Difficult Conversations and Speaking Up Guide
HTML edition updated 9 September 2026. This is an educational planning aid, not an official application form or individual advice.
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WELLBEING & WORKPLACE DIGNITY | PRACTICAL WORKBOOK
Difficult Conversations and Speaking Up Guide
Compare informal, formal and national speaking-up routes, then prepare a safer first communication.
What this resource contains
Private reflective prompts
Writing space for a focused plan
Confidentiality and source safeguards
Important
Independent general guidance. It does not replace clinical, employment, regulatory, immigration or legal advice. Do not include patient-identifiable or unnecessary colleague-identifiable information in worksheets.
Author: Dr N Aziz
Published and reviewed: 7 September 2026
Before you write
Use a trusted device or paper copy. Do not include patient identifiers, unnecessary colleague identifiers or confidential records. This workbook is not sent to SAS Doctors Review.
1. Decide the purpose
Complete only the prompts relevant to your situation. Use factual, proportionate language.
Behaviour change
A formal finding
Patient-safety action
Employment remedy
Reasonable adjustment
System learning
2. Check whether informal action is safe
Complete only the prompts relevant to your situation. Use factual, proportionate language.
Seriousness
Power imbalance
Threat or intimidation
Consent to mediation
Evidence preservation
Previous failed attempts
3. Prepare the conversation
Complete only the prompts relevant to your situation. Use factual, proportionate language.
Specific behaviour or risk
Impact
Requested change
Boundary if conduct continues
Review date
Support or accompaniment
4. Prepare to speak up
Complete only the prompts relevant to your situation. Use factual, proportionate language.
Risk and who may be affected
Evidence
Where it was raised
Action or feedback received
National and local escalation route
Advice about detriment
Action summary
What must happen today?
Who will I contact and for what purpose?
What will be reviewed, by whom and when?
Keep the routes separate
Treatment, employment representation, patient-safety escalation and advocacy serve different purposes. Use each where it is needed.
Sources and disclaimer
Use the current provider, national framework and local employer policy before a significant decision. Legal time limits may continue during internal procedures.
Core sources: GMC Good medical practice 2024; Acas workplace guidance; HSE Management Standards; national NHS speaking-up frameworks; current service provider pages.
Independent guidance
This workbook does not assess risk, diagnose illness, determine bullying or discrimination, calculate legal deadlines or replace individual advice.