Introduction
Safeguarding is a fundamental responsibility of every general practice. All members of the practice team have a role in protecting children, young people and adults who may be at risk of abuse, neglect, exploitation or harm. General practice is often uniquely placed to identify safeguarding concerns because of its long-term relationships with patients and families and its ability to recognise changes over time.
Safeguarding is not solely the responsibility of clinical staff. Receptionists, administrators, managers and volunteers may all observe indicators of risk and have an important role in sharing concerns appropriately. Effective safeguarding requires a culture of professional curiosity, multidisciplinary working, accurate record keeping and a commitment to putting patient welfare at the centre of decision making.
Every practice should maintain clear safeguarding arrangements, including named safeguarding leads, up-to-date policies, staff training, structured safeguarding discussions and effective links with local safeguarding partners.
Key Practice Responsibilities
Every practice should be able to demonstrate that it:
- Maintains safeguarding policies for both children and adults.
- Has a named GP Safeguarding Lead and arrangements for deputy cover.
- Ensures all staff undertake role-appropriate safeguarding training.
- Provides safeguarding induction for new starters.
- Holds regular discussions regarding vulnerable patients and families.
- Understands local referral routes for adult and child safeguarding concerns.
- Maintains robust systems for recording and sharing safeguarding information.
- Reviews safeguarding arrangements annually.
- Promotes a culture where staff feel confident raising concerns.
Safeguarding should be considered as part of routine care rather than as a separate process. Clinicians should remain alert to patterns, behaviours or disclosures that may indicate abuse, neglect or exploitation.
Useful resources:
Safeguarding Hub | RCGP Learning
Safeguarding Training
Current Standards
Safeguarding training within general practice is now aligned with the RCGP Safeguarding Standards. The emphasis has moved away from counting training hours and towards demonstrating safeguarding knowledge, capability, reflection and impact on practice.
Training should be refreshed annually and should include both adult and child safeguarding issues. Staff should understand how safeguarding applies within their specific role and be familiar with local procedures and escalation routes.
Training Levels
| Training Level | Appropriate Staff Groups | Key Requirements |
| Level 1 | • Reception staff • Administrative staff • Secretarial staff • Volunteers |
Staff should receive safeguarding induction, understand local reporting processes, and complete regular safeguarding updates. |
| Level 2 | • Practice managers • Team leaders • Care navigators • Healthcare assistants • Pharmacy technicians • Safeguarding administrators |
Training should support understanding of organisational safeguarding systems, escalation processes, safeguarding responsibilities, and record keeping requirements. |
| Level 3 | • GPs • Practice nurses • Pharmacists • Paramedics • Physician associates • Allied health professionals • ARRS staff in clinical roles |
Training should support independent recognition and management of safeguarding concerns, multi-agency working, and demonstration of safeguarding capabilities across both adult and child safeguarding. Annual updates and reflective learning should form part of ongoing professional development. |
The Five Safeguarding Capability Domains
The RCGP standards are founded on five safeguarding capability areas:
- Professional safeguarding responsibilities.
- Identification of abuse and neglect.
- Responding to abuse and neglect.
- Documentation and record keeping.
- Information sharing and multi-agency working.
Practices should ensure that learning activities address all five domains across the whole practice team.
Useful resources:
RCGP Safeguarding toolkit | RCGP Learning (includes details of the additional training recommended for the Practice Safeguarding Lead and the Practice Manager, plus two templates clinicians are recommended to complete – Case review template and Reflective-Practice Structured-Template)
GP mythbuster 25: Safeguarding adults at risk – Care Quality Commission
GP mythbuster 33: Safeguarding children – Care Quality Commission
Home | Child health Safeguarding
There is FREE e-learning from the Learning Hub for both Adult and Children’s safeguarding.
Professional Curiosity and Trauma-Informed Practice
Professional Curiosity
Professional curiosity involves respectfully exploring concerns rather than accepting explanations at face value. It requires practitioners to gather information, consider the wider context and identify patterns that may indicate risk.
Examples include:
- Frequent non-attendance.
- Repeated unexplained injuries.
- Concerns regarding parenting capacity.
- Indicators of coercive control.
- Sudden behavioural changes.
- Repeated presentations that do not fit the reported history.
Professional curiosity should be balanced with empathy, compassion and respect.
Trauma-Informed Practice
Many patients accessing healthcare services have experienced trauma, including childhood abuse, domestic abuse, exploitation, displacement, discrimination or adverse life events.
A trauma-informed approach recognises:
- The prevalence of trauma.
- The impact trauma may have on health and behaviour.
- The importance of promoting safety and trust.
- The need to avoid re-traumatisation.
- The value of collaborative decision making.
Trauma-informed care supports more effective patient engagement and can improve outcomes for vulnerable individuals.
Useful resources:
Contemporary Safeguarding Risks
Modern safeguarding practice extends beyond traditional concepts of abuse and neglect. Healthcare professionals should remain alert to a range of emerging and complex safeguarding issues.
Domestic Abuse
Domestic abuse can affect people of any age, background, ethnicity, sexuality or gender.
It may include:
- Physical abuse.
- Emotional abuse.
- Psychological abuse.
- Sexual abuse.
- Coercive and controlling behaviour.
- Economic abuse.
- Technology-facilitated abuse.
- Stalking and harassment.
Children living in households where domestic abuse occurs may also experience significant harm even when they are not direct victims.
Useful resources:
Domestic abuse – NHS Safeguarding
E-learning course raising awareness of domestic violence and abuse | Virtual College
Child Criminal Exploitation (CCE)
CCE occurs when children are manipulated or coerced into criminal activity for another person’s benefit.
Potential indicators include:
- Missing episodes.
- Association with older individuals.
- Unexplained money or gifts.
- Travel to unfamiliar locations.
- Possession of multiple mobile phones.
- Sudden changes in behaviour.
Useful resources:
Child criminal exploitation – NHS Safeguarding
Child Sexual Exploitation (CSE)
CSE is a form of child abuse involving manipulation, coercion or deception.
Indicators may include:
- Sexual health concerns.
- Missing episodes.
- Emotional withdrawal.
- Risk-taking behaviours.
- Older partners.
- Online grooming.
Useful resources:
Child sexual exploitation and abuse – NHS Safeguarding
County Lines
County lines activity involves organised criminal groups exploiting children and vulnerable adults to transport drugs or money between locations.
General practice may be one of the few services in contact with affected individuals and therefore has an important role in recognising indicators of exploitation.
Useful resources:
County lines: criminal exploitation of children and vulnerable adults – GOV.UK
Modern Slavery and Human Trafficking
Potential indicators include:
- Restricted movement.
- Fearfulness or anxiety.
- Poor living conditions.
- Lack of control over identity documents.
- Signs of physical neglect.
- Dependence on accompanying individuals.
Useful resources:
Modern slavery and human trafficking – NHS Safeguarding
Modern slavery training: resource page – GOV.UK
Prevent
Healthcare staff should understand their responsibilities under the Prevent Duty and recognise individuals who may be vulnerable to radicalisation.
Concerns should be managed through established local referral pathways and safeguarding procedures.
Useful resources:
NHS Prevent training and competencies framework – GOV.UK
Prevent duty: guidance for healthcare professionals – GOV.UK
Information Sharing and Record Keeping
Good safeguarding practice depends upon accurate, timely and proportionate information sharing.
Records should:
- Be factual and objective.
- Clearly distinguish facts from opinion.
- Include actions taken and referrals made.
- Record discussions and advice received.
- Be entered promptly.
- Remain accessible to relevant clinicians.
Particular care should be taken when managing:
- Domestic abuse information.
- Third-party information.
- Sensitive safeguarding correspondence.
- Information visible through online records access.
Clinicians should remember that data protection legislation does not prevent appropriate information sharing where there are safeguarding concerns. Where uncertainty exists, advice should be sought from safeguarding leads, information governance teams, DPOs or medical defence organisations.
Useful resources:
A 10 step guide to sharing information to safeguard children | ICO
Protecting children and young people: The responsibilities of all doctors – professional standards – GMC (See Paragraph 58)
Multi-Agency Working
Safeguarding is most effective when organisations work collaboratively. General practice should participate in local safeguarding arrangements and contribute information appropriately when concerns arise.
MARAC
Multi-Agency Risk Assessment Conferences (MARACs) bring agencies together to support victims experiencing high-risk domestic abuse.
The aims are to:
- Improve victim safety.
- Reduce repeat victimisation.
- Share relevant information.
- Develop coordinated support plans.
Useful resources:
Learn more about the MARAC – SafeLives
High Risk Domestic Abuse Meetings
Some areas operate High Risk Domestic Abuse (HRDA) arrangements which build upon MARAC principles and adopt a broader whole-family approach.
These processes may involve:
- Police
- Health providers
- Children’s services
- Adult social care
- Housing
- Probation
- Specialist domestic abuse services
MAPPA
Multi-Agency Public Protection Arrangements (MAPPA) support management of individuals who may present a significant risk of serious harm.
These arrangements involve information sharing and coordinated risk management between criminal justice agencies and partner organisations, including health services where appropriate.
Practices receiving MAPPA-related information should ensure it is handled sensitively, recorded appropriately and considered when planning care and staff safety.
MAPPA Categories and Management Levels
Offenders managed under MAPPA (Multi-Agency Public Protection Arrangements) are grouped into three categories:
- Category 1: Registered sexual offenders subject to notification requirements under the Sexual Offences Act 2003.
- Category 2: Violent and other sexual offenders, including those sentenced to 12 months or more imprisonment or detained in hospital and subject to supervision in the community.
- Category 3: Other offenders assessed as posing a risk of serious harm to the public.
MAPPA management is delivered at three levels, according to the degree of risk and multi-agency involvement required:
- Level 1 (Ordinary Agency Management): Most offenders are managed by a single agency, with information shared with other agencies where necessary.
- Level 2 (Multi-Agency Management): Involves coordinated management by several agencies through regular Multi-Agency Public Protection (MAPP) meetings.
- Level 3 (Multi-Agency Protection Panel): Reserved for offenders who pose the highest risk of serious harm or whose management requires intensive multi-agency oversight and resources.
Useful resources:
Multi-agency public protection arrangements (MAPPA): Guidance – GOV.UK
Adult Safeguarding and Mental Capacity
Adult Safeguarding
Adult safeguarding is underpinned by the Care Act 2014 and applies to adults with care and support needs who may be experiencing, or are at risk of, abuse or neglect.
The six safeguarding principles are:
- Empowerment
- Prevention
- Proportionality
- Protection
- Partnership
- Accountability
Potential forms of abuse include:
- Physical abuse
- Emotional abuse
- Sexual abuse
- Financial abuse
- Organisational abuse
- Neglect
- Self-neglect
- Discriminatory abuse
Mental Capacity
The Mental Capacity Act 2005 provides the framework for assessing capacity and making best-interest decisions.
The five statutory principles are:
- Presume capacity unless proven otherwise.
- Support individuals to make decisions.
- Respect unwise decisions.
- Act in best interests where capacity is lacking.
- Choose the least restrictive option.
Capacity assessments should always be:
- Decision specific.
- Time specific.
- Clearly documented.
Best-interest decision making should involve family members, carers and relevant professionals where appropriate.
Useful resources:
Mental Capacity Act – Social care and support guide – NHS
Mental Capacity Act training – The Learning Hub
Mental Capacity Act – Wessex LMCs (opens a separate guidance page)
Mental Capacity Act 2005 and Mental Capacity (Amendment) Act 2019
Female Genital Mutilation (FGM)
FGM is illegal in the UK and is recognised as a serious form of child abuse and violence against women and girls.
Healthcare professionals should:
- Understand the indicators of risk.
- Recognise safeguarding responsibilities.
- Follow local safeguarding procedures.
- Be aware of mandatory reporting duties.
- Record concerns appropriately.
- Support affected women and girls sensitively.
Practices should ensure that staff are aware of available training resources and referral pathways.
Useful resources:
Female genital mutilation (FGM) – NHS
Female Genital Mutilation – Information Sharing – NHS England Digital
NHS England » Female Genital Mutilation: Standards for training healthcare professionals
FGM: mandatory reporting in healthcare – GOV.UK
FGM Mandatory reporting duty flowchart
Additional Vulnerable Groups
Looked After Children and Care Experienced Young People
Looked after children and care experienced young people often experience increased vulnerability and poorer health outcomes.
Practices should ensure that safeguarding considerations are integrated within routine healthcare provision and that appropriate information sharing takes place with relevant professionals.
Useful resources:
Promoting the health and wellbeing of looked-after children – GOV.UK
Looked after children and care leavers – NHS Safeguarding
Overview | Looked-after children and young people | Guidance | NICE
Children in care (looked after children) | NSPCC Learning
Learning Disabilities and Neurodiversity
People with learning disabilities and neurodevelopmental conditions may face increased safeguarding risks and barriers to accessing support.
Professionals should:
- Consider communication requirements.
- Make reasonable adjustments.
- Recognise increased vulnerability to exploitation.
- Ensure safeguarding processes remain accessible.
Useful resources:
Supporting children who have additional needs and disabilities: SEND/ASN/ALN | NSPCC Learning
Recording information about a patient being on the Sex Offenders Register
Information about a patient’s inclusion on the Sex Offenders Register may be relevant to clinical care, staff safety, and lone working arrangements. Any such information should be handled sensitively and, where obtained from a third party, verified before being recorded.
If recorded, disclosure of this information must comply with GMC confidentiality guidance. Consideration should also be given to restricting online visibility or redacting the information where appropriate.
Where coding is used, the correct clinical code should be applied while the patient remains on the register. Once removed, the code should be replaced with an appropriate code indicating a criminal record, while maintaining the audit trail.
Useful Resources:
Confidentiality: good practice in handling patient information – professional standards – GMC
BMA core ethics guidance on-line resource launched – Institute of Medical Ethics
Local Safeguarding Contacts
To the best of our knowledge these contact details are correct, however we would urge practices to contact their local teams for up-to-date information and named contacts and leads.
Local Adult Safeguarding Boards – most have training on offer
- Portsmouth portsmouthsab.uk/training/upcoming-training
- IOW iowsab.org.uk/events/
- Dorset Training – BCP Safeguarding Children Partnership and the Dorset Safeguarding Children Partnership
- Swindon swindon.gov.uk/info/8/training
- Wiltshire wiltshiresvpp.org.uk/p/learning-hub/welcome-to-the-learning-hub-1
- Bath & North East Somerset https://bcssp.org.uk/p/training/about-our-training
Wessex LMCs Resources
Wessex LMCs provides a range of safeguarding resources for practices, including:
- Educational Podcasts and Videos Focusing on Safeguarding
- Level 1 and Level 2 Safeguarding Training Adult and Child Lunch & Learn
- Medical records guidance.
- Education & Events – Wessex LMCs
Practices are encouraged to use these resources alongside national guidance and local safeguarding partnership information.
Further resources: