A new 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.

In 2019, the National Guardian’s Office began a two-year project working with primary care providers to understand how the Freedom to Speak Up Guardian role could be introduced in primary care and integrated settings. This report describes some of the variety of organisations, and the different Freedom to Speak Up models they have adopted.

This report shares the learning which has been identified as a result of this research. It illustrates some of the challenges in implementing Freedom to Speak Up in primary care, as well common themes and learning.

Two types of Freedom to Speak Up model


We have identified two models to support primary care organisations in developing their speaking up arrangements, bridging across the silos of GP, dental, optometry and pharmacy.

  1. Freedom to Speak Up within an organisation – an individual organisation model – such as a GP practice or Dental surgery; or a Clinical Commissioning Group
  2. Freedom to Speak Up within a network or defined structure – a partnership model – for example Primary Care Network or alliance between opticians; a local support model – eg practices supported by their local committee, CCG or NHS Trust; or an Integrated Care System Model.

Whilst organisations may vary in size, structure and business model, the promoters and barriers to speaking up are common to all settings and organisations.

The report shows that the universal nature of the promoters and barriers to speaking up requires, in response, universal principles for embedding effective speaking up arrangements and implementing the Freedom to Speak Up Guardian role.

Universal principles will help to provide a consistent approach to Freedom to Speak Up so workers can be confident when they speak up, they will be supported, listened to, and the appropriate actions taken. This consistency will be vital as the sector evolves into more integrated ways of working, where workers may need to speak up about matters across patient pathways.

Following the publication of this report, the National Guardian’s Office will work in partnership with NHS England/Improvement and the Care Quality Commission to use this learning to describe these universal principles to support healthy speaking up cultures and encourage engagement across health.

Read the press release

Read the report