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All GP practices should have to appoint whistleblower guardians, says DH-commissioned review

All GP practices should have a designated, independent person to which doctors, nurses and staff can turn with concerns about care failings, Sir Robert Francis QC has recommended.

Sir Robert - who led the review into failings at Mid-Staffordshire NHS Foundation Trust - published his high-profile report into a culture of bullying of whistleblowers within the NHS today, which recommended that the GP contract should include a standard for allowing staff to ‘raise concerns freely’.

The Government announced that it supported all of the report’s recommendations in principle and would go ahead and consult on their implementation.

As part of the review, Sir Robert conducted a confidential survey sent to all NHS workers, employers and associated organisations, finding that 30% of those who raised a concern felt unsafe afterwards while 18% of those who had not raised a concern expressed a lack of trust in the system as a reason, and 15% blamed fear of victimisation.

As a result, he recommended 20 action points be taken, one of which exclusively covered the GP contract, and said that all health organisations should have a designated individual to whom staff can turn when they have concerns over care.

He said he considered it essential that the support recommended ‘should be available to NHS staff who work in primary care.’

Consideration should be given to how this can be provided, he added: ‘Federations of GP practices may be able to appoint a Freedom to Speak Up Guardian; others may be able to sign up the services of their local NHS trust’s Guardian, as happens already in at least one area.’

The GP contract should be amended to provide protection for staff who speak up, the report said.

It added: ‘NHS England should include in its contractual terms for general/primary medical services standards for empowering and protecting staff to enable them to raise concerns freely, consistent with these Principles.’

Announcing the Government’s response to the report in the House of Commons today, health secretary Jeremy Hunt said: ‘I can confirm today I am accepting all his recommendations in principle and will consult on a package of measures to implement them.’

He said that the Government will legislate to protect former whistleblowers when seeking new employment in the NHS so that they are not discriminated against and that the royal colleges will be reviewing how there can be more ‘clinical accountability’ in community care, building on the measure of accountable GPs that is already being rolled out.

Mr Hunt added: ‘The only way we will build an NHS with the highest standards is if doctors and nurses who have given their lives to patient care always feel listened to if they speak out about patient care. The message must go out today that we are calling time on bullying, intimidation and victimisation which has no place in our NHS.’

Sir Robert has been leading several reviews into the culture of NHS care since being appointed by the Government to look into failings at the Mid Staffordshire hospital during the 2000s, making several hundreds of recommendations that are being implemented by the Department of Health and NHS England.

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Readers' comments (17)

  • Except it would be as "independent" as DDRB or information commissioner is to the government.

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  • A small organisation where the guardian might be the subject of concern . That's going to work . please could the people who think up this stuff just stop for a moment and work out how this process would operate.

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  • We really aren't independent contractors any more as much as it grieves me to admit.. I think we should throw in the towel and embrace salaried status. Our terms and conditions are now so extensive and binding that the balance in favour has tipped.

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  • And NHSE and all the LATS should have a new set of managers to manage this and some managers to manage them. Hopefully there will be some new forms to fill in every quarter, but they will subtly change every quarter, which we will have to discuss in a whistleblowing meeting with all the primary care team when there is a full moon. More dross to make the job even drossier.

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  • Is this guy really "thick" or just pretending to be??
    What a Hunt !

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  • More silly bureaucracy and non-jobs.

    To understand why this is not necessary in general practice which are not NHS employees you have to understand why the problem existed in the NHS. Then you can understand why the problem is not systemic in general practices which are independent business.

    The vicious suppression of dissent including whistleblowers was not something that happened by accident, it was an intention of the Labour Government.

    Robert Francis has been a waste of time. He has found that the Soviet union is not a nice place to live or work, well big whoop. Who didn't know that? It isn't solved by appointing yet another army of clipboard commisars as Mr Francis believes. It's solved by admitting that the problem is sheer bad appointments right at the top of the NHS who then set the tone of the whole organisation.

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  • This comment has been moderated.

  • Having raised concerns within a practice and been punished for doing so, I totally agree with this.
    The person concerned must be independent and listen to anonymous concerns.

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  • Vinci Ho

    Principles are there but implementation needs a lot of thorough thinking. So often it is one person going against an establishment and hierarchy leading all the way up to politicians . While previous government(s) cannot deny their responsibilities on this , this current government has been advocating a culture of bullying . The SOS has no choice other than accepting the recommendations today from a QC who emphasised 'duty of candour' two years ago.
    The analysis from BBC news is worth reading:
    Analysis
    By Hugh Pym, BBC Health Editor
    Perhaps the most eye-catching remark by Sir Robert Francis this morning is that two years, almost to the day, since his final report on the Mid Staffordshire scandal there is still a "serious problem in the NHS" relating to whistleblowers.
    Sir Robert says that even after the drive for transparency following Mid Staffs there are still too many staff who are afraid and who had told his review they had seen colleagues suffer.
    He proposes there should be "guardians" appointed at hospitals to support whistleblowers, but if the trusts pay their salaries will they be truly independent?
    Sir Robert does not feel he can offer an amnesty for whistleblowers currently in dispute with employers - the legal process, in his view, must be left to take its course though he urges employers involved in cases to "reflect" on his report.
    Sir Robert pointed out that the key change needed related to cultural rather than regulatory reform.
    Few would disagree that culture change needs more than a report from an eminent QC.

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  • Vinci Ho

    Hence , it is so vitally important regulatory body like GMC must serve for independence , fairness and justice . Because the fitness to practise sanction can always be misused by a hierarchy as a penalty to 'tackle' whistleblowers . And everybody can report to GMC under the heading of 'patient safety'........
    Its first priority is therefore INVESTIGATE to prove if rules are broken........

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  • How long has it taken to find suitable chair for the historic child abuse investigation? In principle this whistleblowers policy is needed but Why should anybody trust a Guardian from their local area? They will be of variable competence, independence and appropriateness... at the very least hopefully the 'guardians' won't be the same people who do the rounds on various cttees presently or recently - as why was nothing done whilst they were in place?. It might have been thought that the NHS local Healthwatch organisations could do the job but they are variable, one claiming that they cannot be responsible for the length of time primary care managers respond to concerns, another nearby in Islington has run a 'Mystery Shoppers' project whereby volunteers were sent undercover into GP surgeries across Islington N London to investigate what information was given to the 'shoppers' posing as potential complainants and how helpful and knowledgeable staff would be. Finding that the majority failed to have a transparent or up to date policy and although afterwards some updated practice and policies ,many did not use the healthwatch document which was drawn up. (google Islington Healthwatch) We are in a very strange place these days -

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