Background Three sites in England are piloting a Community Health and Wellbeing Worker (CHWW) scheme based on the Brazilian national Family Health Strategy. CHWWs are proactively approaching households in patches of around 150 houses, offering ongoing monthly visits to help residents access services, identify at-risk populations and reinforce public health messaging. They are hosted by primary care, community health, and Voluntary and Community Sector (VCS) organisations, which provide basic training in health literacy and promotion, household and social determinants of health, and motivational interviewing. The ongoing three-year evaluation documents the operational and contextual challenges in establishing the services and assesses the feasibility and acceptability of the approach.

Methods Productivity data and internal reports, supplemented by participant observer fieldnotes from steering group meetings and data from interviews and focus groups with commissioners, clinicians, VCS providers, CHWW teams and service users, are used to document activity in each locality and assess reach, dose, and fidelity. Qualitative evidence is used to compare causal mechanisms and contextual factors that support or limit implementation in each locality.

Results Preliminary findings from two pilot sites (the third will report in 2023) indicate that securing resident consent to engage with the service is challenging and requires multiple approaches, but when consent is gained CHWWs are effective at building trust and relationships, mediating and counselling, providing practical advice, connecting services, and identifying unmet medical need. Full integration into primary care was not achieved in both settings due to variations in hosting (GP vs VCS) and commissioning routes, creating barriers for reporting outcomes and sharing intelligence, and illustrating challenges of cross-sector collaboration. Where embedded in primary care, service uptake (immunisations, screenings and NHS Health Checks combined) was 40% higher in households receiving at least one CHWW visit compared to households assigned a CHWW but yet to be visited (control). In the same group, average GP consultations per household decreased by 7%. At both sites, the model appeared acceptable among service users and health and social care providers, who approved of the geographic, proactive approach. Better communication of service aims and methods would help to improve referral pathways and differentiate the service from other new additional roles in primary care.

Conclusion Proactive community-based lay health workers have the capacity to identify patient need early on and alleviate demand for primary care. Formative evaluation plays an important role in understanding the contextual factors and mechanisms that facilitate the service, improving implementation and transferability.