Whilst I fully agree that where building works are carried out National Guidance should be followed the issue of proportionality must also be considered in my opinion. In this case it seems that a loft ladder is to be replaced by a staircase. If it is the case that the loft is still to be used for storage only, (we have not been told) then I cannot see why, in addition, the fire resistance of the floor needs to be improved. Lyle - please let us know.
In the scheme of things premises don't come much lower risk than a single storey doctors surgery.
One thing that has always bugged me is that with small low risk premises "applying the book " is often onerous and in my experience these premises are often dealt with a heavy hand by many enforcers when compared to much larger, higher risk premises or developments. That is where a comparative analysis can be useful.