National Guardian's Office: Supporting the introduction of the Freedom to Speak Up Guardian role in primary care and integrated settings

Summary

In this report, Exploring Freedom to Speak Up: Supporting the introduction of the Freedom to Speak Up Guardian role in Primary Care and Integrated Settings, the National Guardian's Office illustrates the challenges and benefits of implementing Freedom to Speak Up in different primary care settings.

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.

Content

This report shares the learning which has been identified as a result of research looking at how the Freedom to Speak Up role could be introduced in Primary Care and Integrated Settings. It illustrates some of the challenges in implementing Freedom to Speak Up in primary care, as well common themes and learning.

The report identifies two models to support primary care organisations in developing their speaking up arrangements, bridging across the silos of GP, dental, optometry and pharmacy:

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. 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.

Further reading

• 2020 Freedom to Speak Up Guardian Survey Report (National Guardian's Office)
• About the Freedom to Speak Up in Healthcare programme in England (National Guardian's Office and Health Education England)
• The right - and duty - of staff to speak up (A blog by Hugh Wilkins)
• Tackling the blame culture? NHS Staff Survey Results 2020 (Patient Safety Learning)