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GP mythbuster 87: Speaking up and listening well

  • Organisations we regulate,
  • GP and GP out-of-hours services

We have been asked for some examples of speaking up and how this might work at in a GP practice.

All staff should feel comfortable to raise concerns and be confident they will be acted on appropriately. This is included in key line of enquiry W3: is there a culture of high-quality, sustainable care?

Speaking up can improve quality of care and have quality improvement benefits for patients and colleagues. It is a professional obligation for some staff members including doctors, nurses and allied health professionals. But this is only part of the equation. Listening well when someone speaks up is key. This is so staff members feel safe to raise concerns, and are assured that their concerns will be considered and appropriately acted upon.

When Sir Robert Francis published Freedom to Speak Up, he recommended primary care be reviewed separately. After consultation with staff working in primary care, which ended in May 2016, the guidance Freedom to speak up in Primary Care was produced.

The whistle blowing in primary care guidance made recommendations on the need for culture change and improved handling of concerns, including in primary care.

The Francis report of the Mid Staffordshire NHS Foundation Trust Public Inquiry has five elements:

  • recognising something is wrong
  • speaking up
  • thanking the person who raises the concern
  • undertaking the necessary actions to remedy
  • providing support to the member of staff throughout the process


This is an example of a situation when speaking up and listening well leads to improvements in patient safety.

The issue

Brenda, a new receptionist, notices a document left in a printer. There are also other papers among free newspapers and food wrappers in the same consulting room.

Locum GPs and a GP partner have used this room. The referral in the printer is a two-week wait. Other half-printed documents include patient identifiable information and an x-ray referral form.

What was done

Brenda tidies the consulting room and speaks to Sanjay, the practice manager. Sanjay thanks her and asks whether or not she wants to keep her involvement confidential. He recognises how serious un-actioned referrals are and immediately cross-checks patients’ notes to make sure referrals are sent.

The matter is discussed at the next clinical meeting and an action plan developed. Feedback is given to GPs who have used the room. A receptionist and GP work together to formulate a checklist for locums. This is to be completed at end of each session and includes:

  • prescriptions
  • referrals
  • outstanding tasks and actions
  • check printer, equipment or supplies needed
  • room left tidy
  • any patient identifiable information to be disposed of in confidential waste
  • shut down the computer

They introduce a new system for referrals, and attach a user guide for this to the screen in each consulting room. After three months they review this change then discuss results and further improvements at a clinical meeting.

Sanjay lets Brenda know what has been done. He also checks how she is feeling and whether she has faced any difficulty as a result of speaking up.

Last updated:
28 April 2021