Child Safeguarding in General Child Safeguarding in General Practice for Sessional GPsPractice for Sessional GPs

Dr D W Jones

What is safeguarding?What is safeguarding?

Child safeguarding: Arrangements to take all reasonable measures to ensure that risks of harm to children’s welfare are minimised

Two components;– protecting children from maltreatment– preventing impairment of children’s health or

development

Child protection: the activity taken to protect children who are suffering or at risk of suffering significant harm

4 categories of abuse: physical, sexual, emotional and neglect

Why GPs are well-placed to Why GPs are well-placed to safeguard childrensafeguard children

GPs know the family – ‘the family doctor’GPs have access to the complete medical

recordGPs are the first point of contact for most

health needs in children (and can examine)Members of the PHCT might be the only

professionals seeing a pre-school child

Bruising in Babies and Bruising in Babies and ChildrenChildren

Bruising is the commonest presenting feature of physical abuse in children

Those who don’t cruise rarely bruise Bruises that are seen away from bony

prominences are suspicious Multiple bruises in clusters or of uniform

shape are suspicious Bruises have to be placed in context

Domestic ViolenceDomestic Violence Any incident of threatening behaviour, violence or abuse

(psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners

Children are often victims too, even if not directly assaulted themselves (emotional abuse)

40% of DV cases also involve physical or sexual abuse of the child by the perpetrator

Identifying and helping women suffering from DV is a vital part of protecting children

Male perpetrators most often present to GPs Freedom Programmes for women and Perpetrator

Programmes for men are available in most places

Information SharingInformation Sharing

The seven golden rules:1. The Data Protection Act is not a barrier to appropriate

sharing information (neither is the duty of confidentiality or the Human Rights Act)

2. Be open and honest3. Seek advice if you have any doubt 4. Share with consent where appropriate5. Consider safety and well-being6. Necessary, proportionate, relevant , accurate, timely

and secure7. Keep a record of your decision and the reasons for it

Information Sharing cont.Information Sharing cont.

Information sharing is essential for children to be effectively safeguarded

There is a clear legal framework to help facilitate rather than hinder such sharing

Information may be released without consent, such as when it is considered in the public interest to do so

It is in the public interest that children are not abused – niggling concerns should be shared

Share information in line with the ‘seven golden rules’ The best interests of the child are of paramount

concern – those of parents are secondary

Working with Children’s Social Working with Children’s Social CareCare

They are a point of referral and advice An initial assessment will be made after referral Then a strategy meeting/discussion, if there are

concerns about risk of significant harm If there are still concerns then there will be s47

enquiries and a core assessment, followed by a child protection conference

The child may then be made subject to a child protection plan

The plan will be reviewed at 3, then every 6 months

Working with Children’s Social Working with Children’s Social CareCare

GPs should “participate fully in child protection procedures”Information may be sought from GPs in line with the 3 areas set out in the Assessment Framework, i.e:

the child’s developmental needs parenting capacity family and environmental factors

A good report is a reasonable substitute ifattendance at conferences is not possible – it shouldbe shown to parents prior to the conference

Recording Child Safeguarding Recording Child Safeguarding InformationInformation

Rubbish in, rubbish out! Information needs to be easily entered and easily

retrieved (codes and templates) What to record: Hx of abuse, parental substance

misuse/mental illness, DV in the household, contact with CSC, social and developmental history

When to record: at registration, opportunistically