The NHS is attempting to ease the pressure on GPs and A&E by sending a new type of health worker door to door in deprived areas to help detect illnesses before people need urgent care.
Community health and wellbeing workers (CHWW) are already deployed in 12 areas of England, with 13 others to follow, in an attempt to improve poor and vulnerable people’s access to care.
Each worker is responsible for 120-150 households, usually on a council estate, which they visit once a month to help residents with money, isolation and housing problems, as well as their health.
Wes Streeting, the heath secretary, is examining the scheme as he pulls together ideas to help “fix” the NHS that may be included in the forthcoming 10-year health plan.
GPs and other advocates of deploying community health and wellbeing workers believe they can help Streeting achieve two of the “three big shifts” in healthcare he has promised: moving care from hospitals into the community and making the NHS a prevention rather than treatment service.
People who are visited by such workers seek help at A&E 10% less often than they did previously and seek unplanned GP appointments for unexpected medical problems 7.3% less than before, according to the National Association of Primary Care (NAPC), which is championing their use.
Evidence from the borough of Westminster in London, which became the first place to use community health and wellbeing workers in 2021, showed that people in the households they help are:
82% more likely to attend a cancer screening.
47% more likely to get vaccinated against major diseases.
82% more likely to undergo an NHS health check.
Cornwall adopted the approach in 2023. Findings from there showed that taking health support to people in such a proactive way has reduced demand for mental health care and community services, as well as reducing the need for visits by district nurses or an urgent care response team.
Community health and wellbeing workers are not clinically trained staff, like doctors, nurses and health visitors. They are mostly recruited from the communities they work in and trained up for the role.
Cornwall’s NHS integrated care board has handed Volunteer Cornwall, a Truro-based charity, a contract to provide the service. It now employs 60 such workers.
But in other places in England, community health and wellbeing workers work for individual GP surgeries or small groups of them.
Marcus McAlister, the NAPC’s programme manager, said those helped by the scheme attend A&E less because they get help for minor infections, mental health problems and flare-ups of diabetes and high blood pressure from community-based services.
“CHWWs are supporting residents to access earlier and more appropriate forms of care, often in community settings,” he said.
“They’re also helping to address wider determinants of health – like housing, finances and loneliness – which are frequently the root cause of escalating health issues that end up in A&E.”
Their job is to build relationships with the people in their households and with health professionals and NHS services locally, he added.
Sarah Woolnough, the chief executive of the King’s Fund thinktank, said: “I recently visited a pilot of this innovative approach, and it exemplifies how the health service can transition from merely treating sickness to actively preventing it.
“By visiting people in their homes, healthcare workers can see all the factors driving a person’s health, not just the symptoms they might disclose during a GP appointment, but also underlying issues such as mouldy housing, debt and unemployment.
“This method could be particularly effective for those requiring support from multiple services, as it ensures a more coordinated and well-rounded approach to their care.”
Streeting said: “We’re seeing some really encouraging signs about what can happen if you’ve got the right care in the right place at the right time, especially among communities and families where they’re likely to become what I call ‘the frequent flyers of the NHS’.”
