Identification of who is responsible for the patient
Hospitals should review whether to reinstate the practice of identifying a senior clinician who is in charge of a patient's case, so that patients and their supporters are clear who is in overall charge of a patient's care.
- The National Health Service (General Medical Services Contracts) Regulations 2015 require primary medical service providers to ensure each registered patient has a named accountable GP (The National Health Service (General Medical Services Contracts) Regulations 2015, SI 2015/1862).
- The Academy of Medical Royal Colleges published guidance in June 2014 stating that a patient's hospital stay should be coordinated by an individual named clinician (Guidance on Taking Responsibility: Accountable Clinicians and Named Nurses, Academy of Medical Royal Colleges, June 2014).
- No further published evidence specific to hospital senior clinician identification has been identified since 2015.
How was this evidence gathered?
Response
Accepted
Response
AcceptedThe government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Progress Timeline
DHSC and NHS England implementation update provided to the Thirlwall Inquiry (April 2025). This is the government's own account of progress, submitted to the inquiry. Reviewed extent of implementation: Implemented - Ongoing. The NHS Constitution sets out that patients have the right to express a preference for using a particular doctor within your GP practice, and for the practice to try to comply. It also includes rights to make choices about the services commissioned by NHS bodies and to information to support these choices. The National Health Service (General Medical Services Contracts) Regulations 2015 require providers of primary medical services under a contract with NHS England must ensure each registered patient has a named accountable GP. The Academy of Medical Royal Colleges published guidance in June 2014 stating that a patient's entire stay in hospital should be coordinated and caring, with an individual named clinician.
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
Research published 2023 marking ten years since the Francis Report found mixed results. Structural and legislative changes largely delivered (duty of candour, FPPR, CQC overhaul, revalidation, Freedom to Speak Up Guardians). However, cultural change not fully embedded; understaffing, fear of speaking up, and poor complaint handling persist in parts of the NHS.
Government published "Culture Change in the NHS" (Cm 9009) reporting progress on all 290 recommendations. Key achievements: 19 hospitals placed in special measures; those trusts recruited 109 additional doctors and 1,805 additional nurses; 129 board-level changes made; excess avoidable deaths fell by 450 in less than a year.
Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.