Client Case Study

Salisbury Plain PCN ‘guards Its Guardian’ With A Technology Safety Net

The National Guardian’s Office and the role of the Freedom to Speak Up Guardian were created in 2015 in response to recommendations made in Sir Robert Francis QC’s report that NHS culture did not always encourage or support staff to speak up, and that patients and workers suffered as a result.

The National Guardian’s office now leads, trains, and supports a network of 600+ Freedom to Speak Up Guardians in England. The aim is to ensure that staff can speak up about any issues impacting their ability to do their job in an effort to improve the local environment and provide learning to the healthcare system as a whole.


The role of the Freedom to Speak Up Guardian was extended to primary care providers in 2017 in a pilot project to understand how it could be introduced into primary care and integrated settings. Salisbury Plain Primary Care Network (PCN) was the first PCN to adopt the Freedom to Speak Up Guardian concept previously only rolled out at larger organisations and trusts. 

“As a small PCN, we place paramount value on the emotional wellbeing of our team. We were very optimistic about the benefits to be gained by having a Freedom to Speak Up Guardian to ensure the whole team felt enabled and empowered to express their needs and concerns,” explains Anna Morton, PCN Manager at Salisbury Plain PCN. “We quickly realised that this role was a key function we wanted to embed into the culture of our PCN.”

At launch, Salisbury PCN’s Freedom to Speak Up Guardian gathered feedback and raised cases via multiple manual processes – submitting and managing cases via paper feedback forms, email, and phone messages. But as the culture of Speaking Up became more central to the PCN’s ethos, the team expressed a need to communicate more efficiently. Leaders recognised they needed a smarter approach and started exploring their options. 

“We were gaining all this great insight into our PCN and associated practices and its valued workers, and we wanted to be 100% confident we were capturing, recording, and responding to that feedback in the best way possible,” explained Anna. “However, we also needed to be respectful of the diverse needs of our team, and we didn’t want to start prescribing avenues of communication at the risk of alienating individuals less familiar with technology.”


When Salisbury PCN discovered WorkInConfidence, they were immediately impressed by the wide range of benefits it offered the PCN practices, and that confidence in the solution has continued to grow post-implementation as other benefits have become apparent.

“The purpose of the Guardian role is to allow people’s voices to be heard – but in my experience, that does not begin and end purely with the Guardian who is, after all, only human. WorkInConfidence provides additional infrastructure and support to the Guardian model and helps overcome any unconscious bias or misinterpretations. It has enabled me to think about what we should be rolling out in a PCN,” she explains. “I like to think of it as a way to ‘guard the guards.”


In the four months since implementation, WorkInConfidence has allowed Salisbury PCN to:

  1. Extend the routes available to the team to provide feedback. Salisbury PCN now offers its team the option of phone, email, letter and the WorkInConfidence platform.
  2. Ensure an objective quality assurance on what the Guardian is going back to say. WorkInConfidence makes the data easily and readily available so that an extra level of QA can be achieved. This collaborative approach to supervision enables Guardians to de-brief and get constructive and independent positions.
  3. Retain all records even after a matter has been closed. This ensures that records can be re-opened to verify what happened and identify if any errors or oversights have crept in.
  4. Improve segregation of responsibility and put in proper backup processes. Salisbury PCN can ensure the original information is retained and maintain the confidentiality of the individual.
  5. Offer Guardians significant efficiency by having feedback and cases in one place, which is easily accessible. 


Rolling out WorkInConfidence provided Salisbury PCN with an opportunity to re-launch the Freedom to Speak Up Guardian programme and reposition it as a more holistic feedback solution, focusing on how feedback increases learning and understanding. Launched and positioned correctly, WorkInConfidence encourages all types of feedback, including constructive suggestions and praise and recognition for jobs done well. 

WorkInConfidence creates a single, transparent lens to capture, record, and review all the team perspectives – whether positive, negative or everything in between. The process ensures that managers have full visibility, and Freedom to Speak Up Guardians has full oversight of both the original case and the manager’s response. This level of transparency provides a safety net for everyone involved to learn, improve, and grow and, most importantly, ensures that everyone knows they have a voice.

“All change can be difficult, and introducing new innovations and processes is always going to meet with some resistance, especially if people haven’t yet realised the extent of the problem and just assume they have to keep doing it the way they always have,” concludes Anna. “However, it does not take long after a Freedom to Speak Up Guardian has been put in place to identify some of the inherent challenges of relying on an individual to manage the process manually. Once the importance of the Guardian role is appreciated, it is easy to create a business case for WorkInConfidence to provide a vital support infrastructure to the Guardian’s role.”


WorkInConfidence works with companies of all sizes to facilitate prompt, confidential and honest communication within an organisation. 

The critical first step to any successful organisation is allowing employees to speak up, be heard, and share their stories safely and securely. 

WorkInConfidence solutions provide platforms that allow for two-way engagement – anonymously if necessary – so that companies are positioned to support their employees in the best way possible.

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