Implementation of a national peer workforce: oncreasing capacity, reach, inclusion and equity within the UK’s Hepatitis C Elimination Programme

WHO goals to eliminate hepatitis C (HCV) worldwide require large incidence and mortality
reductions. In the UK, HCV mainly affects people who inject drugs and others who health services find challenging to engage. Under the national elimination programme, NGO The Hepatitis C Trust (HCT) recruits and trains people with lived experience (peers) to improve this engagement. 130 paid and 355 volunteer peers work in every local NHS HCV team and prison. Peer roles encompass education, support, and clinical services e.g. BBV testing, ultrasounds. In four years, peers have tested 121,987 people and supported 11,570 into HCV treatment.
Aims: to examine the process and impacts of embedding peers into UK NHS teams.
Methods: We draw on findings from two university-led qualitative studies exploring HCT’s peer
work and direct implementation experience.
Results: Data from these studies suggest that integrating peers into NHS teams has impacts for the peer, the patient and the service. Peers can deliver a range of services, increasing NHS
capacity and reach and, as a trusted intermediary for people unable to engage, diffuse tensions and fear. Successfully integrating this peer workforce requires a balance of governance structures; these must enable freedom to innovate whilst providing the systems and oversight to deliver high clinical standards and clear, well supported roles. Equity and inclusion are strengthened by an ‘equity cascade’ stemming from HCT (peer-led and managed). HCT’s inclusive ethos strengthens local peers’ expectations and behaviour, which in turn strengthen inclusion in teams, for volunteers and for patients. This has also improved patient-centred care e.g. through innovative outreach and structural changes to make secondary care more accessible. The integration of peers into a health care system can extend and expand healthcare service delivery, increasing reach and offering valuable benefits to services that need to address severe health inequalities.