Medico-Legal - Child protection

MDU medico-legal adviser Dr Karen Roberts outlines what GPs should consider in suspicious cases.

In cases of suspected child abuse, all decisions should be in accordance with the child’s best interest (Photograph: SPL)
In cases of suspected child abuse, all decisions should be in accordance with the child’s best interest (Photograph: SPL)

Child abuse is an emotive and sensitive issue for doctors. The consequences of getting it wrong can be severe for the child, the parents and the doctor. Some cases result in extensive media coverage criticising the involvement of clinicians.

Fortunately, the Medical Defence Union (MDU) offers specific advice to GP members and there are also some general rules to bear in mind - not least that the child's best interests are paramount in any decision.

Child's best interests
Faced with the possibility that a child is being abused, you will need to carefully consider what you know, before deciding what is in the child's best interests.

The GMC has specific guidance on treating children and young people, namely 0-18 years: guidance for all doctors (2007). This advises on what to take into account when assessing a child's best interests - such as the views of the child or young person and those close to them.

Like adults, children are owed a duty of confidentiality, but in situations where you think a child is at risk of abuse it may be appropriate to disclose confidential information through appropriate channels.

Disclosing information
The GMC advises that information may be disclosed, but the child should be told what information will be disclosed unless doing so would undermine the purpose of the disclosure or put the child at risk. You should also seek consent if a child is competent to make a decision, unless this is not practical.

To do this, you will need to assess a child's capacity to consent. Capacity to consent will depend on factors such as age, maturity and the decision to be made. If the child does not have capacity to consent, you should seek consent from the parents or a person with parental responsibility, but not if this could jeopardise the child's safety.

The information shared should be proportionate to the risk of harm and limited to the minimum necessary.

A young person aged 16 or over is presumed to have capacity to consent.

Justification
The GMC reassures doctors they will be able to justify sharing concerns, even if the concerns turn out to be groundless, if they do so 'honestly, promptly, on the basis of reasonable belief, and through the appropriate channels'. It also says doctors must be able to justify any decision not to share concerns, having taken appropriate advice.

It is vital that you keep good records of all discussions relating to raising your concerns and of any advice you have received.

You should familiarise yourself with local child protection procedures and know who to contact if you suspect abuse is taking place. It is often helpful to seek the opinion of an experienced colleague, a designated person for child protection, or to get advice from your medical defence organisation.

Guidelines
You should be aware of national guidelines on the subject. Examples include:

  • The Department for Children, Schools and Families' (now the Department for Education) guidance Working Together to Safeguard Children (2010) recommends that all organisations working with children have child protection policies, arrangements to work with and share information with other organisations, and arrangements for ensuring staff working with children are aware of their responsibilities and receive appropriate training. It also gives specific advice on the responsibilities of a number of health professionals who work with children, including doctors and nurses who lead on child protection issues within their trusts, paediatricians, dental professionals and GPs.
  • NICE guidelines When to suspect child maltreatment (2009) advise on what signs might alert clinicians to physical, sexual and emotional abuse; neglect; or fabricated or induced illness.
  • The Royal College of Paediatrics and Child Health's Safeguarding children and young people (2006).

Case study
A GP was asked by the local social services to provide the medical records of a five-year-old patient because the social worker was investigating suspected abuse. The GP was concerned about disclosing confidential information.

The MDU advised:

  • Seek information about the concerns.
  • Ask the social worker if it is possible to provide written authority from the person with parental responsibility for the disclosure of information.
  • If parental consent is refused or it is not practical to seek it because it would compromise the child's safety, consider if disclosure is justified in order to safeguard the child.
  • Ask the social worker to confirm that the information requested is necessary to protect the child.
  • If you are satisfied on these points, disclose only the information necessary to safeguard the child and on the understanding that it is shared only with those who need it for that purpose.
  • Make notes of how you reached your decision.
Dr Roberts is a medico-legal adviser for the Medical Defence Union
*The case mentioned is fictitious, but based on those from the MDU's files.
Child protection checklist
  • You have a duty to act if you have reasonable cause to believe a child is at risk.
  • You can disclose confidential information to police or social services without consent or parental authority if it is needed to safeguard a child, but it should be the minimum necessary.
  • Be aware of your local child protection procedures and of relevant guidance.

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