This Summer marked the fifth anniversary of the death of Baby Peter Connolly, following horrific abuse at the hands of those who should have protected and cared for him. 'Baby P' was just 17 months old when he died. Yet despite increasing public and professional awareness, and the ensuing legislation and guidance relating to child protection, children continue to be at risk. Recent figures show that:
On average, one child is killed every week in England and Wales.1
Safeguarding children and young people is a fundamental requirement for general practices, and one of the care quality commission (CQC) essential standards on patient safety and quality. Yet three years ago a CQC report showed that only 35% of GPs had achieved the required level of child protection training, and only 27% of primary care trusts (PCTs) could confirm that all practices in their area had a nominated lead for safeguarding.4 Other deficiencies highlighted by the report concerned:
By April 2013, your practice will need to be registered with the CQC and comply with the new safeguarding requirements; these will also be built into the commissioning arrangements that will transfer from primary care trusts to the NHS Commissioning Board (NHS CB) in April 2013. The minimum standard that the CQC will assess for registration is "taking reasonable steps to identify the possibility of abuse and prevent it before it occurs; and responding appropriately to any allegation of abuse".5
Practice managers have a key role in ensuring not only that the relevant documentation relating to safeguarding is in place, but also that practice staff comply with its requirements. This is an ongoing process and you will find it helpful if you not only have a clear action plan in relation to safeguarding issues, but that you also highlight the subject on your practice risk register. You should consider the relationship between safeguarding and other policies and procedures; for example, those relating to workforce issues such as recruitment and induction. This should include reference to locums and other temporary staff as well as permanent members of the practice. It is also essential that practice staff know the appropriate procedure to follow if they suspect or have reason to consider that a colleague or other member of staff is abusing or has abused a child or young person. This should be integrated with your practice whistleblowing policy.
You will need to work closely with the practice's lead for safeguarding to ensure that compliance with your safeguarding children policy is maintained and monitored. You may find it helpful to use the audit tool developed by the Royal College of General Practitioners and the National Society for the Prevention of Cruelty to Children in the safeguarding toolkit.6 This will enable you to identify gaps and prioritise actions that you need to take (see Box 1 and Resources).
Creating a 'child safe' practice
Safeguarding should not be seen in isolation from other initiatives relating to the health and wellbeing of children and young people; for example, the 'You're Welcome' standards that were first referenced in the 2009/10 NHS Operating Framework.7,8 These highlight ways in which practices can promote a culture in which staff are seen as welcoming, approachable and trustworthy. Barriers which deter young people from accessing health services include fear of being judged, and concern that different standards apply to them with regard to confidentiality. If your practice is to be 'child safe', young people must be able to see it as a place where they feel welcome and confident that their rights will be respected. For example, does your practice provide age-appropriate information, both in-house and on your practice website? This should cover the concerns a young person may have about contact with the practice, and provide reassurance that they are entitled to:
You might also highlight that:
Information relating to confidentiality should mention the rare occasions on which information may have to be shared but that, wherever possible, consent will be sought first. Feedback from young people should also be encouraged, including the way in which they can raise concerns or complaints. It is helpful, too, if you include information about other agencies which may be supportive to them, and provide details about national and/or local confidential telephone lines (see Resources).
While it is the responsibility of the clinical staff to comply with the safeguarding requirements relating to their own professional role, you will want to be assured that they are trained to the appropriate level. In addition to this you will need to ensure that non-clinical staff have an appropriate level of awareness of safeguarding issues. This includes receptionists and administrative staff. Involving all practice staff in occasional training sessions will be helpful in raising general awareness, as well as developing a culture in which the welfare of young people is seen as a priority for the practice. Staff should be alert to physical and behavioural signs of abuse as well as indications that a child is being neglected. The use of case studies and scenarios can be invaluable and can help your non-clinical staff to recognise that they have a role to play too.
Making safeguarding a practice priority
If you regularly keep children's issues on the agenda at practice meetings, you will provide an opportunity for ongoing training for staff and a forum for highlighting any families in which children may be at risk. This will encourage staff to be vigilant and to take preventative measures to protect children wherever possible. For example, factors that increase the risk of neglect in infancy include:
Other factors that apply in relation to children of any age include domestic violence, significant disability in the child, serious mental disorder in a parent, and parental addiction to drugs and alcohol. These otherwise disparate facts can only be brought together if there are systems (such as appropriately-structured practice meetings) where pooling this information can take place within the practice. Practice managers are in a good position to facilitate information sharing of this kind.
The patient population of some practices may include children from ethnic minority backgrounds, some of whom may be refugees or asylum seekers. Staff in such practices need to have an informed understanding of relevant cultural differences, and an ability to recognise the potential tensions between the cultural norms of some ethnic minorities and British law (for example, in the case of arranged marriages).
Since most families with children are registered with general practitioners, primary care professionals are in a unique position to detect and prevent child abuse. By promoting children's wellbeing as a key priority, practices can raise awareness not only among their own staff but in their local communities. Practice managers have an essential leadership role in relation to safeguarding, ensuring that staff are trained to recognise potential abuse and to report it appropriately.
Anne Ward Platt is director of a consultancy specialising in the healthcare sector and writes on health and management issues. An experienced conciliator, she is the author of 'Conciliation in Healthcare: managing and resolving complaints and conflict'. She is former Deputy Chair of Northumberland, Tyne and Wear NHS Foundation Trust.
Royal College of General Practitioners and National Society for the Prevention of Cruelty to Children.
Safeguarding Children & Young People. A toolkit for General Practice 2011.
BMA child protection toolkit
HM Government - Working Together to safeguard children
A guide to inter-agency working to safeguard and promote the welfare of children.
London: Department for Children, Schools and Families; 2010.
NSPCC helpline for adults concerned about a child
0808 800 5000
0800 11 11
1. Home Office. Table 1.07. In: Smith, Kevin (ed.) et al. Homicides, firearms offences and intimate violence 2009/10: supplementary volume 2 to crime in England and Wales 2009/2010. London: Home Office; 2011.
2. Smith, Kevin (ed.) Osborne S, Lau I, Britton A. Homicides, firearm offences and intimate violence 2010/11: supplementary volume 2 to Crime in England and Wales 2010/11. London: Home Office; 2012.
3. Information obtained by NSPCC from all 43 police forces in England and Wales under the Freedom of Information Act. See: NSPCC. Figures obtained by the NSPCC reveal sixty child sex offences a day. NSPCC press release 4 April 2012. London: NSPCC; 2012. Available at: www.nspcc.org.uk.
4. Care Quality Commission. Safeguarding Children: a review of arrangements in the NHS for safeguarding children. London: Care Quality Commission; 2009.
5. Health and Social Care Act 2008, Sec 11.
6. Royal College of General Practitioners and the National Society for the Prevention of Cruelty to Children. Safeguarding Children and Young People: a Toolkit for General Practice, 2011.
7. Department of Health. The NHS in England: The operating framework for 2009/10. HM Government. DH: London; 2008.
8. Department of Health. You're Welcome – quality criteria for young people friendly health services. London: Department of Health; 2011.
9. HM Government. Working Together to safeguard children. A guide to inter-agency working to safeguard and promote the welfare of children. London: Department for Children, Schools and Families; 2010.