If you go to see a GP at the inner city Bromley-By-Bow centre, you may get a prescription for an art course or even an allotment, as opposed to a bottle of antidepressants because it is one of Britain's first 'Healthy Living Centres'.
'The message is that it's no longer valid to put health in a red box, social services in a green box, education in another,' says the dynamic Andrew Mawson, the centre's chief executive as well as a minister of the United Reformed Church which is the site of the centre: 'You don't deal with anything unless you deal with everything.' The Lottery-backed New Opportunities Fund will soon start distributing the £300 million it has allocated to developing projects like that in Bromley-By-Bow. Designed to encourage GPs, therapists, health authorities and patients to think creatively about improving health rather than just treat illness, healthy living centres are a part of the rapidly growing trend towards 'lifestyle' surgeries - or, less sexily, 'integrated healthcare', in which prevention of illness is prioritised, people are treated in a holistic way rather than the traditional medical focus on single ailments, and conventional GPs and complementary practitioners pool their expertise to the benefit of the patients.
'Integrated medicine, to me, means that when patients come to see you, you consider their requirements and try to recommend the most appropriate treatment, whether that means conventional medicine, complementary medicine or a mixture of both,' says Dr George Lewith, lead GP of the Centre for the Study of Complementary Medicine in Southampton, and a council member of the Prince of Wales's Foundation for Integrated Medicine. 'There's a lot of evidence that people who have control over their own illness are more likely to do well, and there are always two or three routes of managing most conditions.' Integrated care can range from the well-known alternative therapies to quite extraordinary practices. Malcolm Rigler and his 11,000 patients from a big estate near Dudley in the West Midlands have ventured into the latter to improve the health of their community. One of their most significant local events is the annual grand lantern procession. All the lanterns are handmade by patient teams over the year and the whole community join in. 'It helps us to introduce people to each other,' says Rigler. 'It has become a massive local event with live bands and schools involved.' Surgery patients also have access to complementary therapists such as acupuncturists who work alongside the practice, although as they are not NHS-funded, patients have to pay. 'We're attempting to break away from the medical tradition that people become healthy only if you fix their bodies,' says Rigler. 'Better modern thinking says people fall ill within the context of social relationships. We've found creative arts classes have a powerful effect on social problems. The real health problem in this neighbourhood is lack of self-esteem.' Blackthorn Medical Centre in Maidstone, Kent, has made similarly innovative strides.There, doctors and patients have collaborated to set up an organic cafe and garden project to help people with long-term mental and physical problems (who run the project), and provide local people with delicious healthy foods. Again the aim is to improve self-esteem as opposed to just treating illness.
'Working in the garden and the cafe helps people cope differently with their illness,' says Tijno Voors, Blackthorn Rehabilitation Centre director. 'They gain confidence.' Blackthorn also provides art, music and movement therapy and massage for the chronically ill, funded by the NHS.
'Instead of passive medication, these therapies ask people to engage with their illness and life,' says Voors. 'These are the traditional 'heart sink' patients which have in fact turned out to be the greatest assets of the whole practice. We work as a team here. GPs and therapists work together to treat an illness. There are no wonder drugs for people with multiple sclerosis or ME, but a supportive environment can do wonders.' Critics complain that 'integrated medicine' only produces happier patients because practitioners, whether doctors or therapists, spend far longer with them than the seven-minute consultation that most pressurised GPs can manage. But studies of some practices, where conventional and complementary practitioners work together, show rates of prescribing can be cut by up to 50 per cent, which more than makes up for the extra time spent.
'The idea is to engage people affected by illness in an enjoyable and therapeutic way,' says GP Bill Gowans, whose practice at Mytton Oak in Shrewsbury offers garden 'prescriptions' as well as arts in health projects, craft groups and complementary therapies . 'We're trying to retain the best bits of the medical model. For instance, if you've got pneumonia, you need antibiotics but they are not appropriate for many kinds of illness. I'm a homoeopath and we have other GPs who do acupuncture and psychotherapy. We think in an integrated way about medical care.' Surgeries it seems are no longer just a place for a prescription.
• The Foundation For Integrated Medicine and the Guild Of Health Writers are running an award for practices involved in integrated healthcare with a £5,000 prize. Entries close April 2. Entry forms from Guild Administrator Stephanie Cargill, phone/fax 0181 941 2977.
