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Practices should develop networks to support whistleblowing, says report

by Jess Hacker
9 June 2021

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GP practices and other primary care organisations should develop local networks to support whistleblowing, the National Guardian’s Office (NGO) has said.

It made the recommendation after its review of the Freedom to Speak Up programme – which aims to encourage staff to feel confident in whistleblowing – found some primary care staff still face barriers to speaking up.  

Under the programme, some sites will have Freedom to Speak Up Guardian – who may be a practice manager, receptionist or GP – and whose role is to ensure the organisation in question provides a response to the matters raised and that it is escalated appropriately.

But the NGO’s review of how the programme is currently working in primary care found that staff who work in services spanning a wide geography struggle to access a Guardian.

By comparison, many NHS Trusts serving over 100 sites have developed local networks of ‘Freedom to Speak Up Champions’ who are able to signpost staff to a Guardian, it said.

For some staff, having a Guardian located at a different site was preferable, it added.

The NGO said that there is ‘no reason why primary care organisations, or any organisation that faces similar challenges around size and spread, cannot adopt a similar approach’.

Understanding of programme ‘generally low’

The review also found that understanding of the speaking up processes was ‘variable and generally low throughout primary care settings’.

Freedom to Speak Up in Primary Care guidance was first produced in 2016 to help improve speaking up arrangements, but the NGO found that while many providers deliver services under the NHS Standard Contract, some were ‘unaware’ of the contractual obligation to appoint a Guardian.

It said that this and the lack of a mandate for organisations not within the NHS Contract resulted in ‘unwelcome variation or a ‘two-tier system’’ of speaking up provision.

Improving routes

Because many primary care services are small in size, a staff member’s referral route can escalate more quickly from internal to external, such as to CCG level, the NGO said.

For example, it said some arrangements present staff members in one GP practice with the option to speak with a Guardian in another practice or to one within their CCG.

Meanwhile, other services had formed ‘alliances among organisations and are developing regional or national structures’ to appropriately escalate cases, the report said.

To improve the model in general practice, the NGO said that speaking up should become ‘ business as usual’, and for leaders to create a work culture where staff feel confident to speak up, whether through a Guardian or other route.

It added that to eliminate the risk of barriers preventing staff from speaking up, it is important to offer alternative routes for workers in small primary care organisations.