Child Safeguarding in General Practice for Sessional GPs

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Child Safeguarding in General Practice for
Sessional GPs

• Dr D W Jones

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What is safeguarding?

• Child safeguarding Arrangements to take all
  reasonable measures to ensure that risks of harm
  to childrens welfare are minimised
• Two components
• protecting children from maltreatment
• preventing impairment of childrens 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

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Why GPs are well-placed to safeguard children

• GPs know the family the family doctor
• GPs have access to the complete medical record
• GPs 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

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Bruising in Babies and Children

• Bruising is the commonest presenting feature of
  physical abuse in children
• Those who dont 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

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Domestic 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

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Information 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 honest
• 3. Seek advice if you have any doubt
• 4. Share with consent where appropriate
• 5. Consider safety and well-being
• 6. Necessary, proportionate, relevant , accurate,
  timely and secure
• 7. Keep a record of your decision and the reasons
  for it

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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

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Working with Childrens Social Care

• 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

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Working with Childrens Social Care

• 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 childs developmental needs
• parenting capacity
• family and environmental factors
• A good report is a reasonable substitute if
• attendance at conferences is not possible it
  should
• be shown to parents prior to the conference

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Recording Child Safeguarding Information

• 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

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