Building Trust, Partnership and Health Equity with GRT Communities in London

By Riyadul Karim, Assistant Director, Community Engagement and Vaccine and Screening Equity, NHS England, London Region 

As we approach Gypsy, Roma and Traveller History Month this June, there is an important opportunity not only to celebrate the histories, cultures and contributions of Romani Gypsy, Roma and Traveller communities, but also to reflect on what inclusion means in practice.

History Month is a time to challenge stereotypes, raise awareness and amplify community voices. For those of us working in health and public services, it should also prompt a deeper question: how do we ensure that Gypsy, Roma and Traveller communities are not only recognised, but genuinely heard, respected and better served?

For me, the answer begins with trust.

For many communities, particularly those who have experienced exclusion, discrimination or poor access to services, trust cannot be assumed. It has to be built patiently, respectfully and through relationships that recognise people as active partners in their own health and wellbeing.

My role at NHS England, London Region, focuses on building partnerships between communities, the voluntary and community sector, local authorities, the NHS and wider system partners, spanning place, system and region. The aim is simple but important: to improve access, confidence and participation in vaccination, immunisation, screening, prevention and wider health services among communities who have too often been underserved.

This work has grown from lessons learned during the pandemic. In Enfield, during the COVID-19 response, NHS and local authority partners worked closely with Revival Christian Church of Enfield, a Black African and Black Caribbean heritage church, to create open and honest conversations about health, vaccination and trust.

These were not formal lectures or top-down campaigns. They were town hall-style breakfast conversations, brought together with local partners, held in a trusted place and opened by a trusted faith leader, Pastor (Dr) Nick Chanda. They were supported by trusted local medical and nursing voices who could listen, respond and speak with faith, cultural understanding and clinical credibility.

Those early conversations helped shape the model I now call the 3Ts: Trusted Leaders, Trusted Places and Trusted Voices.

The 3Ts is a practical framework for moving from generic outreach to culturally intelligent, community-centred partnership. It recognises that communities have their own leadership, knowledge, relationships and systems of influence. If public services want to improve access and confidence, they must work with these assets, not around them.

Trusted Leaders are people who already hold credibility and influence within communities. Trusted Places are the spaces where people feel safe, known and respected. Trusted Voices are those who can communicate with authenticity, cultural understanding and lived insight.

Together, these three elements help services listen differently, work in partnership more meaningfully and design services with communities rather than simply for them.

Across London, this approach has informed the development of Vaccination and Screening Groups, which I have convened with partners and which are now evolving into Community Health Equity Forums. These forums bring together NHS colleagues, local authorities, voluntary and community organisations, faith and community networks, clinicians and people with lived experience to address inequalities in vaccination, screening, prevention and wider health access.

The purpose is not only to improve communication, although that matters. It is also to improve cultural accessibility. That means asking whether services are easy to understand, easy to reach, respectful of cultural realities and shaped by the communities they are intended to serve.

This includes co-developing and co-producing culturally authentic health materials, strengthening trusted community routes into services, and creating spaces where communities can raise concerns, share insight and influence system practice.

We have seen this approach develop through partnerships with a wide range of communities, including Bangladeshi, Pakistani, Indian, Sikh, Somali, Black African and Black Caribbean, Polish, Romanian, Brazilian and Portuguese-speaking communities.

The London Bangladeshi Health Partnership (LBHP), for example, has shown how trusted relationships and community-led approaches can support health promotion, vaccination confidence and prevention in ways that feel meaningful and locally grounded. Its work has been captured through reports hosted by Voice4Change England and its activities delivered through Bangla Housing Association Ltd.

More recently, similar principles informed the Romanian Health Roundtable and the development of the Romanian Health Equity Forum, bringing together community, academic, local authority and NHS partners to focus on access, prevention and trust with Romanian communities in London. The Romanian Health Roundtable Event Report provides an example of how community insight, academic partnership and system leadership can come together to support more equitable health engagement.

The London Romani Gypsy, Roma and Irish, Scottish and Welsh Traveller Communities Health Equity Forum is part of this wider movement towards community-centred health equity.

The Forum has been convened and co-developed with key voluntary and community sector partners, local authorities, NHS colleagues and community representatives across London. This includes valuable and integral input from Phil Regan at the Traveller Movement, colleagues from Enfield, Hammersmith and Fulham, Brent, Barnet, Bromley and Haringey councils, Friends, Families and Travellers, London Gypsies and Travellers, Roma Support Group and others.

The Forum meets monthly and uses the 3Ts methodology as a framework for strengthening engagement, sharing learning and identifying practical action.

For GRT communities, this work is especially important.

Romani Gypsy, Roma and Traveller communities continue to experience significant and persistent health inequalities, shaped by structural exclusion, discrimination, poor access to culturally appropriate services and lower levels of trust in institutions. Improving vaccination, immunisation and screening equity cannot be separated from these wider realities.

This is why partnership matters. No single organisation can address these issues alone. Progress depends on bringing together those who understand the system with those who understand community experience, culture and history.

The Forum creates a space for that shared work. It enables partners to discuss what is happening across London, share examples of good practice, identify barriers, strengthen routes into services and consider what needs to change at a system level.

One of the key areas of focus is the need for better evidence and a clearer understanding of the health needs of GRT communities across London. Collectively, Forum members have discussed how a pan-London Health Needs Assessment for Romani Gypsy, Roma and Irish, Scottish and Welsh Traveller communities could provide an important foundation for more equitable planning, commissioning and service delivery.

Such an assessment would help local authorities, the NHS and community partners better understand health needs, access barriers, prevention opportunities and gaps in provision. It could also support more targeted work on immunisation, vaccination, cancer screening, health checks and wider prevention.

Alongside this, the Forum provides an opportunity to raise awareness of important initiatives such as the Propel  Project, build collective momentum and connect this work with wider health equity priorities across London.

The aim is not to create another talking shop. The aim is to build a practical, trusted and sustained partnership that can help improve outcomes.

That means listening to communities about what is not working. It means recognising the impact of stigma and discrimination. It means working through trusted organisations and community advocates. It means making health information clearer, more culturally authentic and more accessible. It means ensuring that services are not only available, but genuinely reachable and acceptable.

Most importantly, it means recognising GRT communities as partners in health equity, not simply as populations to be reached.

The Traveller Movement and many other community and voluntary sector organisations have long played an important role in amplifying the voices, experiences and rights of Romani Gypsy, Roma and Traveller communities. The development of the London GRT Communities Health Equity Forum builds on this collective legacy of advocacy, partnership and community leadership.

It provides a shared space where community insight, voluntary sector expertise, local authority and NHS partners, and wider system stakeholders can come together to strengthen understanding, shape solutions and drive progress towards greater health equity.

As we mark Gypsy, Roma and Traveller History Month, this feels especially important. Celebration and recognition matter. But recognition must also translate into practical change: better listening, better evidence, better access and services shaped with communities rather than simply directed towards them.

For me, this work is part of a broader commitment to cultural transformation in health systems. Institutions need to become better at listening, better at collaborating and better at working with the communities they serve.

The 3Ts model offers one way to do this. It reminds us that trust is not a soft extra. It is core infrastructure for health equity.

If we want to improve vaccination, screening, prevention and wider health access, we must begin where trust already lives: with trusted leaders, in trusted places, through trusted voices.

The London GRT Communities Health Equity Forum is an important step in that direction. It brings partners together around a shared purpose: to improve health equity,  strengthen cultural understanding and ensure that Romani Gypsy, Roma and Traveller communities are heard, valued and better served across London.

There is much still to do. But by working together, listening carefully and building from trust, we can move from recognition to action, and from aspiration to lasting change.