July BSLM Newsletter Director Spotlight

Dr Alex Maxwell is one of our London Directors and is also our Social Prescribing Director. He currently works in Thornton Heath as a GP. In September he is moving on to become Harrow School’s doctor. He is looking to integrate his love for Lifestyle Medicine and sports medicine into all aspects of life at Harrow. He is Clinical Director for Croydon SocialP the Social Prescribing initiative in Croydon which has had great success over the last three years. Here, Alex shares his thoughts about Lifestyle Medicine and Social Prescribing and why they are such a powerful combination.

As a GP the basic premise of our job is to help. Because of our position in the community I think we can probably add to that sentence for it to become “try to help everyone”.

For decades, GPs have been the “catch-all” net supporting people in their journey through life. “Ask your GP” is a phrase uttered by many; hospital doctors, social workers, friends, family.

A person’s health and wellbeing are intrinsically linked with so many factors: their genetics, socio-economic status, geographical location, family situation, friendship group, personal choices of health behaviour etc.

These factors, and many more I haven’t mentioned, bubble together to create the phenotype we observe before us in our consultation room and beyond.

Through many decades of being the catch-all, and due to these factors above all being linked to a person’s health, a GP deals with matters far beyond the classic medical model taught us.

We understand the impact of poverty, privilege, personal choice and the upstream determinants of health and disease as we observe them on a daily basis. Unfortunately, some of the responsibilities thrust upon us, or more insidiously dripped into our work remit, over these last few decades are issues beyond our control. In fact, many are topics we are not experts in and are not prepared for with our training.

The reflective amongst us (in the true sense, not in the overegged GPST version!) and those who are not so overworked and stressed to have the headspace to identify our PUNs (Patient unmet need) and DENs (doctor’s education need) learn through necessity. We learn about our community resources so we know where that mum’s group is that supported Sarah through her post-natal depression, we learn that Chloe does a great exercise class for young black women where they don’t feel intimidated and have a great time. We learn the basics of shoulder rehabilitation because we feel it must be unnecessary to send all of them to a physio for them only to be seen in three months. And CBT because we notice it works well with certain groups. We learn the basics of so many things and sometimes hone our skills in certain areas to become experts in topics barely covered in our training.

A GP is the great adaptor and adapt we must; the landscape of health and social care in the UK is ever changing and more challenges are surely approaching.

Lifestyle Medicine and Social Prescribing give us the basis to support our patients in a far more fundamental way than many of our medical degrees even hinted. Instead of the classic teaching of “we must encourage them to improve their lifestyle factors, but anyway, let’s talk about drugs and surgery” we now have an evidence-based and critical approach towards supporting someone make appropriate change to their lifestyle factors.

Instead of “remember to eat better…!” as they walk out of the consultation room we have a paradigm that can teach us and support us to apply behaviour change techniques to give evidence-based dietary recommendations and feel confident of their validity.

I am pleased to report that many medical schools, encouraged by some of our members, understand and echo this importance, with Lifestyle Medicine beginning to take root in many institutions throughout the UK.

As advocates for Lifestyle Medicine I urge you, if you haven’t already, to engage with your local medical school and training programs to empower the next generation to be able to deliver the kind of healthcare we know must exist.

Lifestyle Medicine demonstrates that care begins with self-care and one’s experience of applying its principles first to oneself. This approach will help create a more resilient and healthy population of junior doctors who are more able to deal with the considerable challenges of providing healthcare.

I remember the feeling of impotence when sitting in front of a patient (now with COVID-19, that is often via a telephone – but this will pass) having said, “How can I help” and, after having explored their situation, being utterly unable to help them.

The classic medical model would have let us both down at that point. I almost never experience that feeling anymore; on top of the clinical resources available I have community resources for any eventuality such as an expert link-worker. If I feel my patients need further support in integrating them with their community and with my knowledge, and qualification of Lifestyle Medicine, I am able to support their health and wellbeing.

Being Clinical Director of SocialP is an absolute privilege; supporting the community leaders and our link workers in their endeavours is a role I will never tire of. We have had hundreds of thousands of attendances now, to over 150 community resources. Inspiring case studies are flowing on a weekly basis and we now work to create good quality data demonstrating the efficacy of Social Prescribing so it can be properly funded and supported.

I am also absolutely convinced that the robust social infrastructure and avenue for support/information dissemination allowed our community to be more resilient to the particular challenge of COVID-19 than the equivalent community without Social Prescribing. It will take a brighter epidemiological mind than mine to extricate this but if anyone is out there please do contact me!

Many thanks for giving me the opportunity to discuss an overview of my thoughts about just how powerful Lifestyle Medicine and Social Prescribing are for our communities. I am aware I have barely scratched the surface but hope I have outlined why I know that Lifestyle Medicine and Social Prescribing are a winning combination!

If you would like to contact Dr Maxwell about Social Prescribing or any other matters please email him on alexmaxwell@nhs.net.

Alex is creating a BSLM Social Prescribing special interest group; if you would like to be involved please contact him on the above email.