Sarah’s Health Notes: Pill-free social prescriptions from the NHS
Pharmaceutical drugs can do good – in some cases they are true lifesavers. But they can also cause harm. The Government’s National Overprescribing Review, launched in September 2021, estimated that at least 10% of prescriptions dispensed at primary care (1.14 million items) are unnecessary, inappropriate or can cause harm – in some cases leading to premature death.
Tackling overprescribing could improve the health of millions, achieving benefits ‘comparable to a new blockbuster medicine’, according to the Review’s author, Dr Keith Ridge, NHS England Chief Pharmaceutical Officer.
The Review recommends social prescribing as a constructive addition or, in some cases, alternative to drugs. ‘Health is influenced by a range of social, economic and environmental factors. Often, medicines only deal with symptoms, and do not tackle the underlying causes of illness or effect a cure. Medicines are sometimes prescribed where the patient would benefit from other forms of advice and support to tackle or alleviate these underlying causes.’
Devon GP Dr Michael Dixon describes social prescribing as ‘a radical rethink of medicine, planting health and healing in the heart of the community’. Social prescribing, which is part of the NHS Long Term Plan, aims to improve patients’ health holistically by referrals to link workers who spend time with them exploring different non-medical interventions, often provided by voluntary or charity organisations based in the local community. Activities might include music, art, sports, dancing, knitting, walking, group learning, yoga, fishing and cookery among many others. Link workers may also help patients address housing, legal and financial problems.
Ten years ago, GP Dr Laura Marshall-Andrews set up the Brighton Health and Wellbeing Centre on the basis of social prescribing. As she says, ‘social prescribing is still prescribing’. It’s a very different approach both for staff and patients.
For instance, practice learning days at the Centre used to be ‘pretty dry affairs’. Then Laura invited dance teacher Rachel Pittman to get the group throwing around some mood lifting moves to ‘really happy music’ like Abba and the Beach Boys. ‘It took minutes to get everyone buzzing,’ she says.
Patients are encouraged to join in the fun in this bright colourful surgery, where patients’ art decorates the walls. One of the most popular sessions for patients is ‘Mood Boosting Moves’, alongside other dance classes. Also on the schedule are Singing for Better Health, Art for Relaxation, and Photography Workshops. There are also programmes for refugees and asylum seekers, and for trauma awareness.
Some photography sessions combine art, nature and mindfulness –being present in the seconds it takes to catch a dragonfly on the wing, clouds racing over a hill or sunbeams on water. The South Downs are 15 minutes away but this might be the first visit for some patients. ‘They haven’t felt empowered to catch a bus and take themselves to the nearby countryside. This shows them it’s quite simple to go for a walk there,’ says Laura.
It’s all part of the integrated care at the practice, which focuses on caring for patients as individuals. The sessions are mostly provided by Hera – the Healing Expressive and Recovery Arts Project set up by Laura in 2014 when she took over the practice, then in a very deprived area of Brighton. Since its inception, the considerable funding needed for the creative workshops and training for arts and health professionals has come from Brighton & Hove City Council and the Arts Council.
As Laura explains in her recent book What Seems To Be The Problem (pub Harper Collins), her original ‘huge problem’ was the number of patients on prescribed benzodiazepines, opiates and other drugs. The surgery was sited between four homeless hospitals housing many addicts. ‘We needed some sort of “buy in” to get them to work with us on their addictions,’ she says. ‘Our prescribing pharmacist Shilpa Patel’s first job was to create a withdrawal programme that worked in combination with arts activities, and therapies like acupuncture, osteopathy and physiotherapy.’
You might think that sounds contrary to the usual job of a pharmacist and doctor but ‘the job of a pharmacist is not solely around meds,’ says Laura. ‘Like doctors, they’re concerned with how to rationalise and reduce medication. And social prescribing is still prescribing.’
Today, around 30% of Brighton’s population live with ongoing long-term health concerns, and 5% have significant and complex issues. Hera programme director Emma Drew explains that ‘the project continues to develop new ways to support patients like these with their physical and mental health, using dance, music, art, photography, creative writing and creative computing.’
Many thousands of people have been helped by Hera. For the year 2020-21, these creative groups supported 778 participants, some registered at different GP practices round the city. They ranged in age from 16-90, with 74% reporting mental health issues and 26% physical health concerns, although there is some overlap. According to an evaluation by Brighton & Sussex Medical School, people engaging in three or more group sessions saw an average 41% reduction in their need for GP appointments.
In addition, the practice’s NHS Social Prescribing Link Workers supported 456 patients whose health and wellbeing was adversely affected by the social determinants of health. The most frequent problems were related to money, housing, mental health, loneliness, and barriers presented by long-term health worries. A total of 778 patients also took part in Hera groups, which had a multiplier effect on wellbeing.
As Laura’s book makes abundantly clear, this has not been an easy path to choose. But, she says, ‘as clinicians, we have to do what we think is right, even if it’s hard. We have to try and be the change.’
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