‘Stop medicating our way out of problems!’
WHEN Dr Laura Marshall-andrews took over a GP surgery in Brighton, staff had been used to cowering behind reinforced security screens and police were called to the site on a weekly basis.
Ten years on and her thriving health centre, bedecked in cheerful pastel colours, has been hailed as an exemplar of a new approach to frontline treatment.
The protective screens have gone, and where patients were once handed out opiate prescriptions and sent on their way, now they are more likely to be offered therapies to tackle the root cause of their problems. These range from longer consultations to classes in yoga and art.
Today, the award-winning East Sussex practice has 25,000 patients – four times more than when Laura took over in 2013.
She decided to take on the practice – now called Wellbn – after becoming disillusioned with a largely drug-based approach to medicine. In a city seen as an epicentre for drug, housing and alcohol problems, many patients suffer addiction.
Yet Laura was so sure she could make a difference that she put her own money into the practice. It now has three branches and a team of 90 staff. Grants, including lottery funding, helped it thrive, and it now offers
‘We can create and promote good health’
an array of “social prescriptions”, from talking therapy to walking on the South Downs.
Laura said: “We are stuck in a system where we’re trying to medicate our way out of problems that come from social issues – such as loneliness, lack of connection, lack of exercise, poor diets and lack of sleep.”
Her practice has a specialist pharmacy team dedicated to using social prescribing to help wean patients off drugs that may not help them get better long term.
These include opioids, anti-depressants and sedatives to treat anxiety.
Lead pharmacist Shilpa Patel said: “In a recent case a lady had her baby taken at birth because her addiction to opiates and benzodiazepines meant that local authorities did not trust her to look after it.
“We helped her with counselling and other social prescribing support. Then one day she came into the practice with her two children by her side. She had got clean and managed to get them back.”
Those engaging in three or more group sessions at the practice have seen a 41 per cent fall in their need for GP appointments.
Research from the University of Westminster suggests that where someone has support through social prescribing, GP consultations fall by an average of 28 per cent and A&E attendances by 24 per cent.
Laura said: “It is so much cheaper to help people become well and stay well, than to try to treat illness.
“GPS are perfectly situated in our communities to help create and promote good health, as well as sifting out the symptoms and signs of more serious disease which require hospital repair. This is what we should be investing in.”
Laura said a more rigid approach to care can often mean those with complex needs “fall through the gaps”. She said: “The NHS has become increasingly fragmented. Different organisations are running different services and it’s created this culture of everyone saying, ‘this doesn’t fit my box’.
“This means patients end up falling through the gaps or are bounced from service to service, becoming increasingly frustrated and, often, increasingly ill.”
Early in her career Laura noticed people responding to non-medical treatments, undermining “the gods of mass trial data and clinical evidence”, the gold standards of medical teaching.
She said: “I realised people are not textbooks. They are far more complicated – and more interesting.”
Her approach, outlined in her recent book What Seems to Be The Problem?, has not been without controversy.
In 2014 her health authority brought a case against her for prescribing unlicensed thyroid medication to help a patient’s tiredness symptoms where conventional treatments had failed. She won that case.
The same year she appeared before the General Medical Council for prescribing fentanyl lollipops to someone with chronic pain. The case against her was thrown out but she was forced to stop his prescription.
Lord Nigel Crisp, former NHS chief executive, has visited the practice. He said: “This is what the future of the NHS needs to be – welcoming, therapeutic, concerned with wellbeing as well as health.”