The GMC's Protecting children and young people: the responsibilities of all doctors came into effect on 3 September 2012.
As a primary care specialist, you may have a valuable insight into a child or young person's family situation. Being familiar with the procedure for raising concerns and sharing information can ensure children at risk get the help that they need without delay.
Child protection is a complex and emotive issue, so the Medical Protection Society (MPS) welcomes this new guidance, which not only clarifies but extends the responsibilities of doctors dealing with matters relating to children and young people who may be at risk.
As GPs are often the first health professionals to have contact with children and young people, it is important that they are aware of the extent of these new responsibilities and have the skills to discharge them.
There is now an obligation for all doctors to be aware of services in their locality that can help parents and children if a child is potentially at risk, including services provided by voluntary groups. This might prove challenging for GPs who have recently moved to a new locality.
The GMC also requires doctors to develop an understanding of the practices and beliefs of the different cultural and religious communities that they serve, presenting a challenge for GPs who work in ethnically diverse areas.
Making a referral
Doctors have new responsibilities when it comes to referring concerns to an appropriate person or agency. Previously, once a doctor had referred their concerns, they had discharged their responsibilities. However, the GMC now makes clear that doctors should follow up concerns and take them to the next level of authority, if they believe the person or agency to whom they have referred the issue has not acted on them appropriately and a child or young person remains at risk of abuse or neglect.
It is essential to keep clear, accurate and legible records when raising child protection concerns. Any information that might be relevant to keeping a child or young person safe must also be available to other clinicians providing care to them. Not only do doctors have a responsibility to keep comprehensive records, they also have to ensure they are stored securely and shared with relevant parties.
Sometimes, concerns may be raised about the content of a child's records by members of their family, either at the time or at a later date. The GMC provides helpful guidance, making it clear that even where a doctor's concerns later prove to be unsubstantiated, it is important that a careful record of them is made. A record indicating that the concerns proved to be unsubstantiated should be added to the notes, but the concerns have to remain on the medical records. This may well lead to friction between a doctor and the child's parents, but the guidance is clear and this should be explained to parents.
Information or records from other organisations, for example, child protection conference minutes, must be placed with the child or young person's medical records. Alternatively, the information must be made available to clinicians who take over their care. If a doctor is providing care to several family members, information about family relationships should be included in the child or young person's medical records. Records should only be destroyed in accordance with the NHS DH guidelines, even if they are made in a private healthcare setting.
If a child or young person needs to be examined for child protection purposes, appropriate consent must be obtained.
Often, this may be provided by someone who holds parental responsibility for the child or young person and frequently, this consent is conveyed to the doctor by either the police or another agency.
Previously, this consent might have been unquestioningly accepted as appropriate and valid.
However, the new guidance stresses that the doctor has an obligation to check the person providing consent has been given appropriate information about the nature of the examination to be carried out and the purposes for which the information will be used; as evidence in court, for example.
The need to share information typically arises in the light of a child protection investigation being carried out by social services, often with the police or other authorities. Doctors must have the appropriate authority or justification for disclosing information. This would normally be the consent of the patient involved or other lawful authorisation, such as a court order, or when the disclosure of the information could be justified as being in the public interest.
Agencies must provide sufficient information for the doctor to weigh the evidence and make a judgment about whether information should be shared, unless a court order exists.
Once a decision has been made to share the information, only information relevant to the request should be shared. This could include family risk factors, drug and alcohol misuse or previous instances of abuse or neglect. The guidance stresses this would not usually involve sharing the complete records; a helpful clarification, as this issue has caused some confusion for doctors in the past.
If a doctor seeks advice about sharing information, they must record not only the decision reached and the reasons for it, but details of the advice.
A welcome challenge
The new child protection guidance is helpful and welcome. It extends the responsibility of all doctors, including GPs, in the area of safeguarding children. Its implementation may at first prove to be challenging, particularly at a time when the NHS is already subject to considerable change.
- Dr Bown is director of policy and communications at MPS.
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