Safeguarding Children (Child Protection) - Clarification of GP obligations

The LMC view is that there is now a clear legal and professional requirement for GPs to engage with and cooperate with local child protection procedures.

Child Protection Procedure - Wessex LMCS template document for you to download and customise for your surgery Dec 09

BMA Child Protection Toolkit. (Excellent Document but over 60 pages long. We recommend you have this printed out and with your Child Protection Folder. Please encourage staff to familiarise themselves with the relevant pages)

LMC Summary of advice We strongly recommend you download this document, discuss at a practice meeting and review your procedures. You might wish to add this to your personal learning portfolio. This should "count" towards your learning and CPD.

Child abuse may consist of

Physical abuse
Emotional abuse
Sexual abuse
Neglect

Primary Care Responsibilities

The doctor must be familiar with relevant local child protection procedures and must know how to deal promptly and professionally with any concerns
A doctor's primary responsibility is always to the child or children which overrides the interests of parents or carers and normal data protection issues

If concerns are raised the doctor must ensure follow-on care

Clear, accurate, comprehensive and contemporaneous notes are essential, must include a future care plan and must identify who has lead responsibility
concerns about a child's welfare should always be recorded whether or not further action is taken
any discussions about a child's welfare should be recorded
at the close of a discussion a clear and explicit recorded agreement should be reached about who will be taking what action if any

All doctors must

understand risk factors and recognise children who may need support and/or safeguarding, including unborn children who may be at future risk
recognise the needs of parents and know how to seek help and support for children at risk, especially if domestic violence or substance misuse is involved
liaise closely with other agencies and contribute to enquiries from other professionals about children and their family or carers
assess the needs of children and the capacity of parents/carers to meet those needs
contribute to child protection conferences, family group conferences, strategy discussions and serious case reviews and their implementation
help ensure that abused children and parents under stress, eg with mental health problems, have access to support services
play an active part, through the child protection plan, in safeguarding children from significant harm
provide ongoing support to children, families and expectant parents.

When making a child protection decision

Children and young people should be involved in decisions which closely affect them
The involvement and support of those with parental responsibility for, or regular care of, a child should be encouraged, provided it is judged to be in the best interests of the child or children, and provided an older child with mental capacity agrees to this approach
The family should not be involved in discussions relating to these concerns if it would potentially increase the risk to the child
It may be necessary to proceed without the consent of parents, carers, or, exceptionally, the children concerned. Both the law and the GMC permit the disclosure of information if it is necessary to protect a child against a risk of significant harm since the public interest in protecting children overrides the public interest in maintaining confidentiality
Good communication is essential and children should be assured that confidential information will only be revealed if it is absolutely necessary and in their best interests
Doctors should avoid making promises of confidentiality that they cannot keep. If there is a risk of significant harm to the child, siblings or to others, doctors have a duty to take action, including, where necessary, the disclosure of relevant confidential information
Distress should be minimised and adequate time taken to protect the child and to increase the chance of gaining accurate and complete information
Leading or suggestive communication with children or other members of the family should be avoided

If serious risk of immediate harm is suspected the doctor must act immediately to protect the child by contacting one of following statutory bodies with responsibilities for child protection

police
local authority social services
National Society for the Prevention of Cruelty to Children (NSPCC)

The doctor should always make a full report of concerns and the precise action taken, which should be governed by the procedures set out by the Local Safeguarding Children Boards

A doctor must never delay emergency action required to protect a child from harm or ignore early warning signs

Decisions may have to be based on fragmentary and ambiguous evidence
Discussion with colleagues and the advice of trained professionals eg named child protection doctors and nurses should be sought
Corroboration from other sources may be helpful. Consultations, home visits, as well as information from health visitors, midwives and practice nurses can all help to build up a picture of a child in difficulty.

It may be in the best interests of the child to undergo an examination for which consent is normally required. This may be permissible without explicit consent if there is a clear justification based upon an informed judgement of the child's best interests. This should be recorded in the child's medical notes.

Practices should have written protocols that identify roles and responsibilities for their entire team, including receptionists, and set out best practice in relation to child protection and the management of confidential information.

All members of the primary health care team should know how to act on concerns, especially if a child is considered to be at risk of significant harm.

All members of the primary health care team should be familiar with local procedures and the names and contact details of colleagues with experience in child protection, such as the named and designated professionals within their Trust. Effective support and protection for vulnerable children can only be provided by an interdisciplinary team of health and social care professionals where good liaison and communication exists.

GPs are well placed to recognise when a parent or other adult carer has problems which may affect their ability to look after a child
Doctors should collaborate closely with all members of the primary care team to secure the safety and wellbeing of children
Health visitors have an important role in the protection of vulnerable children and support of families
There should be structured liaison between health visitors and GPs in order to identify and support children who may be at risk
Midwives are also well placed to identify any problems during pregnancy, birth and the child's early care
An increasingly multi-professional approach to child protection means that teachers, school nurses and nursery nurses may provide important information about children who may be vulnerable or at risk.

Doctors have a key role to play in child protection case conferences and the BMA considers it important that, as far as possible, doctors should attend them in person, in addition to sending a written report containing relevant information such as immunisations, A&E and out-of-hours attendance and non-attended appointments.

CED 6/07/09