Integrated care boards (ICBs) must take action to ensure general practice nurses (GPNs) and other primary care staff are aware of and have access to speaking up routes, a letter from NHS England has urged.
Signed by NHS England’s deputy chair, Sir Andrew Morris, the letter to ICBs stressed that while reporting through the national Freedom to Speak Up (FTSU) scheme had improved, ‘substantial gaps remain’.
The FTSU policy was established in 2016 following the Mid Staffordshire NHS Foundation Trust care scandal and saw the creation of FTSU Guardians – whom staff can raise concerns with about their workplace.
NHS trusts have been required to nominate a FTSU Guardian since late 2016, and in recent years there has been a drive to put FTSU arrangements in place across primary care.
‘We know that reporting through FTSU in primary care settings is improving, but substantial gaps remain, with relatively low reported numbers overall,’ said Sir Andrew.
‘Routes to escalate concerns are more limited than in secondary care, with risks to individual confidentiality due to the size of some providers.’
All NHS organisations, including ICBs were asked by NHS England to ensure they had adopted the national FTSU policy by the end of January 2024, including an updated FTSU guide for leaders and self-reflection tool.
For those that have not yet done this, the letter said this must be prioritised over October – which is FTSU awareness month.
The letter sets out three key actions for all ICBs to take, including:
- Ensuring that primary care staff are aware of and have access to speaking up routes
- Raise the profile of FTSU in primary care by identifying and sharing good practice examples
- Ensuring an executive lead has been appointed to oversee this work and identify who will work with ICBs to support it
And by 2026, it is expected that ensuring access to FTSU Guardians in primary care will form a new part of ICB delegation arrangements.
Concluding the letter, Sir Andrew said: ‘Thank you for all your continued work on this important agenda, creating the right cultures that enable our people to feel safe to raise concerns, which is invaluable to our efforts to continually improve services and make the NHS a safer place.’
As Nursing in Practice reported earlier this year, 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.
A recent analysis by Nursing in Practice explored the current processes used to guide whistleblowers in primary care and the changes needed to better aid nurses who raise the alarm at work.
One GPN told Nursing in Practice about their experience of being bullied, excluded and subsequently on sick leave after raising concerns about patient safety and poor practice in their workplace.
