Freedom to Speak Up
UPDATE: The future of Freedom to Speak Up
On 16 April 2026 NHS England published the following statement: NHS England » The future of Freedom to Speak Up
From 1 July 2026, following a recommendation in July 2025 by the Dash review of patient safety across health and care, NHS England will deliver some activities previously undertaken by the National Guardian’s Office (NGO). Trusts, primary care organisations, integrated care boards (ICBs) and independent providers will be taking on greater responsibility and accountability for embedding effective Freedom to Speak Up arrangements.
We would recommend that you read the article in full. We do not currently have any further information, but will update our guidance as more details are available.
Current Guidance:
GP mythbuster 87: Freedom to Speak Up – Care Quality Commission
Freedom to Speak Up is about encouraging a positive culture where people feel they can speak up, their voices will be heard, and their concerns and suggestions acted on with no retribution.
Speaking up can be about anything that affects care for patients or the working life for colleagues. It includes:
- learning lessons from complaints and when things have gone wrong
- feeling able to speak up to prevent potential harm
- being able to make suggestions as an opportunity to improve.
Speaking up can improve the quality of care for people and can benefit colleagues in the workplace. It is a professional obligation for some members of staff including doctors, nurses and allied health professionals.
There are some unique challenges to speaking up in primary care. Some staff can feel particularly isolated because they work in smaller practices or they fear a risk to their employment if they are raising concerns about someone who may be their direct employer.
There are different models to support primary care organisations in developing their speaking up arrangements in general practice. These include providing Freedom to Speak Up:
- within an organisation, such as a GP practice, GP federation or primary care network
- or at an integrated care system-wide level.
See National Guardian Exploring Freedom to Speak Up in Primary Care and Integrated Settings for more details.
A report from National Guardian’s Office finds that Primary Care providers need further support to implement Freedom to Speak Up effectively.
Exploring Freedom to Speak Up: Supporting the introduction of the Freedom to Speak Up Guardian role in Primary Care and Integrated Settings illustrates the challenges and benefits of implementing Freedom to Speak Up in different primary care settings.
See also:
NHS England » Freedom to Speak Up
Whistleblowing
Whistleblowing Guidance for providers who are registered with the Care Quality Commission v5
Whistleblowing is the term used when someone who works for an employer raises a concern about malpractice, risk (for example about patient safety), wrongdoing or possible illegality, which harms, or creates a risk of harm, to people who use the service, colleagues or the wider public.
Ideally, such concerns should be dealt with by the employer. However, if the management have not dealt with those concerns by responding appropriately to them, perhaps by using the employer’s own whistleblowing policy, or the worker does not feel confident that the management will deal with those concerns properly, they can instead make a disclosure to a ‘prescribed body’, such as a regulator like CQC.
NHS England: whistleblowing-guidance.pdf
GMC policy on whistleblowing Whistleblowing guidance
Raising and acting on concerns about patient safety – professional standards – GMC
Speaking up – ethical topic – GMC
BMA Legislative reforms and whistleblowing
See also:
Doctors Whose Performance Gives Cause for Concern – Wessex LMCs
Professional Standards & Reporting Concerns – Wessex LMCs