Design in Progress 

COMMUNITY SUPPORTED MEDICINE  (CSM) or COMMUNITY SUPPORTED HERBALISM (CSH)

Often people are more familiar with CSA Community Supported Agriculture, a scheme where a group of people support and take part in local food production. CSM is a natural route for me as a herbalist to follow. I want to work in the community as a herbalist and have a way of ensuring I can do so, i.e. some continuity of patients and revenue. Web searches reveal that is not at all common, so I hope that this design can be replicated by others. The vision is how to be a transition herbalist and this design will help form the chapter on transition herbalism in the herbs book.

Briefly I see CSM working like this: I get paid a regular direct debit to provide herbal medicine consultations and medicine to those that subscribe. Payments could be the same whether you are ill or well. You use the service when ill, but you can book seasonal check ups and when medicines are being made e.g. Elderberry cordial you would get some to see you through the winter. So the regular payments would give me a stable income and I could focus on treating those in need. I see this working similar to a CSA so that I (with the help of the community) would help grow most of the herbs that would be used. 

Initial thoughts: figures from the top of my head £24,000 salary would need 200 people to pay £10/ month.
200 X 10 + £2,000  x 12 months = £24,000
(Min 2 days but probably more)

Second thoughts: For a guaranteed income of £5,000/year  I would need 25 people to pay a £40 annual check up / membership. If they then paid £160 over the year. (13.34/ month- £3/ week).
25 x £40 = £1,000.       25 X £160 = £4,000
(Min 2 days)

I would have to commit to a day for consultations and if land based then another day for growing. There would be other benefits to me, being involved with herbs for two regular days means being ready for other clients, massage referrals, selling products. But two full days may need more than £5,000 income. I suppose there would be capacity in one whole day for consulations for more patients and if 50 people joined up ( what about whole families) then I would be looking at £10,000. If 100 people joined then that would be £20,000 and I imagine at least 2 days of clinics.

They beauty is that a conventional view might be..."what if someone comes every week" my answer would be that they can stay in the healing herbal environment and help with the growing of the herbs. I dream of returning to slow health including bathing and group cooking.  A contract to protect against weird behaviour would be prudent though, any legal beagles out there wanting to barter?

When to start, what to prepare, If land based where? What herbs to grow?

Look at Other CSA (Community Supported Agriculture) models e.g. small and slow solutions to Oak Tree Farm, with the land under private ownership. Ideally a long term project has stable tenure for a site.

Medical Herbalism in the Community

One day a week could be usefully spent with the following design for Community Health Clubs.
This would generate £20,000 over two years for the facilitator.
There is also £5,000 over two years being generated for the venue if the GP surgery was not used.

Community Heath Clubs / Herbal Medicine on Prescription


Demonstrate Need: If no need do not proceed.

Government Statistics for the area? Council targets? 

Speak to East Suffolk Local Strategic Partnership, Write to GP surgeries. Is this viable?

Question to GP’s: Is there a client group that could fit this project?

“heart sink” patients, those that when you see them your heart sinks.

Proposed clients groups would be those with digestive complaints like IBS, mild to moderate depression, skin issues like eczema etc. Basically any patient groups which may have reoccurring symptoms, do not take medicines as prescribed, need social interaction or just those you want to see less of.

Track record of those involved in the proposals:

Dan Wheals is a Member of the National Institute of Medical Herbalists (MNIMH) and consults with patients in Ipswich. Dan see’s his role as working along side orthodox medicine not separate or alternative to it. In February 2011 medical herbalists will be regulated by the Health Professionals Council  (see www.nimh.org.uk and www.herbaculture.co.uk ).

From 2007 to 2010 Dan Wheals worked with the Town and Bridge Project voluntarily to help set up a community garden, and then as an employee for two years with the People’s Community Garden in Ipswich. Community gardens are a safe place to reach communities and inspire them to grow produce, skills, friendships and themselves. This amazing project already has links with the NHS and had trialled patient referral for exercise see www.townandbridge.org.uk

Groundwork East of England - Community Environmental Action Adviser- 2010- 2012

Eastfeast Waveney Local Food for Thought 2012- 2014


The following proposals could be supported by a new social enterprise, with a cooperative style structure being set up. See about options for the School of Social Entrepreneurship  grants.

Proposal 1: Community Health Clubs

Growing myself back to health.

8 Patients with related symptoms on an 8 week (one day/week/) programme to explore new methods of helping their condition. A medical herbalist will lead the facilitation of the sessions and bring in expertise where necessary to deliver in partnership with GP, nurse or other health professional. Sessions will include growing and preparing suitable herbs, investigations into other self help methods and support within the group will be encouraged. Venue ideally would be the creation of a GP surgery garden/ waiting room  (please see proposal 2) or at the People’s Community Garden, an established community resource in Maidenhall Allotments off Halifax Road IP2 8RE.

OUTCOMES:

Reduction of symptoms in the short, medium and long term
Reduction of prescriptions e.g. antibiotics in the medium to long term
Increased empowerment and healthy lifestyle choices in the long term
Improved GP appointment waiting time.

OUTPUTS:

Community Cohesion, The surgery forms new social networks.
Recipe book created by patients, and other educational and information resources.
Product ranges tested by patients which could be sold: e.g. a digestive tea blend
Seasonal Feasts/ Party as a finale to each group’s Health Club.
Maintenance of any garden areas, if used.

METHOD:

Patients referred by GP according to symptoms.     
Five Cohorts a year over two years.  Programme would run 40 weeks of the year.                                                            Max. 8 per cohort. 10 cohorts x 8  = 80 people engaged over 2 years.                                                                                   Each Cohort: 1 day/ week for eight weeks. 10-2pm.                                                  
MYMOP Questionnaire to assess symptoms
Tailored Questionnaire for other Monitoring to include soft and hard measures such as empowerment (soft) and GP visits & prescriptions (hard).
8 week programme of learning about their condition, growing herbs, preparing them and trialing them for efficacy.
Nurse, GP or other health professional input.
Meal times will introduce food awareness, preparation and cooking.                                                                                       A final party/ feast will be for the group to organise.
Venue ideally in surgery garden, People’s Community Garden or a suitable community venue.


BUDGET

Funding will be sought for this pilot project. GP surgery will need to show support to prove the sustainability of the project over the proposed time of 2 years. Income generation will be important for the future of the project.

EXPENDITURE

FACILITATION @ £200/ day
2 planning days including pre- meetings.
8 delivery days
1 celebration day
1 evaluation day
1 management oversight day including webpage updating

13 days @ £200 = £2,600

Lunch and Refreshments £10 x 8 = £80
Celebration= £60
Materials = £60
Hire of Community Garden £50 x 10  = £500 (avoided if at surgery or accounted as in kind support for funding bids)
Celebration and meetings venue hire included in previous budget above.
Creation, Design and Printing for creation of Resources or Webpages  £200


TOTAL EXPENDITURE      £2,600 + 900 = £3,500 per Cohort.   10 Cohorts = £35,000

INCOME

If 10 cohorts:

10 x £500 = £5,000 in kind support from surgery if surgery has suitable venue and it is used.
10 x £200 x 2 = £4,000 in kind support if Nurse, GP facilitated 2 of the 8 sessions  (or multiple thereof) 
10 x £200  = £1,000 in kind for the management oversight day from surgery for admin

Further support from community and local business to be sought for lunch, some materials, celebration event and informational resources 10 x £100  = £1,000. (This is half of the accounted expenditure for these items).

£1,000 Income from any product ranges created e.g. herb teas, fundraising at celebration events and Pledges of support e.g. If i give up smoking I will give £1 a week.  (£100 per cohort)

IN KIND GP SUPPORT                        £10,000 (10 days admin) (20 days delivery nurse/GP)
INCOME GENERATION                       £1,000
COMMUNITY/ BUSINESS SUPPORT £1,000
TOTAL  £12,000

Funding Bids Therefore needed for £23,000

Liaison with GP and surgery on this important. Various legal structures may need investigation and could I join a cooperative of herbalists to bid for funding. KEYWORDS: Health, Community Health, Adult Education.....

80 PATIENTS SEEN

TOTAL RECOVERED COST/ PATIENT £35,000/80 = £437.5 per patient

TOTAL COST/ PATIENT FOR FUNDER £23,000/80 = £287.5 per patient

If the pilot project was successful, would this be deemed cost effective for a GP practice to consider?


Proposal 2 : GP surgery garden and waiting room

Creation of a garden area within the GP surgery. This could be used for the health clubs above and also act as a pleasant waiting area for patients. It does however need sufficient land, but even the smallest spaces may prove effective. The initial infrastructure costs will be outlined in this proposal. There should be a desire to maintain the garden area for the sustainability of the proposal. Health Clubs (previous proposals), staff de-stressing or accounting for minimal maintenance in the property budget are ideas to consider.

An initial vision for any garden waiting area would include a small polytunnel or green house, water collection devices, raised beds, tools and tool storage. Smaller areas would have appropriate medicinal herbs which would need to look lovely and have interpretation. Larger gardens could grow food, cut flowers to sell, medicinal herbs and could include a house plant care home. Any waiting area outside would need access easy access to reception, appropriate calling devise and have shelter, but it may be sufficient to have a window from the waiting room looking out over the area.


OUTCOMES:

Creation of a garden/ waiting area
Beautifying of the surgery.
Involvement of the community in designing, building and maintaining of the area.
Setting for health clubs, staff down time.

OUPUTS:

Community cohesion, The surgery forms new social networks.
Happier staff.
Local and national awareness and media acclaim.
Revenue from produce/ plant sales.
Opportunities for reaching patients in new ways.


METHOD

Assessing need and practical land/space options
Business plan and funding options discussed including future usage.
Eco awareness of bike parking, water saving and any renewable energy options.
Design process using local talent and schools.
Liaison with other local groups such as the People’s Commnity Garden.
Construction stage should use patients and local people.
Opening Ceremony with special guests and locals.
With high awareness of the project, use initial energy to start the health clubs.


BUDGET

Totally dependent on size of site and involvement of the local community.
Larger items will include shelter, greenhouse or polytunnel, raised beds, intercom system, power and water connections or renewables. tools and H&S equipment, tool storage, plants and seeds.

This could be part of a larger bid to include the health clubs or be seen in the light of any building work undertaken at the surgery.  It could happen very cheaply if donations and time are given freely but it is advisable to have a good grasp of the overall plan. The health clubs could be used as a team to initiate and manage the building. Other groups such as the Princes Trust and Community Payback can also undertake the hard work. documentation of the project would also be needed to celebrate the process and inspire others.

Money will be needed for materials and infrastructure but funding may cover this. It is proposed that a budget of £500 be set aside to pull together the plans and a further £9,500 for materials would be necessary.


These ideas are intended for shared use.

I would appreciate knowing if you set up any of these ideas and herbaculture being mentioned in any credits.