NWL ICB’s Community Outreach and Health Equity Fund for Primary Care

  • Project partners:
    NHS North West London ICB, Envoy Partnership
  • Project location:
    North West London, UK
  • Project type:
    Impact evaluation
  • Sector:
    Public health, Primary care
  • Publication year:
    2025

About the Project

In February 2024, the Northwest London (NWL) Integrated Care Board (ICB) launched the Community Outreach and Health Equity Fund for Primary Care (COHEF) to test and evaluate community-based strategies aimed at enhancing health equity. Four Primary Care Networks (PCNs) with the highest proportions of patients living in deprivation were funded to pilot unique outreach projects targeting specific patient populations, with interventions running from February/March to December 2024.

NWL ICB commissioned Envoy Partnership in March 2024 to conduct an external evaluation of COHEF with two primary objectives:

  • Assess the impact of enhanced community outreach capacity on increasing health equity in areas of high deprivation
  • Identify approaches which effectively improve health outcomes and reduce systemic barriers to access

Methodology

The study employed the following mixed-methods approach.

Qualitative research
  • Semi-structured interviews with project leads and delivery partners
  • Service user interviews
  • Case studies
  • Process mapping exercises with PCN teams
  • Clinical outcomes and diagnostics from health checks
  • Service usage statistics and referral pathways
  • Patient wellbeing metrics
  • Referral and uptake rates across interventions
  • Patient feedback questionnaires at baseline and follow-up

Findings

Projects that successfully integrated clinical expertise with community engagement showed particular promise in reaching traditionally underserved populations. Strong engagement with ethnic minority communities, particularly in SMI-focused interventions, demonstrated how targeted outreach can help address documented disparities. However, several significant barriers emerged, including limited-service capacity in deprived areas, complex healthcare navigation requirements, physical and operational constraints, and historical distrusts of healthcare systems.

Learnings

The following themes emerged as critical process elements, providing practical examples of how different approaches can address population needs. These learnings focus on operational effectiveness and engagement strategies rather than resource allocation and reporting requirements, which are addressed separately in the Recommendations section.

Integration of Clinical and Social Support 

Successful integration of clinical and social support requires more than simple service coordination. The pilots demonstrated most impact when creating unified pathways that combined clinical expertise with social support in practical, accessible ways.

  • Shared physical spaces are essential for successful cross-sector integration
  • Multidisciplinary outreach requires intensive coordination but can reach previously disengaged groups

  • Defined care/referral pathways with handover points can encourage cross-sector service utilisation

Sustainable partnerships require dedicated time and resources to build and maintain trust between services, staff, and communities.

  • Consistent staff interactions can build stronger collaboration than formal structures alone
  • Defined governance structures and agreements are key to sustainable cross-sector partnerships

This early testing suggests that successful INT development may require elements of different service approaches, carefully balanced according to local context and population needs.

  • Combine service delivery with long-term infrastructure development to maintain momentum

  • Different target populations require tailored engagement approaches

Further Information

Contact details