Aim:

To improve population health outcomes, recent UK National Health Service policy plans propose three big shifts: moving from treatment to prevention, analogue to digital, and hospital to community. As demonstrated by the Marmot Review, addressing health inequalities in the UK requires innovative care models based on equitable prevention. The Community Health and Wellbeing Workers (CHWW) programme, inspired by the Brazilian Family Health Strategy, integrates community-based prevention with primary care targeting vulnerable communities, addressing health inequalities in Westminster, Cornwall, and Southwest London. This study investigated its impact and adaptability to the UK context. 

Method:

A mixed-methods approach was used to address the study’s aims. Quantitative analysis of primary care patient records and data collection sheets for households assigned a CHWW were used to evaluate the model’s impact on prevention uptake. Qualitative analysis in the form of focus groups and case studies explored barriers and challenges to adopting the model and opportunities for scaling.  

Results:

Across all sites, engagement rates reached 30-50%. In Westminster, households supported by a CHWW showed 40% higher service uptake, unscheduled GP visits reduced by 7%, and vaccination and screening rates increased by 47% and 82%, respectively. In Cornwall, the model addressed social health determinants through preventative interventions showing a 90% improvement in health and wellbeing scores. In Southwest London, early data demonstrated positive impacts, including increased uptake of preventative services and activities to enhance social determinants of health through integrated and holistic support.  

Qualitative analysis revealed that the programme's success relied on trust, continuity of care, GP engagement, and multisectoral collaboration, with CHWWs addressing financial stability, housing, diet, and physical activity.   

Conclusions:

The study showed effectiveness of adopting the Brazil Family Health Strategy model in diverse UK settings, highlighting the positive impact of primary care-community integration on the uptake of preventative health services and reduction of health inequalities.