Speaking up in the NHS in England: the work of the National Guardian and NHS England.

Abstract

The Francis Report following the Public Inquiry at Mid Staffordshire NHS Foundation Trust identified that workers had tried to speak up about patient safety concerns but had been ignored and even victimised as a result.1 In the subsequent Freedom to Speak Up Report, Sir Robert Francis made recommendations for the changes needed to improve the NHS, leading to an open and transparent culture for the benefit of patient care.2 Freedom to Speak Up builds on the work already undertaken in primary care in order to tackle and prevent patient safety incidents. Nearly a quarter of responders to the consultation were from primary care, demonstrating that there is still more to do.3 NHS England’s guidance requires all primary care providers to identify a Freedom to Speak Up Guardian either within or outside the organisation. This editorial describes the requirements for Freedom to Speak Up in primary care in England and how NHS organisations are developing a culture of safety and learning where all workers are able to speak up safely. The landscape of primary care is complex, with numerous smaller providers and some larger, multisite providers. Speaking up in small teams can be challenging particularly if your manager is also your employer, or for GPs, raising concerns about a partner or colleague. Regulations in primary care include the National Performers List regulations4 and Revalidation regulations5 which are the statutory responsibility of NHS England and the General Medical Council respectively. The commissioning landscape is complex and shifting, with CCGs taking on co-commissioning of general practice with NHS England. This raises the question — who do you turn …