Changing the conversation about health

“Social prescribing is still prescribing”: Dr Laura Marshall-Andrews on how patient-focused integrated care is helping Brighton’s most vulnerable communities

Practice learning days at The Brighton Health and Wellbeing Centre used to be ‘pretty dry affairs’, according to Principal GP and founder Dr Laura Marshall-Andrews. Then she 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,’ Laura says. It’s not just the staff who dance around the 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.

Laura Marshall-Andrews, pictured speaking at The Royal Society of Medicine, began her Healing Expressive and Recovery Arts Project (Hera) in 2014, which provides sessions focusing on individual, integrated care

Also on the schedule this autumn 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.

The Finding your Compass sessions at The Brighton Health and Wellbeing Centre include a singing group, and film and dance group

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, 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. According to research quoted by the Culture Health & Wellbeing Alliance*, for every £1 invested in arts on prescription there is a
social return of between £4 and £11.

A GP’s journey: Dr Marshall-Andrews’ book What Seems to be the Problem? was published earlier this year

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.’

What Seems To Be The Problem by Laura Marshall-Andrews is out now, published by Harper Collins

  • Creative Health: The Arts for Health & Wellbeing. All-Party Parliamentary Group for Arts, Health & Wellbeing Inquiry Report, 2nd edition (2017).