Consultation skills - Working with social services

Issues around consent and information sharing are complex but help is at hand, says Dr Lizzie Croton.

GPs may identify patients who need additional support from social services, such as victims of child abuse (Photograph: Istock)
GPs may identify patients who need additional support from social services, such as victims of child abuse (Photograph: Istock)

The generic term 'social services' will be familiar to all who work in primary care. It is a term relating to care services provided by local councils to support individuals with particular personal and care needs.

The Care Quality Commission (CQC) is the health and social care regulator for England. The aim of the CQC is to provide joined up regulation for health and social care and provide better outcomes for service users.

All health and social care providers must now register with the CQC to be able to provide services. The CQC monitors service providers to ensure they are providing good quality care.

Typical services provided by social services include residential care services, home care and nursing services.

Individuals with care needs are offered a care assessment to identify their needs. The level of care required is ascertained and the client's income is means tested to decide if they are eligible for financial assistance to meet the cost of services. Many patients with chronic disease and complex health needs are involved with social services and GPs work alongside social care providers in meeting health needs.

Given the nature of the GP role, doctors may also be instrumental in identifying patients that may need the additional support of social services by, for example, identifying signs of abuse.

GP involvement
The following are typical circumstances where GPs become involved with social services.

  • An 83-year-old lady with a previous fractured neck of femur and limited mobility is cared for at home by her elderly husband and carers provided by social services.

The GP visits one winter to find the husband ill with pneumonia and requiring admission. The GP makes an urgent referral to social services which arranges for the wife to go into residential respite until her husband is able to care for her again.

  • A GP sees a three-year-old child with her mother. The child presents with urinary symptoms and mother discloses that she suspects the child's father has been sexually abusing her. The parents are separated and the child visits the father once a month.

The GP makes a telephone referral to social services, which deems the child safe to go with her mother and arrange an assessment the following day with the mother and child.

  • A 74-year-old gentleman with multi-infarct dementia presents with recurrent falls requiring A&E attendances via ambulance.

After discharge, the case manager visits the patient on the request of the GP. She finds that the bathroom and stairs are unsuitable for a man with limited mobility.

Following a referral to social services, funds are provided for a stair lift and disabled bathroom reducing the risk of further falls.

The process of referral
Typically GPs can refer to social services through a letter or a common assessment framework (CAF) form where a description of the patient's difficulties can be detailed.

Child protection concerns are generally referred via a CAF form for children. Social services will then arrange an assessment of the patient's needs. Case managers attached to GP surgeries will visit vulnerable patients prone to hospital admissions and can also request social service assessment.

Consent and information sharing
Issues around consent and information sharing are complex but there are a number of succinct publications available that can help (see resources).

Information sharing is a key part of the government's goal of delivering more efficient public services co-ordinated around the needs of the individual.

When referring patients to social services, it is important that the individual/their parent or guardian or authorised representative consents to the referral and also to the sharing of information about the individual to other parties involved in their care. Consent should be obtained ideally in writing and all discussions should be documented clearly in the patient's records.

However, there are instances when consent is not needed to share information. GPs can share information without consent when failure to do so will put a patient in danger of serious harm. GPs should act promptly to avoid delays to any potential investigations. Professionals may also share information to help prevent or detect serious crime.

When sharing information, be open and honest with the individual and/or family affected. Tell them why you want to pass on information to the social services and how information will be shared.

Decisions about sharing information should be based on maintaining the safety and well-being of the individual and others who may be affected.

It is also important to check that information shared is necessary for the purpose for which you are sharing it and it is shared with only those colleagues who need to have it. It should be accurate and up-to-date.

For further information and help in specific cases, your local child protection leads, Caldicott Guardians or medical defence agency will be able to help.

  • Dr Croton is a GP in Birmingham.

Resources

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Review your PCT policies on child protection and familiarise yourself with the referral processes in cases of concern.
  • Review and reflect on the selection of downloadable resources on information sharing and share with your colleagues at a practice meeting.
  • Arrange a regular meeting with your case manager to discuss vulnerable patients on their caseload and review any concerns.

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