Is raising a concern a professional duty?
Yes. Every UK healthcare regulator says you must act if you believe patients are at risk, and that you must not stop others from speaking up. Raising a safety concern is not disloyalty to your team. Public inquiries into failing services have repeatedly found that staff saw problems but felt unable to speak, or spoke and were ignored.
| Regulator | What it expects, in short |
|---|---|
| GMC (doctors) | Act promptly if patient safety or dignity is or may be compromised. The duty to put patients first overrides personal and professional loyalty. Leaders must make sure concerns can be raised and are acted on. |
| NMC (nurses, midwives, nursing associates) | The Code requires you to act without delay if there is a risk to patient safety or public protection, to raise and escalate concerns, and not to obstruct anyone else from doing so. |
| HCPC (physiotherapists, paramedics and other AHPs) | Report concerns about service users' safety or wellbeing promptly, support others to do so, and follow up and escalate if needed. |
| GPhC (pharmacy professionals) | Speak up when things go wrong, even when it is not easy, and help build a culture of learning. |
Silence carries its own risk. Regulators have taken action against registrants who knew about unsafe practice and said nothing, and against those who discouraged or punished colleagues for speaking up.
What counts as a concern, and how is it different from a grievance?
- Unsafe staffing or skill mix that puts patients at risk.
- Faulty or missing equipment, or unsafe premises.
- A colleague whose practice, health or behaviour may be putting patients at risk.
- Bullying, harassment or discrimination affecting safety or the working environment.
- Abuse or neglect of a patient (which must also go through safeguarding procedures).
- Fraud, falsified records or other dishonesty.
- Pressure to act against your judgement or outside your competence.
- An unsafe policy, or a safe policy that is not followed.
A concern is about a risk to patients, colleagues, the public or the organisation. A grievance is about how you personally have been treated, such as pay, contract or a dispute with a manager. Grievances usually go through your employer's grievance policy, and concerns through its speaking up policy. They can overlap: being repeatedly rostered beyond safe hours is personal, but it can also be a safety concern. If you are unsure which route to use, a Freedom to Speak Up Guardian can help you decide.
How do you raise a concern in the NHS? Step by step
Start as close to the problem as you safely can. Raising it early and locally is often the quickest fix and protects working relationships. Your organisation's speaking up policy will name the exact routes.
- Deal with any immediate risk: If a patient is in danger now, act first. Stop an unsafe procedure if it is safe to do so, call for senior help and make the patient safe. Then raise the concern formally.
- Tell your line manager or clinical lead: Speak to the person responsible for the area, such as the ward manager, consultant or pharmacy manager. Explain what you saw, why it is a risk and what might help. Follow up in writing.
- Report incidents on the local system: If the concern relates to a specific incident or near miss, complete an incident report as well. This creates a record and lets patterns be seen.
- Escalate within the organisation: If nothing happens, or the concern involves your manager, go to a more senior person such as a matron, clinical director, head of profession, director of nursing or medical director.
- Speak to a Freedom to Speak Up Guardian: You can go to a guardian at any stage, including first. They can advise you, help you raise the concern and check it gets a response.
- Raise it outside the organisation: If internal routes have failed or are not appropriate, you can go to a prescribed body such as the CQC or your professional regulator. Get advice first from your trade union, defence organisation or the whistleblowing charity Protect.
Keep a record
Note what you saw, when, who was involved, who you told and what they said. Keep copies of emails. Stick to facts and avoid opinions about people. Do not take patient records or identifiable information home or share them outside proper channels, as that can breach confidentiality and data protection law.
What should you write when raising a concern?
Concerns that are factual, specific and focused on patient risk are far more likely to be acted on. They also create a clear record that you raised the issue.
I'm really worried about nights. It's a disaster and someone is going to die. Nobody cares about the night staff. Something needs to change.
I want to raise a patient safety concern about night staffing on Ward 7. On three nights this month (dates below) there were two registered nurses for 28 patients, including four on enhanced observation. On one of those nights, two patients' 2am observations were recorded nearly two hours late, and a rising early warning score was not escalated until 4am. I have completed incident reports for both. I am concerned that deterioration at night may be missed. Could we discuss this at the next safety huddle and include night-time acuity in the staffing review? I am happy to help.
The stronger version sets out facts, dates and impact, links to incident reports, suggests a next step and offers help. It does not attack anyone.
What does a Freedom to Speak Up Guardian do?
Freedom to Speak Up Guardians came out of the 2015 Freedom to Speak Up review. They are independent of line management and report to the board. NHS trusts in England have guardians, and many primary care and independent providers have access to one.
| A guardian can | A guardian does not |
|---|---|
| Listen confidentially and help you choose the best route | Investigate the concern themselves |
| Raise the concern with you or on your behalf | Replace your manager or the incident reporting system |
| Check it is followed up and that you get feedback | Replace safeguarding procedures |
| Watch for and challenge detriment because you spoke up | Give legal advice |
Confidential is not the same as anonymous
Raising a concern confidentially means the person you tell knows who you are but will not share your identity without consent, unless the law requires it. Anonymous means nobody knows who you are. Anonymous concerns are accepted, but they are harder to investigate and you cannot easily receive feedback or support. Confidential is usually the better choice.
Are you legally protected if you blow the whistle?
The Public Interest Disclosure Act 1998 added whistleblowing protection to the Employment Rights Act 1996. It covers workers, which includes employees, agency workers and doctors in training. If you make a protected disclosure, you are protected from dismissal and from detriment because of it.
- It must disclose information, not just an opinion or general complaint.
- You must reasonably believe it is in the public interest.
- You must reasonably believe it shows a criminal offence, a breach of a legal obligation, a miscarriage of justice, danger to anyone's health and safety, damage to the environment, or deliberate concealment of any of these.
- It must go to the right person: usually your employer or a prescribed person, which includes the healthcare regulators and the CQC.
Wider disclosures, such as to the media, are protected only in narrow circumstances. Take advice from your union or a lawyer before considering this. A clause in a contract or settlement agreement that tries to stop you making a protected disclosure is void.
Why staff stay silent, especially international staff
Most people who do not speak up are not indifferent. They are afraid, unsure or tired of being ignored. Internationally educated staff may also have trained where challenging seniors was unacceptable, or worry about visa sponsorship.
Amira, recently arrived in the UK on a sponsored visa, notices a colleague signing controlled drug register entries he did not witness, and two unexplained balance corrections. She mentions it to him and he laughs it off. Worried about being seen as difficult, she does nothing more. An inspection later finds a stock discrepancy, and she is asked why she did not report it. In her reflection she is honest about her fear, but does not use it as an excuse. She names the GPhC standard, the routes she could have used (the superintendent pharmacist, her professional body, Protect), and agrees with her manager to report any discrepancy in writing on the same day.
If you are senior, you will also receive concerns. Thank the person, listen, deal with any immediate risk, agree when they will hear back, protect their identity, give feedback and make sure they suffer no detriment. How you respond decides whether anyone speaks up again.
Learning more about raising concerns
If you need to show insight after failing to raise a concern, or simply want to feel confident about the routes, our course Raising Concerns and Freedom to Speak Up walks through regulator standards, the escalation steps, legal protections and how to write a reflection and action plan. If your concern involved medicines or records, Medication Errors: Reflection and Remediation and Record Keeping and Documentation: Remediation Course may also help. If you are under investigation, seek advice from your defence organisation, trade union or legal representative. A course does not decide the outcome of any process.
Frequently asked questions
Can I raise a concern anonymously in the NHS?
Yes, most NHS organisations accept anonymous concerns, but they are harder to investigate and you cannot easily get feedback or support. Raising a concern confidentially is usually better: the person you tell knows who you are but will not share your identity without your consent, unless required by law. A Freedom to Speak Up Guardian can explain the options.
What is the difference between raising a concern and whistleblowing?
In everyday NHS use the terms overlap. Raising a concern usually means speaking up internally about a risk. Whistleblowing often refers to a protected disclosure under employment law, which can be internal or made to a prescribed body such as a regulator or the CQC. Both are about the public interest, not personal grievances.
Who can I go to if my manager is the problem?
Go over or around them. Your organisation's speaking up policy will name senior contacts such as a matron, clinical director, head of profession, director of nursing or medical director. You can also go straight to a Freedom to Speak Up Guardian, or to a prescribed body such as your regulator or the CQC if internal routes are not appropriate.
Will I get in trouble with the NMC or GMC for raising a concern that turns out to be wrong?
Not if you raised it honestly, on the basis of reasonable belief and through appropriate channels. Regulators expect you to raise concerns without waiting for proof, and you are not expected to investigate. Raising concerns maliciously or knowing them to be false is a different matter and could be a conduct issue.
Does the National Guardian's Office still exist?
No. The National Guardian's Office closed at the end of June 2026, and NHS England took on some of its national Freedom to Speak Up functions from July 2026. Local Freedom to Speak Up Guardians continue in NHS organisations. Check your employer's speaking up policy for current contacts.
Can I raise a concern directly with the CQC?
Yes. The CQC is a prescribed person for whistleblowing about health and social care services in England, so disclosures to it can be protected. Usually it is best to raise concerns internally first, but you can go to the CQC or your professional regulator if internal routes have failed or are not appropriate.
Where can I get free whistleblowing advice?
Protect is a UK charity that gives free, confidential advice on whistleblowing. Trade unions such as the RCN, BMA, Unison and professional bodies can also advise members, as can medical and nursing defence organisations. Seek advice early, especially before going outside your organisation or if you experience detriment.
Related courses
Raising Concerns and Freedom to Speak Up
This course explains your professional duty to raise concerns about patient safety and wrongdoing, how to raise a concern well, and where to go if…
Medication Errors: Reflection and Remediation
This course explains why medication errors happen, what you must do when one occurs, and how to show a regulator or employer that you have understood…
Record Keeping and Documentation: Remediation Course
This course explains what good clinical documentation looks like, why record-keeping concerns arise, and why altering or falsifying a record is…
Sources and further reading
- Raising and acting on concerns about patient safety. General Medical Council.
- Raising concerns: guidance for nurses, midwives and nursing associates. Nursing and Midwifery Council.
- Standards of conduct, performance and ethics. Health and Care Professions Council.
- Standards for pharmacy professionals. General Pharmaceutical Council.
- The future of Freedom to Speak Up (2026). NHS England.
- Public Interest Disclosure Act 1998. legislation.gov.uk.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
More guides
Duty of Candour: What to Do When Things Go Wrong
Duty of candour explained for UK healthcare professionals: what to do when things go wrong, how to apologise, near misses and the statutory duty.
Probity and Dishonesty: Why Regulators Treat It So Seriously
Why the GMC, NMC and HCPC treat dishonesty so seriously, what makes a probity case worse or less serious, and how to respond to a dishonesty concern.
Record Keeping Mistakes That Lead to Complaints and Referrals
The record keeping mistakes that most often lead to complaints and regulator referrals for nurses and doctors, and how to write safer clinical notes.