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Exploring Freedom to Speak Up: Supporting the introduction of the Freedom to Speak Up Guardian role in Primary Care and Integrated Settings

Primary Care providers need further support to implement Freedom to Speak Up effectively.

The National Guardian’s Office published a report on 3rd June 2021 which illustrates the challenges and benefits of implementing Freedom to Speak Up in different primary care settings.

The pandemic has shown how vital Freedom to Speak Up is for all workers in health, not just to ensure that patients receive the best care, but also to protect the safety of workers. As the sector rebuilds following the pressures of the pandemic, retaining these highly skilled, dedicated workers has never been more essential.

In 2019, the National Guardian’s Office began a two-year project working with primary care providers to understand how the Freedom to Speak Up Guardian role could be introduced in primary care and integrated settings. This report describes some of the variety of organisations, and the different Freedom to Speak Up models they have adopted.

This report shares the learning which has been identified as a result of this research. It illustrates some of the challenges in implementing Freedom to Speak Up in primary care, as well common themes and learning.

The primary care landscape is complex and interconnected including General Practice, Primary Care Networks, Clinical Commissioning Groups, community dental, pharmacy and ophthalmic services. This report describes some of the variety of organisations, and the different Freedom to Speak Up models they have adopted.

Through engaging with diverse types of primary care organisations, the National Guardian’s Office has identified two models to support primary care organisations in developing their speaking up arrangements, bridging across the silos of GP, dental, optometry and pharmacy.

There are two types of model:

  1. Freedom to Speak Up within an organisation – an individual organisation model – such as a GP practice or Dental surgery; or a Clinical Commissioning Group
  2. Freedom to Speak Up within a network or defined structure – a partnership model – for example Primary Care Network or alliance between opticians; a local support model – eg practices supported by their local committee, CCG or NHS Trust; or an Integrated Care System Model.

Whilst organisations may vary in size, structure and business model, the promoters and barriers to speaking up are common to all settings and organisations. Workers need to be assured that they will be supported when they speak up; that they will be listened to; and that the correct actions will be taken as a result.

The report shows that the universal nature of the promoters and barriers to speaking up requires, in response, universal principles for embedding effective speaking up arrangements and implementing the Freedom to Speak Up Guardian role.

Universal principles will help to provide a consistent approach to Freedom to Speak Up so workers can be confident when they speak up, they will be supported, listened to, and the appropriate actions taken. This consistency will be vital as the sector evolves into more integrated ways of working, where workers may need to speak up about matters across patient pathways.

Following the publication of this report, the National Guardian’s Office will work in partnership with NHS England/Improvement and the Care Quality Commission to use this learning to describe these universal principles to support healthy speaking up cultures and encourage engagement across health.

Dr Henrietta Hughes OBE, National Guardian for the NHS said: “I am grateful to those organisations who have worked with us as they develop their speaking up arrangements, to help us understand the challenges and benefits to implementing Freedom to Speak Up in different types of organisations.

“Just as patients expect the same high quality level of care and compassionate service across the system, a universal, integrated approach to Freedom to Speak Up will provide workers with the same consistency of worker experience, no matter what their role or where they work. Our vision is that by applying universal principles, we can help to make speaking up business as usual throughout the sector.”

Dr Nikki Kanani, Medical Director of Primary Care for the NHS said: “I welcome this report which provides a consistent approach to Freedom to Speak Up. Having this in place will ensure NHS staff across primary care know that  – wherever they work –  when they speak up, they will be supported, listened to, and the appropriate actions will be taken.

“These universal principles will help us foster a healthy culture of speaking up and we will work in partnership with the National Guardian’s Office to see them successfully embedded across the system.”

Rosie Benneyworth, Chief Inspector of Primary Medical Services and Integrated Care, for Care Quality Commission, said: “As the way that we deliver primary care develops and evolves, knowing that the principles of Freedom to Speak Up can apply in any setting provides a great opportunity to promote and foster consistent and complementary approaches to speaking up, listening and learning.

“This also means that through a shared understanding and commitment, strong cultures of reflection and learning in primary care could dovetail with the work being done in other parts of the system as we see more and more collaboration in local areas.

“Now more than ever, having relied so greatly on the agility and dedication of people working in all sections of health and social care in recent months, it’s vital that the system is able to listen and learn from their experiences.”

For more information or interviews contact: comms@nationalguardianoffice.org.uk