The scale and complexity of primary care means there isn’t always a reliable system in place to support nurses when speaking up. Madeleine Anderson looks at the current processes used to guide whistleblowers, and asks what changes are needed to better aid nurses who raise the alarm at work.
There has been a recent rise in the number of nurses and colleagues speaking up, with data from whistleblowing charity Protect and not for profit organisation WhistleblowersUK reporting high numbers of calls from health and social care staff in the last year.
But data from the Freedom to Speak Up (FTSU) Guardian scheme – which works to support staff to raise concerns within healthcare – suggests the proportion of issues raised in primary care is much lower than in secondary care overall.
Nursing in Practice spoke with a general practice nurse (GPN) about their experience and who said the level of protection for whistleblowers has to improve, with more support needed outside of practices to help aid nurses raising concerns.
‘It’s understanding that the value we provide in the raising of concerns is of genuine value’
Long-term conditions lead at the Royal College of Nursing (RCN) and primary care advanced nurse practitioner, Callum Metcalfe-O’Shea, says the variability of primary care – coupled with ‘lone working’ – can make it harder for nurses in the sector to speak up.
With general practices being independent employers, there can be different processes from practice to practice.
Mr Metcalfe-O’Shea argues that colleagues in secondary care benefit from having more structure and formal processes and policies in place.
He says lone and autonomous aspects of working in primary care, alongside capacity issues, ‘can sometimes make it a bit more difficult to have that sound board’.
‘Capacity can sometimes make it a bit more difficult to have that sound board of being able to speak to other colleagues in a timely fashion, and getting their input and ideas and just understanding what their concerns or thoughts or feelings may be towards a particular situation,’ he tells Nursing in Practice.
‘[In secondary care] there’s always lots of people around, lots of people you can speak to,’ says Mr Metcalfe-O’Shea.
But he adds: ‘With primary care being so big and variable, with different practices having different staff sizes, it can make it really difficult to raise concerns.’
Ensuring nursing staff are aware of whistleblowing processes within their workplace is key to valuing nursing as a ‘safety critical profession’, says Mr Metcalfe-O’Shea, who listed induction periods, team meetings and annual appraisals as ideal opportunities to update staff on whistleblowing procedure.
‘They’re registered professionals and they have to feel confident that if they do have concerns, they need to raise them,’ he says.
‘It’s understanding that the value we provide in the raising of concerns is of genuine value.’
‘It’s about having the confidence to recognise that there’s a reason you’re raising this concern and… that doesn’t just impact on your patient, but every other patient and staff member you’re working with,’ he adds.
Registered nurse and founder of campaign group NMCWatch, Catherine Watters, echoes the importance of speaking up, but recognises the lack of protection whistleblowers may have.
‘Whistleblowing is the core of nursing,’ she tells Nursing in Practice.
‘We’re supposed to speak up for those who are more vulnerable than ourselves. We’re supposed to put the patient in the centre of everything that we do.’
Through her NMCWatch work, Ms Watters supports nurses going through fitness to practise referrals and has worked closely with whistleblowers seeking advice and reassurance in recent years.
‘Anybody that’s raising concerns is potentially a whistleblower, particularly if those concerns are about immediate line management or things that are happening in their immediate area, and there’s just no protection whatsoever.’
She adds: ‘In fact, we get penalised for doing it.
‘At the moment whistleblowers are just out on their own, and they’ve been doing it for years on their own, swimming at sea, and they’re lost really.’
What support is out there?
While not compulsory, the National Guardian’s Office ‘expects’ primary care providers and health and care leadership organisations and regulators to appoint a Freedom to Speak Up (FTSU) Guardian who is separate from line management or the practice partnership.
In 2023/24 nurses accounted for the biggest proportion of cases (28.3%) raised with FTSU Guardians.
FTSU Guardians were recently introduced into primary care, but just 21.8% of primary care organisations had one in post for 2023/24.
And the number of cases reported to the scheme within primary care accounted for less than 1% of the overall total, compared to 90.8% in secondary care.
Meanwhile, several whistleblowing charities are available for support, which can range from legal advice on whistleblowing rights to emotional assistance for those who have raised the alarm.
Protect – a charity which supports whistleblowers and campaigns for policy change – saw almost a third (30%) of its whistleblowing calls come from those working in health and social work, according to information shared with Nursing in Practice. Protect had a total of 533 calls from the health and social work sector in 2023– a 48% increase from 2022.
Andrew Pepper-Parsons, director of policy at Protect, says the ‘status’ of staff is ‘critical when gauging who gets listened to’ at work.
‘Primary care services and the NHS have a unique set of challenges which can create additional tensions between doctors, nurses, consultants and management,’ he says.
‘There does seem to be a set of factors within the health sector that put a prize on seniority and hierarchy that you don’t get in other sectors.’
Separately, WhistleblowersUK, a not for profit organisation which represents whistleblowers, saw half of its calls in 2023 from people working in health and social care – with one in three of those calls coming from staff working in primary and community care.
Georgina Halford Hall – chief executive officer at the organisation – believes a more simple, centralised ‘office of the whistleblower’ is needed to protect whistleblowers.
She says that the variation and number of reporting and speaking up policies sees nurses ‘waste time’ and ‘use the wrong policy’ in some cases.
‘The biggest reward to any of our nurses, no matter where they work, public, private sector, primary care… is the security of knowing that when they see something that they just think might be causing harm or fraud or disruption, or cover up of any of the above, that they can safely speak up in the knowledge that they will not face retaliation.
‘And if they do that, there is somebody at the office of the whistleblower who will be in their corner fighting for them.’
A nurse’s perspective
Nursing in Practice spoke with one GPN, who wanted to remain anonymous, about their poor experience of speaking up in their practice.
They told us they have faced bullying, exclusion and stress-induced sick leave after raising concerns about patient safety and poor practice in their workplace.
But the GPN, who works in the South of England, says despite receiving unfair treatment since speaking out earlier this year, they will not leave their workplace because they are worried that if they go, the situation will continue unaddressed.
And they called for a ‘safe place’ for GP staff – potentially away from the workplace – where they can go to raise complaints and feel assured that they will be taken seriously.
Click here, to read our exclusive nurse whistleblower interview in full.
