Building Bridges Between Community and Primary Care: Insights from Belgium and England

I never expected that my pharmacy internship would shape the direction of my career. But day after day, I met people who came in for medication and ended up sharing stories about unstable housing, unpaid bills, loneliness, or the struggle to navigate the healthcare system. I realised that behind every prescription lies a much bigger context. Those conversations sparked my interest in the everyday circumstances that shape health. They led me to study how community pharmacists recognise and respond to these needs during my master’s thesis, and eventually to the COMPASS project, which I have worked on for my PhD. As an interdisciplinary team, we co‑created a community health worker (CHW) intervention and implemented it in 18 primary care practices in Antwerp, working closely with patients, primary care staff, and community organisations.

The COMPASS study

CHWs supported around 20 patients per practice, helping them identify their needs, set personal goals, and navigate both health and social services. Embedded within primary care teams, CHWs participated in multidisciplinary meetings and strengthened collaboration across disciplines. Early findings show that CHWs in the COMPASS-project mainly addressed non‑medical needs that practices often lack the time or expertise to manage. Their work resembles the link worker role in England, which sparked my interest in how different systems organise and support these community‑centred roles. As I explored this further, a more fundamental question emerged: How are collaboration patterns between primary care teams and community‑centred roles shaped by the organisational structures, processes, and contextual factors of the health system in which they are embedded?

Health care delivery in Belgium and England

Belgium is often praised for its universal health insurance and broad availability of services. On paper, access looks comprehensive. In practice, however, important gaps remain. The system is built on free provider choice and the absence of formal gatekeeping. While this offers flexibility, it also creates complexity. Patients face relatively high out‑of‑pocket costs and must navigate fragmented administrative pathways, challenges that disproportionately affect those with fewer resources. As a result, people with low incomes report some of the highest levels of unmet medical need.

These issues are closely tied to fragmentation across the system. The development of interprofessional primary care teams with shared responsibility for a defined population varies across settings. Patients often assemble their own network of providers, which leads to variability in coordination and continuity of care. Within this context, roles such as CHWs become important connectors, helping bridge gaps between medical care and the wider social realities of patients’ lives.

England’s NHS, by contrast, provides care free at the point of use, largely removing financial barriers. Yet it faces its own pressures: workforce shortages, long waiting times, and stretched community services. What is particularly relevant for my research is how primary care is organised. Through Primary Care Networks (PCNs), practices collaborate to serve defined populations and receive dedicated funding to build multidisciplinary teams. Within these teams, link workers play a role in supporting patients with non‑medical needs and connecting them to community resources.

Research whilst staying in Oxford

From 18 May to 17 July 2026, I am based at the University of Oxford to deepen this comparison. During my stay, I am analysing interview data from Belgium and England to understand how CHWs and link workers are experienced in practice. I am conducting this research under the supervision of Stephanie Tierney and Debra Westlake, whose expertise in social prescribing, community-based care, and qualitative health research has been invaluable in shaping my thinking throughout this project. But I also want to gain a more grounded sense of the English context. I am meeting researchers, attending seminars and speaking with healthcare professionals and link workers to see how these roles operate in their own environment. These conversations will help me to interpret the data more meaningfully and give me a richer understanding of how collaboration takes shape in everyday practice. These conversations have shaped the research protocol I have developed during my stay.

This experience has reminded me why I started this journey in the first place: to understand how care can be organised in ways that truly meet people where they are. I’m excited to take these insights back home and continue building bridges between community and primary care.