me for abandoning them whilst refurbishments took place! As the practice is in a basement property, access is moderately difficult down a fairly steep staircase with a 90 degree turn. Unlike a shop front property, we are discretely located, which makes it harder for new patients to find us. Additionally, the terms of my lease do not permit any external signage. Therefore, in order for new patients to find me I printed my logo and address details on a roller blind that hangs in my waiting room window!”

Technology Tools

“With hindsight I should have been a little less cautious and set up the IT and telephone system using one supplier, with expertise in this area. Not anticipating how quickly the business needs would expand, my husband and I installed the IT network ourselves. Whilst my husband is very IT literate and was able to set up a small network using only three software licenses, we do concede that we should have bit the bullet and designed a proper small business system. There are pros and cons to being cautious and I guess this was a con. One positive result in adopting a piecemeal approach is that I’ve kept my sanity and never felt that the renovations interfered with my work and the level of care experienced by my patients. 90% of our business comes via word- of-mouth so we must be doing something right and feel eternally grateful to both our patients and referring dentists for their vote of confidence!” 

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