Staff in primary care are considered a vulnerable group in terms of raising concerns with managers, according to the Freedom to Speak up Review carried out by Sir Robert Francis QC.
The Freedom to Speak up review looked at creating an open and honest culture in the NHS and creating an environment in which all healthcare professionals can report any concerns that they may have.
Sir Robert stated in the review that it was 'surprisingly hard to get a clear understanding of the options open to staff who work in primary care'.
He acknowledged that it may be difficult for staff in primary care to raise concerns about managers because they work in smaller organisations such as GP practices and may not have the option to consult anyone outside of the practice.
In order to get past this, he recommended that federations of GP practices appoint a Freedom to Speak Up guardian and that other primary care workers could sign up to the services of their local NHS trust's guardian.
He also recommended that NHS England works with all commissioned primary care services to clarify where employees can go for support and to register a concern in line with the principles in the report.
In his introductory message, Sir Robert said: 'This Review is not about deciding on past judgements and I realise that I am asking something quite difficult of people; that they tell me about their personal experiences of making disclosures in the public interest without me being able to so anything to resolve their individual cases. Nonetheless I hope that people will come forward to the Review and share their views and experiences in order to help inform better practice in the future.'
The review was commissioned by health secretary Jeremy Hunt in June 2014 as a follow up to the Francis Report, published in 2013, which looked at the care failings in Mid-Staffordshire.