NAMES such as Victoria Climbié, Baby P, Daniel Pelka and Liam Fee will be familiar to many and serve as a stark reminder of the vital work that needs to be done to keep children safe.
They are just a few high-profile cases of child abuse in the UK that have come to light over the past two decades, highlighting the continuing need for robust and wide-ranging safeguarding systems.
Much of the focus (and often the criticism) has fallen on the shoulders of social work professionals, but doctors also have a key role to play.
The Royal College of GPs has long advocated a strong role for the involvement of primary care. The College points out that a quarter of a GP’s patients are under 19 with more children and young people seen in general practice than in any other part of the health service.
For this reason, the RCGP has recommended that all practices in England have a GP lead for child safeguarding and a deputy lead. This advice is underpinned by legislation (Section 11 of the Children Act 2004 England) and by Care Quality Commission regulatory requirements. In addition, most clinical commissioning groups in England also choose to employ a “named GP” for safeguarding children to support GPs in their area.
Arrangements in the rest of the UK differ, with doctors in Scotland, for example, working in line with the Getting it right for every child (GIRFEC) scheme.
GPs in England with an interest in this field may follow a formal training pathway with a view to applying for the post of “named safeguarding GP”. According to the RCGP/ NSPCC Safeguarding Children Toolkit for General Practice, the named safeguarding children GP should be “an experienced GP of good professional standing with extended knowledge and skills in the care of children and young people”. This would be evidenced by a higher qualification in child health such as a diploma in child health (DCH) or MSc, and/or experience working in delivery of child health services within community paediatrics, schools or secondary care.
GPs may also have developed expertise through a range of other activities, including education, research, involvement with service development and management. This can include experience or working in relevant departments and professional specialties, for example attachment to a community paediatric unit under the supervision of a specialist practitioner.
Other options include self-directed learning, attendance at recognised meetings/ lectures/tutorials on specific relevant topics, a recognised university course or successful completion of a diploma or equivalent. Such courses are offered by the likes of the University of Kent, University of Greenwich, the University of Central Lancashire, University of the West of Scotland and Birmingham City University amongst others. GPs may also opt to work under the supervision of a specialist clinician in relevant clinical areas.
Many GPs are actively engaged in programmes and schemes across the UK aimed at safeguarding children and young people. In England, this is likely to involve working as a named safeguarding GP or as a GP lead/ deputy lead for child safeguarding in a practice.
Named safeguarding GP
GPs in this role would be employed by NHS England or a CCG to support all activities necessary to ensure the organisation meets its legal responsibilities to safeguard/protect children and young people. They have interagency responsibilities, participating in the health group and other subcommittees of the local safeguarding children board (LSCB)/the safeguarding panel of the health and social care trust/the child protection committee.
They advise local police, children’s social care and other statutory and voluntary agencies on health matters with regard to safeguarding/child protection.They offer advice to the board of the healthcare organisation and offer advice to colleagues on the assessment, treatment and clinical services for all forms of child maltreatment including neglect, emotional and physical abuse, fabricated or induced illness (FII), child sexual abuse, honour-based violence, child trafficking, sexual exploitation and detention.
The role also includes a clinical element (where relevant) in supporting and advising colleagues in the clinical assessment and care of children and young people where there are safeguarding concerns. They help to coordinate safeguarding across the health community: agreeing and supporting training needs and priorities, and helping monitor the effectiveness and quality of services.
Practice GP lead
The practice GP lead for safeguarding has a number of duties including ensuring practice child protection policy and procedures are developed, implemented and regularly monitored and updated. They will have regular meetings with others in the primary healthcare team and personnel from other agencies such as health visitors, school nurses, community children’s nurses and social workers to discuss any concerns about vulnerable children and families.
A key focus of the role is ensuring the practice fulfils its obligations in a variety of areas such as statutory responsibilities; contractual guidance; national/local regulatory requirements and inspection requirements in relation to information sharing and record keeping. When new staff are employed by the practice, the lead must make sure safe recruiting procedures have been followed and that the relevant vetting and barring checks have been carried out.
A GP safeguarding lead will also provide valuable advice and support to colleagues, helping them with child protection referrals and ensuring requests for child protection reports are responded to fully and promptly.
In Scotland under GIRFEC, the plan is for a “lead professional” to be appointed for children who need extra support – a role which can be taken on by a doctor, teachers, health visitors and social workers. The Scottish Government describes a lead professional as “someone who helps to organise support for a child and their family” and who “makes sure all the people who support a child work well together”. For doctors, this is commonly someone who holds consultant status or equivalent who has undergone higher professional training in paediatrics. However, GPs with dual qualifications in other specialties such as public health, forensic medicine or psychiatry may be able to demonstrate the required competence to undertake the role. The lead professional would help organise a “Child’s Plan” (due to be launched in 2018) detailing information about the child’s wellbeing needs and services that will provide support.
Q&A Dr N Vimal Tiwari, Named Safeguarding GP Herts Valleys CCG
What attracted you to develop an interest in safeguarding children and young people?
I have a strong interest in child health and was pulled into safeguarding while working in community paediatrics. GPs, as the first point of contact for most health-related problems, may be the only professional to realise when a family or parent is running into difficulties which could place a child at risk but can find such problems very challenging.
What does your role involve?
I support GP colleagues by offering practice visits, educational seminars and sessions and advice on safeguarding issues. I meet with health colleagues regularly to discuss policy and practice and attend multiagency forums to learn about safeguarding initiatives, achievements and concerns of other agencies such as education, the police and social care.
What do you enjoy most about the job?
Meeting many hard-working conscientious GPs who care deeply about their patients and are eager to do their best despite time constraints and resource issues. It is deeply rewarding to see major improvement in the way practices now approach their safeguarding duties.
Are there any downsides?
Child protection reviews centre on desperately tragic events involving the death or serious injury of a child which can be traumatic for all involved. Support from colleagues is vital when involved in writing reports for case reviews.
What do you find most challenging?
The few GPs who cannot accept that child maltreatment exists. They are unwilling to participate in child safeguarding activities and refuse to provide essential information for child protection purposes.
What about the role has surprised you?
Many GPs already possess a deep instinctive knowledge of the subject although they may not always be able to articulate their worries. Small changes can be enough to increase confidence and improve practice.
What is your most memorable experience so far?
The ‘light-bulb’ moment in an educational session when a GP suddenly realises that a series of apparently inexplicable events or a perplexing presentation in a consultation is related to child abuse or neglect.
What advice would you give to a trainee GP who is interested in this field?
An interest in child health is essential because a knowledge of normal child development/behaviour is required to identify variation from the expected. Curiosity about mental health and human behaviour is useful as the causes of child maltreatment remain poorly understood and under-researched.