To ask His Majesty’s Government what assessment they have made of the community health worker model in relation to reducing inequality of access to primary care.
My Lords, the Government have made no formal assessment of the community health worker model. However, they are supporting the development of models like the Brazilian one through the additional roles reimbursement scheme. We have delivered on our manifesto commitment to recruit 26,000 additional primary care professionals a year ahead of the March 2024 target. Our Delivery Plan for Recovering Access to Primary Care will also create a more equitable approach, regardless of patients’ routes to access.
I thank the Minister for his answer. The community health and well-being worker model is widely used in Brazil and has proven extremely effective in improving health outcomes. In Brazil the model accounts for a 34% fall in cardiovascular deaths. In Westminster, the community health worker pilot in Churchill Gardens has been running for two years. Households that receive community health worker visits were 82% more likely to have received screening and health checks that they were eligible for, compared with households that had not received visits. In the light of the success of this pilot, will the Government consider rolling this scheme out, as they seek to reduce health inequalities?
My Lords, I am grateful to the right reverend Prelate for highlighting the benefits of this model, which is a great example of local innovation to tackle health inequalities. I pay tribute to her work as co-chair of the APPG on Rural Health and Care. I also congratulate those involved in rolling out this model in Churchill Gardens and other areas across the country. I understand that plans are under way to expand that further in Westminster. I shall follow the Brazilian model with interest, as I can see how it will work in urban areas. The challenge is to make sure that the model is scalable and able to work in rural and remote communities—a point raised regularly by the right reverend Prelate the Bishop of St Albans and Exeter.
My Lords, how does my noble friend intend to reduce inequalities in rural areas? He just mentioned the difficulties of rolling out primary care in sparsely populated, deeply rural areas. Community health workers and care workers spend a lot of time on the road and have less time to spend with patients. This is something that I hope my noble friend will be able to address.
Our Delivery Plan for Recovering Access to Primary Care, published on 9 May, sets out our ambitions to reduce the number of people struggling to contact their practice and make sure arrangements are made for patients’ care on the day they contact their practice. This plan is committed to improving access experience and outcomes for all patients, including those in diverse groups and rural areas.
My Lords, have the Government considered making it compulsory for every GP practice to have a physiotherapy and a psychological therapy service available in the practice? The numbers of hours, of course, would depend on the size of the practice.
The noble Baroness makes a very good point and she is absolutely right: GP practices are diversifying in the number of people and the types of services that they offer, including those she mentioned.
My Lords, does the Minister agree, from the achievements of the scheme in Brazil and the impact coming through from the London pilot, that CHWs could prove particularly valuable in the management of people with multi-morbidities in their own homes? The CHW role of being the eyes and ears of the GP in the community and visiting people in their home the day after hospital discharge to make sure they are okay could be a tool for addressing the revolving-door hospital discharge problem and helping prevent unnecessary visits to A&E. Will the promised primary care emergency care funding be used to support this and the development of other important public health work?
The noble Baroness is exactly right, and that funding will be made available. There are currently four community health and well-being workers covering 500 households in the example I gave. My understanding is that they will not only help with healthcare provision with GPs and local hospitals but work with Jobcentre Plus so they can help people get work and access benefits, to help with mental health conditions and others.
My Lords, as well as the Westminster pilot, studies by organisations such as Imperial College have shown the potential for significant benefits to come from the community health worker model, yet the Minister said in his first response that the department had carried out no formal assessment of the model. Given the potential to improve health outcomes and make savings in acute services, does he agree that such a formal assessment would make sense? Is it something the department would like to do but has just not got round to yet?
The noble Lord raises a good point. He is right that it is still relatively early days: we have to give it an opportunity to embed. I mentioned Churchill Gardens, but it is also happening in rural areas such as Cornwall, west Yorkshire and other parts of the country. We want to see how the scheme works out, because there will be similar results but with a different flavour depending on whether the area is rural, city, metropolitan or coastal.
My Lords, it is very good to see that this model is being copied elsewhere, as the noble Lord has just said, but what consideration are the Government giving to developing a new model of primary care that recognises the role that local people, such as these community health workers and, indeed local organisations, can play in delivering both care and support to people locally?
It is a proven case with primary healthcare provision at local level. The noble Lord mentioned local people: it is a combination of charities, friends, neighbours and, indeed, the local parish church, working together to help local people. It is not just a case of turning up at the GP practice; there is an awful lot of work that can be done before it gets to the GP.
My Lords, social prescribing is an important part of community health, because it acts directly on the social determinants of health. The long-term plan committed to 1,000 new social prescribing link workers in place by 2021, with the goal that at least 900,000 people will be referred to social prescribing by this year. Can the Minister update us on progress so far?
We know that the general practice services are still under huge pressure. I am grateful to the GPs and teams who are working incredibly hard to provide high-quality care in their communities. Our Delivery Plan for Recovering Access to Primary Care, published on 9 May, has shown a significant ability to increase appointments. In the 12 months up to April 2023, an estimated 346 million appointments were booked across all general practices in England, which was an increase of 38 million compared with the 12 months to April 2019. About 550,000 more appointments were delivered per working day in April 2023 than in April 2022 and 150,000 more per working day compared with April 2019. These figures show that we are making progress.