Around 40 paces from the health centre in Alness in the Scottish Highlands is a gateway leading into a field.

Today, it’s relatively sunny, and there’s a bit of a festival vibe, with children running round, various artworks hanging up to dry – and enticing smells coming from a newly purchased outdoor pizza oven.

This is the Centre for Creative Health – affectionately called The Flipside – which is bringing a quiet revolution to this small town. Run by a charity called Flip of the Coin, it’s a glorious space, which includes a community garden, a shed filled with bicycles and a yurt for holding events all year round.

It’s providing a lifeline to local people – but it’s also bringing benefits to local health services, and the doctors who work in them.

Kath Jones (pictured above), a salaried GP working for the Alness and Invergordon Medical Group, says the centre is making a real difference to her working life, and not just because she can see its positive effect on patients.

‘I definitely see a shift when people go there, just in terms of confidence and self-belonging. It feels more powerful than what I’m able to offer here [as a GP] for this group of people. And by this amazing stroke of luck, it’s right next to the practice.

‘My job is to get people over there, when they’re up for it, and it takes the pressure off me. In a way, I’m the warm-up act, and the real magic happens over there.’

Dr Jones is being modest. This is the third article published in The Doctor in what might loosely be considered a series. In the first, headlined From Rescuer to Coach, she described how rethinking the role of the general practitioner enabled her to embrace the job again. In the second, Redefining Health, she spoke more about her approach to general practice, which combines biomedical care with a broader whole-person approach.

Unusually, she actively seeks out patients who are frequent users of health services – perhaps because of chronic pain, or some mental health issues; in other words, the patients often known as heartsink. After taking a thorough history – and ruling out any immediate clinical red flags – she will then ask if they are prepared to take a different approach.

If they are, and not everyone is, she uses evidence-informed resources, underpinned by trauma-informed principles, to help them make sense of their symptoms, develop shared explanations and identify next steps towards getting their life back, with or without symptoms.

This third article takes that thinking into exploring what Dr Jones has come to describe as ‘creating the conditions for health’ – integrating whole-person care within the realities and constraints of general practice. 

And for some patients, the shift has been striking. Last year, The Doctor magazine reported on the case of Judith, a retired teacher who – despite her initial reluctance (her actual words were ‘if she wants me to hug a tree, I’m out of here’) – found the whole-person approach helped her to turn round a life blighted with chronic pain, anxiety and depression.

Dr Jones has seen similar patterns in other patients. One young woman she worked with had undergone multiple medical procedures and made frequent use of hospital and urgent-care services in the preceding year. Despite considerable healthcare input, she continued to experience symptoms that were having a significant effect on her life.

Dr Jones used her Six-Step Consultation Framework, a structured approach designed to help people make sense of their experiences and identify what might support recovery.

‘She has since reported a significant reduction in her symptoms, been discharged from three specialist services and has got a job,’ says Dr Jones. ‘Her feedback perhaps captures the shift most simply: “Thank you for helping me to help myself.”’

This was the sort of patient, she says, who, while she was still following a traditional general practice approach, would have filled her with trepidation. Under her new approach, she actively sought her out.

‘Before, I would have been thinking what on earth am I supposed to do with this person,’ she says. ‘Now I’m thinking, this is exciting, because this might be one of the people who can make the shift. It’s the opposite reaction to what I’d have had before.’

Of course it’s not that easy, and Dr Jones is the first to admit that there have been a few setbacks on the way. But the fact is that she, as a GP, has found greater job satisfaction in running towards a patient that she previously would have run from (metaphorically).

Making referrals to Flip of the Coin is just one small element of Dr Jones’ approach, but it’s an important one. Patients who are referred there credit it with changing their lives and making them more meaningful, by encouraging them to be in nature, to be creative, and to become part of a community.

Lucy Campbell is the chief executive of Flip of the Coin. An academic and community educator by background, she founded the charity to create a space for workshops in art and creative pursuits. ‘It went from four of us in a Portakabin over the winter huddled round a little stove and trying to keep warm while doing creative activities to workshops with 30 or 40 participants,’ she laughs.

‘We work very closely with the GP practice, and I think it works because we have such a good relationship with the GPs.’

Gordon Robertson works for the charity three days a week as site manager and is largely responsible for the productive and beautiful gardens. He is semi-retired now, after a varied career ranging from farming to teaching, and he particularly enjoys the hands-on nature of his work at The Flipside and seeing the effect it has on those who come along.

‘A lot of people come here because they have been struggling in different ways, a lot have been referred by their GP. There’s one lad over there – he got referred here and comes most Tuesdays, Wednesdays and Thursdays, and he’s really coming out of his shell. It’s made a huge difference.’

It’s all very lovely at The Flipside, especially today with the sunshine (and the pizza). And it’s certainly handily located for the GP practice. But what about the evidence that it makes a difference? That’s where Dr Marisa de Andrade comes in. A senior lecturer in health science and society at the University of Edinburgh, she leads on the REALITIES, a Scottish consortium part of a UK-wide programme researching how mobilising community assets such as green spaces, nature, creativity and relationships can tackle health inequalities.

The project is gathering qualitative, quantitative, arts-informed and economic evidence to show that creative, relationship-based community projects can reduce demand on health services – including GP workload – and improve outcomes. Flip of the Coin is one of five Scottish initiatives or hubs that come under the REALITIES umbrella.

‘There’s some really clear evidence coming through that hub of the value of collaboration with the NHS, particularly through Kath and her practice, and Lucy’s work at Flip of the Coin,’ she says. ‘What we’re seeing is that what we’re calling creative health, which uses arts, culture and creative activity to support health and wellbeing, is a good investment that’s showing positive outcomes.’

Elsewhere, the evidence for a new approach to general practice and healthcare more generally is also building. Dr Jones points to the multiple symptoms study, reported in The Lancet in 2024, a randomised controlled trial that shows the effectiveness of a symptom-clinic intervention delivered by GPs with an extended role, for people with multiple and persistent symptoms in England.

The intervention focused on recognition, explanation, action and learning – helping people make sense of their symptoms, identify possible actions and learn from what happened next – and led to sustained improvements in symptom burden.

The connection between general practice and The Flipside has made a significant difference to Pamela, who spoke to The Doctor in a break from attending an art session. She explains that, having moved back to Alness, she had several health issues that meant she found it very hard to leave the house.

‘Dr Jones referred me here and I didn’t want to come,’ she says. ‘I’d moved back home to be near my parents and I didn’t know anybody. I didn’t want to just walk into somewhere I don’t know.’

Lucy kept in touch, and eventually Pamela decided to give it a go. ‘Lucy phoned me, and phoned me and phoned me and we had long conversations,’ she says. ‘I still thought I couldn’t do it, but Lucy promised she would meet me at the door. And she did.’

Pamela now comes twice a week and participates in activities including art classes – and has brought her mum along too. ‘Everyone makes you so welcome, you can mingle and it’s absolutely fantastic. I don’t know what I’d do without this place now.’

It’s helped her mental health enormously and is having physical benefits too. She now enjoys gardening and even took part in a group cycle ride recently. ‘It was amazing – I laughed the whole way there and then cried the whole way back because I’m so unfit,’ she smiles.

‘I can’t thank Dr Jones enough for referring me here, and I just wish I’d come sooner.’