By Ojali Yusuff and Aiysha Raoof, Associate Leads at Nottingham and Nottinghamshire Integrated Care System
Addressing long-standing inequities
COVID-19 highlighted again long-standing inequities in health and care, particularly for healthcare staff from Black and Minority Ethnic communities [1]. As part of measures to tackle aspects of these inequities, the Nottingham and Nottinghamshire Integrated Care System (ICS) established two system-level Associate Lead roles for Racial Equity and Diversity, open to all professions. We were subsequently appointed, demonstrating how the profession’s skill sets can move and be utilised beyond traditional boundaries into strategic system leadership.
The Primary Care Racial Equity and Diversity Survey
Working with multidisciplinary partners and front-line staff, we designed and launched the Primary Care Racial Equity and Diversity Survey, modelled on the national Workforce Race Equality Standard.
The report showed that 33% of respondents had witnessed racism and 68% were unaware of a Freedom to Speak Up (FTSU) guardian, adding evidence to the informal reports from primary care colleagues on fragile psychological safety and witnessed or experienced racial inequity.
Although the roles were conceived for primary care, we brought commitment, forward-thinking leadership and tangible actions that quickly informed the wider system agenda - shaping ICS recruitment, workforce equity, population health priorities and integrated care design.
Three flagship interventions
Drawing on survey data and the lived experiences of racially minoritised colleagues, system leaders, and allies, we produced a system-backed report, prioritising three flagship interventions:
1. A collaborative FTSU model introducing trained guardians, anonymous digital reporting and restorative forums
2. The Race Equality Maturity Matrix Toolkit based on the incredible work of the Nottingham City Health Inequalities group, enabling every general practice to self-assess, create SMART objectives and rack interventions to improve equity across leadership, recruitment, culture and service delivery
3. Trauma-informed wellbeing resources provide peer-led support and counselling for race-based stress.
We're proud that our work has attracted regional and national recognition, including commendation from Professor Claire Fuller, and believe it demonstrates how clinical leaders can influence systems at scale.
Aligning with National Visions
The approach echoes the Royal Pharmaceutical Society’s ten-year Vision for Pharmacy Professional Practice in England, which champions inclusive leadership, integrated care and a workforce empowered to narrow health inequalities.
It also anticipated the governments newly released Fit for the Future: 10-Year Health Plan for England, and its focus on treating the NHS workforce through providing support in domains such as accountability workplace culture, workforce well-being, psychological support and burnout reduction.
By translating national ambition into practical, co-designed solutions, the Nottingham and Nottinghamshire initiative shows how pharmacists can step into non-traditional settings to enhance and drive system-wide transformation.
Next steps
The next phase will pilot the Maturity Matrix across the ICS, test the FTSU model within newly clustered neighbourhoods and extend trauma-informed support region-wide. Organisations wishing to adopt or adapt any element of the programme are invited to contact us.
We thank every colleague who has been an ally to this work, shared experiences or co-created solutions; your voices remain central to building an NHS that is both equitable and future-ready to all. Thanks, are also due to the Royal Pharmaceutical Society for selecting this work as a trailblazer presentation at the inaugural RPS Midlands 2025 Conference.
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