A launch year well done: Westminster’s Community Health & Wellbeing Worker (CHWW) Programme

A different way of working 

The CHWW model is simple yet innovative. Local, entrenched members of the community, (trained and paid) proactively visit around 120 households each month. These visits go beyond health check — they’re about building trust, nurturing relationships, and connecting residents to local services. The programme is hyperlocal, universal, and integrated. This means everyone gets seen regularly, with more time spent on households that need extra support. 

• Within the bottom 20% most deprived LSOAs, Westminster’s CHWW team covers 25% of the micro-areas (or ‘villages’) with the highest need. This allocation distribution made robust evaluation by Imperial College London possible too. 

• We already knew from the pilot that CHWWs had lowered unplanned GP appointments by 7%, increased the likelihood of vaccination by 47%, and cancer screening and NHS health checks by 82%.  

• After the first year of the CHWW initiative expansion, data indicates that CHWWs lowered A&E admissions by 7%, and hospital admissions by 10% in their postcodes compared to the previous year. All while increasing prevention opportunities and scheduled GP reviews. 

The numbers speak for themselves 

In its first year, the programme has reached up to 25% of households, with each CHWW making up to 10 visits a month. Integration with eight GP practices, St Mary’s A&E, and various community services has happened in an intuitive way. The average number of door knocks needed to achieve a visit has decreased from 11 to 5, showing that trust is building. 

The impact on hospital admissions has been building too. Postcodes with a CHWW saw an 10% reduction in hospital admissions compared to the previous year. Residents are also reporting higher satisfaction with their GP and council services, a testament to the programme’s all-encompassing approach. 

Case studies — the human side of the data 

Behind the numbers are real stories of lives changed. Take the young man who wasn’t able to address a skin infection until it turned into an abscess. A CHWW noticed the worsening condition and him becoming unwell, so persuaded him to go to the GP to get treatment, preventing sepsis and a potential A&E admission.  

Or Ms A, who was struggling with eye pain and couldn’t read her medication instructions, or the clock to keep to timings for taking it. Her CHWW set up phone alarms, and checked in weekly, making sure treatment was successful and preventing a deterioration of her eyesight. 

Then there’s Mr S, a frequent A&E visitor because of anxiety, and issues with drug use, who did not have a GP. The CHWW knocked on his door, managed to register him with a GP, and help him sort out a multitude of issues. He began attending A&E less frequently, plus joined a patient group at the Abbey Centre.  

These stories highlight the programme’s ability to address health and wellbeing holistically. 

The Octopus model — a coordinated approach 

The CHWW programme operates under the ‘Octopus’ model, a framework designed to bring together health, local authority, and voluntary sector services. The model’s tentacles represent the many frontline roles that contribute to a person’s health and wellbeing, from GPs and social workers to community champions and faith leaders. 

This model is flexible, agile, and holistic. It allows CHWWs to act quickly in urgent situations, whether it’s a mental health emergency or a new baby in the household. Importantly, CHWWs don’t discharge anyone; they’re a lifelong support point for their residents. 

The roadmap for 2025 

Looking ahead, the goal is ambitious but achievable: up to 76 CHWWs covering all areas of need in Westminster, reaching at least 60-70% of over 9,000 households. The programme aims to secure sustainable funding, boosting reliable support and continuity of care. Full integration with all GP practices, hospital trusts, and frontline roles in the borough is also on the agenda. 

The programme’s success has already caught the attention of national media, with the BBC highlighting its innovative approach. It started out as a local healthcare initiative, but as Westminster continues to refine and expand the CHWW model — it’s becoming a blueprint strategy towards a healthier, more connected community that could be applied nationwide. 

Beyond that, what’s next? 

By putting human connection at the heart of care, beyond improving health outcomes across Westminster, this programme is also helping to build a community where everyone feels seen, heard, and supported. 

As Dr Matthew Harris, one of the programme’s advocates, says: “This is about giving communities dignity and agency over their health and wellbeing.”  

So, here’s to the CHWWs — Westminster’s community game changers, quietly tapping into personalised care and support, one doorstep at a time. 

With thanks to NHS England, the City of Westminster, and all partners involved in making this programme a success.