Integrating a nationally scaled workforce of community health workers in primary care: a modelling study

J R Soc Med. 2018 Dec;111(12):453-461. doi: 10.1177/0141076818803443. Epub 2018 Oct 4.


Objective: To model cost and benefit of a national community health worker workforce.

Design: Modelling exercise based on all general practices in England.

Setting: United Kingdom National Health Service Primary Care.

Participants: Not applicable.

Data sources: Publicly available data on general practice demographics, population density, household size, salary scales and screening and immunisation uptake.

Main outcome measures: We estimated numbers of community health workers needed, anticipated workload and likely benefits to patients.

Results: Conservative modelling suggests that 110,585 community health workers would be needed to cover the general practice registered population in England, costing £2.22bn annually. Assuming community health workerss could engage with and successfully refer 20% of eligible unscreened or unimmunised individuals, an additional 753,592 cervical cancer screenings, 365,166 breast cancer screenings and 482,924 bowel cancer screenings could be expected within respective review periods. A total of 16,398 additional children annually could receive their MMR1 at 12 months and 24,716 their MMR2 at five years of age. Community health workerss would also provide home-based health promotion and lifestyle support to patients with chronic disease.

Conclusion: A scaled community health worker workforce integrated into primary care may be a valuable policy alternative. Pilot studies are required to establish feasibility and impact in NHS primary care.

Keywords: Clinical; family medicine; general practice/family medicine; health policy; non-clinical; public health.

MeSH terms

  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Chronic Disease
  • Community Health Workers*
  • Cost-Benefit Analysis*
  • England
  • Female
  • General Practice*
  • Health Promotion
  • Health Workforce*
  • Humans
  • Infant
  • Male
  • Mass Screening
  • Middle Aged
  • Models, Theoretical
  • Neoplasms / diagnosis
  • Primary Health Care / economics
  • Primary Health Care / methods*
  • Referral and Consultation
  • State Medicine*
  • Vaccination
  • Workload