Building an equal partnership for global emergency care
An emergency care partnership linking Bristol in and Laikipia County in Kenya has grown into a wider platform for workforce development and rural education, with clinicians in Kenya and the UK sharing lessons that strengthen care.
Dharura is a charity based within Bristol NHS Foundation Trust that is offering mutual development between NHS and Laikipia County health professionals. The relationship connects hospital services with rural clinics and brings Kenyan experience into NHS practice. During the COVID-19 pandemic, Bristol Royal Infirmary drew on its Kenyan colleagues’ approach to managing infectious disease when adapting its emergency department triage. The experience illustrates how a partnership developed around emergency care can create benefits for patients in both countries. Dharura became a charity in 2022, providing a structure for the fellowships and wider projects that grew from the original collaboration.
For Andy Lockyer, a Bristol Emergency Medicine Consultant and Dharura trustee, the COVID experience captures the purpose of the relationship. He saw that international work could offer substantial value to NHS services, provided organisations created a structure through which staff could participate safely and bring their learning home. The partnership with Laikipia County, which began in 2018, was developed around that principle.
“The problem I’d identified was that lots of NHS staff had great global perspective and experience outside the NHS, but we weren’t harnessing it for the NHS benefit,” he says. He recognised opportunities to improve the governance and effectiveness of international work, ensuring staff didn’t consider leaving the NHS to pursue it.
“I had worked on the model of institutional NHS partnerships for staff development and was presenting the concept at a conference,” he continues. An audience member who had worked in northern Kenya suggested a motivated local team would offer an opportunity to develop the concept. “I visited and met a small but amazing team and we agreed to trial a partnership model.”
The arrangement allows NHS staff to contribute within an agreed structure, with their experience becoming part of an ongoing collaboration rather than ending when a placement finished. Dharura’s work grew from the relationship between Bristol Royal Infirmary’s Emergency Department and Laikipia County, combining global emergency care fellowships with hospital and community projects.
The format has been designed so that proposals can come from existing partnership teams or external approaches. “Each partnership has a combined steering group so mutually beneficial projects are identified and approved with a proposed funding model,” Andy explains. Kenyan fire and police services recently approached the partnership because their personnel provide some of the care provided by ambulance services in the UK. Training is being widened with Kenyan health partners’ approval. “We will ensure they lead it with us,” he says.
Wider collaboration
Bristol NHS Foundation Trust was formed on 1 July 2026, bringing together North Bristol NHS Trust and University Hospitals Bristol and Weston NHS Foundation Trust. The new organisation has more than 28,000 staff caring for more than 1.1m people each year.
Tim Keen, Associate Director of Innovation at Bristol NHS Foundation Trust, sees opportunities to extend the work beyond the hospital. “The project has expanded to include wider UK and Kenyan collaborations, with a strong focus on rural education and training for remote clinics,” he says. His June 2026 visit was planned to review the programme and the partnership’s strategic direction. “This year, we’re piloting a new collaboration with the University of Bristol to provide a three-week global health experience for students, including training and deployment in rural clinics and Nanyuki Hospital.”
Looking ahead, Tim sees scope to extend the work beyond the Trust. “The partnership has shown what becomes possible when organisations commit to learning as equals,” he says. “Our opportunity now is to connect a wider range of colleagues around needs identified together, including data, digital, clinical engineering and innovation, while protecting the trust, reciprocity and local leadership on which the relationship is built.”
Fellowships give Bristol staff a structured route into that collaboration. Dharura describes a 12-month emergency medicine fellowship at Bristol Royal Infirmary, with 20 per cent of paid time dedicated to global emergency medicine. Fellows undertake preparation and UK project work, with deployments of up to eight weeks supporting Nanyuki and surrounding rural clinics. Global health activity becomes part of the role rather than something clinicians must pursue entirely outside their NHS employment.
Senior leaders’ willingness to support an unfamiliar idea was important at the outset, and their continued support has helped the relationship endure. Nursing fellows are recruited from Bristol Royal Infirmary’s Emergency Department for ten-week deployments supporting education and quality improvement. Dharura identifies resource management and leadership as areas of professional development, alongside experience of conditions rarely encountered in the UK. Senior Bristol clinicians provide remote advice during placements, maintaining a connection to the organisation while fellows work with their Kenyan colleagues.
“The project has captured the enthusiasm in the department and feels ‘owned’ by the department and wider trust,” Andy Lockyer says. “Partners feel like our colleagues and the rewards mean large numbers of staff feel highly motivated to remain involved,” he says. “As an organisation, we mainly just set the conditions for these relationships to flourish and be effective.”
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