The new guidance for primary care providers on supporting whistleblowing in the NHS follows the Freedom to Speak Up report on the review by Sir Robert Francis, which recommended the need for culture change and improved handling of concerns raised by staff, including in primary care.
All practices are expected to update and review their local policies and procedures by September 2017 to ensure they align with the guidance.
Practices are also required to name a 'freedom to speak up guardian'. This person must be independent of the line management chain and not the direct employer. Their role is to ensure that policies are in place and that staff know who to contact if they have a concern.
The guidance says that some providers may want to go further and involve the freedom to speak up guardians in offering advice and supporting staff that have concerns.
It suggests a range of options for primary care providers for filling this role, the following of which could apply to practices:
- Arrangement with another local provider
- Assigned staff role within a larger provider federation/network
- Arrangement with the local hospital trust freedom to speak up guardian
- Nominated member of the local CCG
- Nominated member of the LMC
- Regional manager in larger provider organisations
- NHS England responsible officers.
NHS England will be working with CCGs and LMCs to support local nominations and will be establishing a network of Freedom to Speak Up Guardians in Primary Care to offer support, resources and further guidance to individuals in this role.
What does the guidance cover?
The guidance also says that all staff working in primary care should be encouraged to raise any concern, at the earliest opportunity. Practices should be proactive in preventing any inappropriate behaviour, such as bullying or harassment, towards staff who raise a concern.
So that staff in primary care staff feel safe to speak up, practices should should ensure that:
- Supervisors and others identified to manage concerns are approachable and trained in how to receive concerns.
- There is a clear positive procedure in place.
- There is support and advice can be easily accessed to help those raising concerns.
- Concerns are taken seriously and clear records are kept,
- Individuals raising concerns will know what will happen if they do so and will be kept informed.
The guidance provides a new standard integrated NHS whistleblowing policy for primary care. All practices need to review and update their own policies so that they align with this by September 2017.
NHS England will monitor implementation using the annual GP practice electronic declaration.
All practices should also have a policy and procedure in place that identifies appropriate external points of referral, that are easily accessible to all staff, where staff can access support and register a concern.
What else must practices do?
- Ensure that contact details for all supervisors or others who are identified to manage concerns are available to staff.
- Be flexible about how concerns can be raised (i.e. in person, by phone, by email).
- Ensure named individuals have access to national learning materials.
- Provide information on additional advice and support available to those raising concerns including, as a minimum, contact details for the NHS Whistleblowing Helpline, Public Concern at Work or union representatives.
Practices must also make sure that staff know:
- That it is right to speak up if they have concerns - practices should spend time reinforcing the message it is safe to speak up and ensure there is a focus on patient safety and improvement.
- The practice is supportive to those raising concerns - practices should ensure 'visible senior management commitment' to implementing whistleblowing policies and procedures and creating safe learning environments, welcome all concerns and accept concerns being raised anonymously.
- How to raise concerns and have access to training which explains what to do - practices should periodically check with staff that they have read and understood the whistleblowing policy and ensure all temporary or locum staff know that they can seek advice on how to raise concerns from their freedom to speak up guardian or via other agencies.
- That they will not be bullied, victimised or harassed as a result of raising concerns.
- That concerns will be reviewed or investigated based on examination of the facts.
An independent, fair and objective investigation into any concerns raised should take place promptly and without seeking to apply blame.
The investigation should have the necessary resource and scope and the recommendations it produces should be based on facts and primarily support safety and learning.
The individual raising the concern should be kept informed of developments.
The investigation must be separate to disciplinary or performance management actions.
Practices must consider, on a case by case basis, the levels of independence required for their investigations. Subject to the gravity or complexity of the concern raised, the level of independence may need to be raised. Options available to primary care providers may include:
- Local peer review of the investigation and outcomes
- Local commissioner review (NHS England or CCG as appropriate)
- Escalating the concern externally formally.
Those conducting the investigation must have the appropriate expertise, training and time to do so immediately.
Staff must also feel confident that any lessons learned will be identified and acted upon. Where possible, finding and actions taken will be shared with the individual raising the concern.
The outcome should be seen as fair and reasonable and plans to monitor the situation should be put in place.