Child Safeguarding in General Practice for Sessional GPs

1. Child Safeguarding in General Practice for Sessional GPs Dr D W Jones

2. 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

3. 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

5. Bruising in Babies and Children • 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

7. 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

9. 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

10. 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

12. Working with Children’s 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

13. Working with Children’s 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 child’s 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

14. 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