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Improve whistleblowing support in primary care, ICBs told

by Eliza Parr
21 June 2023

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ICBs must improve access to ways that primary care workers can ‘speak up’, as current whistleblowing levels are ‘extremely low’, NHS England (NHSE) has said.

Freedom to Speak Up is NHS England’s scheme to ensure staff feel safe and confident speaking up, including via ‘guardians’ who can support staff to speak up when they feel unable to do so by other routes.

In new guidance issued to ICBs last week, NHSE said there are ‘relatively very few trained and registered Freedom to Speak Up guardians’ for primary care workers.

As such, the national commissioner asked ICBs to ‘think about’ ensuring better access to routes for whistleblowing for those working in primary care.

The guidance said: ‘Even where guardians are in place, levels of speaking up (both reported and not reported to the National Guardian’s Office) remain extremely low.’

In 2016, NHS England mandated that all GP practices have a guardian in place by September 2017, following a five-week consultation. 

NHSE and the National Guardian’s Office are currently working with those guardians already in place ‘to better understand the practical challenges’ in primary care and ‘create a menu of support for organisations’.

By the end of this financial year, NHSE will publish more ‘precise expectations’ for ICBs in relation to Freedom to Speak Up for primary care workers.

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The national speak up policy, published last year, said: ‘You can speak up about anything that gets in the way of patient care or affects your working life.

‘That could be something which doesn’t feel right to you: for example, a way of working or a process that isn’t being followed; you feel you are being discriminated against; or you feel the behaviours of others is affecting your wellbeing, or that of your colleagues or patients.’

In this new guidance, NHSE has also asked ICBs to think about how good access to Freedom to Speak Up can help with the delivery of other performance outcomes ‘in terms of worker voice, worker experience and patient safety’.

The guidance said: ‘ICBs have a great opportunity to ensure speaking up routes are available for all workers in NHS healthcare providers across the ICS.

‘This must include access to a Freedom to Speak Up guardian(s) at organisation, place and/or system level.’

Sir Robert Francis QC completed a report in 2015 into the culture of bullying in the NHS, named ‘Freedom to Speak Up’, which suggested the GP contract should include a standard for allowing staff to ‘raise concerns freely’, noting that a smaller work setting can present challenges around anonymity and conflicts with employers.

In 2019, NHSE launched a support system for whistleblowing employees who have drawn attention to unsafe practice following two pilots, one of which was in primary care.

A version of this story was first published by our sister publication Pulse.