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Over the last 34 years the model in Brazil has scaled throughout the whole country, with 250,000 CHWWs serving 70% of the population, in 95% of all municipalities.

  • Areas with high coverage (>70%) of this approach demonstrate a 34% lower cardiovascular disease mortality, compared to areas with a low coverage.
  • The system improves horizontal equity and reduces ambulatory care sensitive hospitalisations.

First rolled out in the UK in July 2021 in Churchill Gardens, Westminster. The CHWW’s provide proactive monthly support to around 120 households each in a defined geographical area. Funded and managed initially by Westminster City Council from a public health grant but contracts with the partnering GP practice meant they were part of the Primary Care team ensuring integration.

Evaluation in the first 18 months showed:

  • The initiative to be acceptable & feasible.
  • Residents were appreciative of the ease of access, support and comprehensive approach provided
  • Engagement had been maintained with 60% of residents within this timeframe.
  • Multiple instances of issues being unearthed around suicidal ideation, child carers, domestic violence and intractable housing.
  • The households were 47% more likely to have immunisations that they were eligible for and 82%more likely to have cancer screenings and NHS health checks.
  • These households saw a 7.3% drop in unscheduled GP consultations.

There are four key characteristics of the Community Health and Wellbeing Worker that makes them unique from other roles that currently exist within the NHS. These  characteristics are built upon the experience from Brazil and they are:

 

  • Comprehensive – Life-course approach, not defined by socio-demographic characteristics, clinical need or risk profile, providing light touch bio-psycho-social support for all ages and all residents, with a focus on prevention, health promotion and service navigation.

 

  • Hyperlocal – Geographical, covering well-defined neighbourhoods or postcodes, of between 100-150 households per CHWW.  CHWWs are recruited from the local area, have connections to or are very familiar with that area, live within a thirty-minute walk from the area where they work.

 

  • Universal – All households within the geographical area are visited once per month, or more frequently if there is a need to do so (proportionate universalism)  No referral needed, no discharge unless residents move out of the area, all residents’ needs are supported.

 

  • Integrated – Paid, full time (or close to full time), with NHS honorary contracts, NHS email, and access to EPRs after appropriate training and approvals. Weekly MDT or training within primary care.  Clear links into VCS organisations, local authorities and allied health and social care professionals.  Identified CHWW on patient record and defined geographies with CHWW contact details available to all staff.

 

 

Evaluations of the Westminster pilot have shown that, even in only a short period of time, the Community Health and Wellbeing Workers (CHWWs) in the UK, delivered in the same way as in Brazil, improve the likelihood of uptake of immunisations (by 47%), screening and health checks (by 82%), and also reduce unscheduled GP appointments (by 7%). They are effective at identifying unmet need, coordinating care, bridging health and social care, addressing loneliness and social isolation, identifying mental health problems, encouraging residents to access health care services, resolving intractable issues with housing or domestic violence, and many more things besides.

 

For more information about how the NAPC can help support you to develop a CHWW initiative in your area, please contact napc@napc.co.uk.