13/05/2010
Safeguarding
Children
and
Adults
Protocol
for
General Practitioners (GPs)
Final version 13th May 2010
We strive to safeguard all members of our Practice in particular it is the
responsibility of each of us prevent physical, sexual, and emotional abuse and
neglect of children, young people and adults.
Safeguarding is everyone’s business and applies to all
children under 18 years and vulnerable adults.
Final version Safeguarding Children and Adults protocol for GPs 13th May 2010
Cath Erine and Karen Bennett, Service Managers for Safeguarding Adults and Children respectively
13/05/2010
Introduction:
The aim of this protocol is to provide GPs with a concise document that
provides them with information that is needed to manage a situation where a
child or vulnerable adult needs safeguarding and where to obtain advice and
support.
GMC guidance on confidentiality
Ideally all disclosures to protect adults and children from harm should be
made with the consent of the patient, except where they lack capacity to make
this decision.
However disclosures can be made without patient consent:



To prevent or aid the detection of crime
If it is in the public interest
If the patient’s refusal to consent to disclosure leaves others exposed
to a risk that it outweighs the patient’s right to confidentiality
Ref – Confidentiality – GMC 12/10/09
If you are unsure about this take advice from your safeguarding lead or
external safeguarding colleagues
If a concern is raised about a child or adult you should discuss it with:
1. Your peers
2. The LEAD Safeguarding (children) person in the practice
Urgent consultation externally may be required if:
a) You are unable to access the LEAD Safeguarding person.
b) You are still unsure after consultation if there is a clear safeguarding
child / adult concern.
c) If there is a disagreement or conflict between the person consulted and
yourself.
d) If the allegation is about the person with whom you would normally
consult.
Consultation externally is not the same as making a referral
External Consultation can be with any of the contacts given later in this
document.
Final version Safeguarding Children and Adults protocol for GPs 13th May 2010
Cath Erine and Karen Bennett, Service Managers for Safeguarding Adults and Children respectively
13/05/2010
Definitions
For children and young people
A child is anyone who has not yet reached their 18th birthday (Children Acts,
1989 and 2004). ‘Children’ therefore means ‘children and young people’
throughout. The fact that a child has reached 16 years of age, is living
independently or is in further education, is a member of the armed forces, is in
hospital, in prison or in a Young Offenders’ Institution, does not change his or
her status or entitlement to services or protection under the Children Act
1989.
Safeguarding and promoting the welfare of children is defined as:
 Protecting children from maltreatment;
 Preventing impairment of children’s health or development;
 Ensuring that children are growing up in circumstances consistent with
the provision of safe and effective care;
Child protection is a part of safeguarding and promoting welfare. This refers
to the activity that is undertaken to protect specific children who are suffering,
or are at risk of suffering, significant harm.
Children in need are defined under section 17 of the Children Act 1989, as
those whose vulnerability is such that they are unlikely to reach or maintain a
satisfactory level of health or development, or their health and development
will be significantly impaired, without the provision of services (section 17(10)
of the Children Act 1989), plus those who are disabled. The critical factors to
be taken into account in deciding whether a child is in need under the
Children Act 1989 are:
 What will happen to the child’s health or development without services
being provided; and
 The likely effect the services will have on the child’s standard of health
and development.
For vulnerable adults
Abuse – Is a violation of an individual’s human or civil rights by any other
person or persons (DoH No Secrets 2000)
Vulnerable adult – Is 18 or over, in receipt of or eligible for community care
services by reason of mental or other disability, age or illness and is or maybe
unable to take care of him or herself, or able to protect him or herself against
significant harm or exploitation. DoH No Secrets 2000 (All adults who meet
the threshold for safeguarding will be assessed – even if they do not qualify
for other social care services)
Final version Safeguarding Children and Adults protocol for GPs 13th May 2010
Cath Erine and Karen Bennett, Service Managers for Safeguarding Adults and Children respectively
13/05/2010
When assessing patients and considering signposting to safeguarding
adults, it is essential to answer the following:
Is the individual a vulnerable adult? When assessing this, the following may
assist:
 Lives with a physical disability (including sensory impairment) or illness
which means they struggle to manage any aspect of day to day life with
or without support
 Lives with a mental health issue or lives with dementia, Alzheimer’s etc
or lacks mental capacity or impaired capacity due to a brain
injury/stroke etc
 Lives with a learning disability
 Is 65 or over (this may not make them a vulnerable adult – unless
some of the above apply OR the context of harm is significant)
 Has an alcohol or substance misuse issue
 All of the above or other factors may mean that the person is less able
to protect themselves and/or take care of themselves (if you are in
doubt – refer to safeguarding OR talk to the safeguarding adults office
on 2736870)
Exploring the issue of significant harm and/or exploitation
Significant harm is determined using the following criteria:
 The individual’s perception of the harm
 Has a crime been committed
 Is the adult at risk of continued and/or escalating abuse
 Are any other adults at risk (parents/grandparents etc)
 Was the harm caused intentionally (unintentional may come into
procedures – it will depend on the impact on the individual or others)
 Did the abuse result in the alleged perpetrator “gaining” from the
situation
Reasons to refer:
1)
A child / adult clearly alleges abuse
2)
A child or vulnerable adult has an injury not consistent with the event
reported as causing it.
3)
A pre-mobile child or an immobile adult has an injury without clear
accidental explanation
4)
A third party makes a credible allegation of abuse.
5)
Concerns regarding sexual abuse even though there is no direct
allegation.
6)
Concerns about a child or vulnerable adult living with or having contact
with a person posing a risk
7)
Neglect
8)
Abandonment.
9)
Child / vulnerable adult refused urgent medical treatment
10)
Emotional abuse
11)
Genital mutilation and forced marriage.
12)
Child / vulnerable adult at risk of sexual exploitation
Final version Safeguarding Children and Adults protocol for GPs 13th May 2010
Cath Erine and Karen Bennett, Service Managers for Safeguarding Adults and Children respectively
13/05/2010
Situations that may cause a GP to consider or suspect maltreatment:
1)
Children / vulnerable adults who have mental health problems or their
parents or carers have.
2)
Children under 16 or vulnerable adults who are pregnant.
3)
Domestic violence / honour based violence
4)
Children / vulnerable adults who are substance misusers or their
parents / carers are.
5)
Children / vulnerable adults with disabilities
6)
Missing families – will they want definition of ‘missing’. If they see them
in surgery they may not think they are missing
7)
Non attenders for immunisations and Health Professional clinics or
hospital appointments etc
8)
Female genital mutilation.
9)
Bullying at home or at school or work, including via computers or
mobile phones.
10)
Frequent surgery or hospital attenders e.g. frequent minor illnesses,
frequent “accidents” etc
11)
Child abuse images
12)
Basic care needs not being met e.g. poor nutrition and hygiene,
dehydration and pressure area problems. This may be self neglect or
lack of care by others
13)
Fabricated / induced illness
14)
Sexual exploitation
15)
Forced marriage
16)
Children from abroad – not with their parents
17)
Parents / carers who are hostile and uncooperative in your attempts to
treat their child/ren
Final version Safeguarding Children and Adults protocol for GPs 13th May 2010
Cath Erine and Karen Bennett, Service Managers for Safeguarding Adults and Children respectively
13/05/2010
Further advice and information is available from:
For children and young people:
 Safeguarding Children Advisory Service – 0114 2053535
 South Yorkshire Child Protection Procedures and different protocols for
safeguarding children in specific circumstances available on the
Safeguarding Children website –
www.safeguardingsheffieldchildren.org.uk
 Every Child Matters website – www.dcsf.gov.uk/everychildmatters
 NICE clinical guideline 89 – “When to suspect child maltreatment”,
issue date: July 2009 Available at: www.nice.org.uk
 Named Doctor Safeguarding Children (Ian Davidson and Dilys Noble)
For vulnerable adults:
 Safeguarding adults’ office – 0114 2736870 or email –
safeguardingadults@sheffield.gov.uk
Making a referral
Child Protection
 Phone the appropriate Area Social Care Office
 Follow up referral in writing within 24 hours
Area Social Care Offices for Children and Young People:
North – Meade House,
96 – 100 Middlewood Road,
Hillsborough, Sheffield
S6 4HA.
Tel: 0114 2039594 or 203 9591
Fax: 0114 2039633
East – The Old School,
Station Road,
Darnall,
Sheffield, S9 4JT
Tel: 0114 2037506 or 2037463
Fax: 0114 2037510
West – Floor 7,
Redvers House,
Union Street,
Sheffield, S1 2JQ
Tel: 0114 2734491
Fax: 0114 2734853
Jessop Wing /
Children’s Hospital Social Work
Team
Out of hours
Tel: 0114 2268355 or 0114 2717310
Tel: 0114 2053332
Final version Safeguarding Children and Adults protocol for GPs 13th May 2010
Cath Erine and Karen Bennett, Service Managers for Safeguarding Adults and Children respectively
13/05/2010
Child In Need / Child with Additional Needs
 A Common Assessment Framework (CAF) should be completed and
sent to the relevant Multi-Agency Support Team (MAST) who will send
CAF through to the Multi-Agency Allocation Meeting (MAAM) for
consideration as necessary
Area MASTs for Children and Young People:
Parson Cross / Ecclesfield MAST
281 Wordsworth Avenue
Sheffield
S5 8NG
Tel: 0114 205 3805
Fax: 0114 233 6270
Team Email: ParsonCrossEcclesfieldMAST@sheffield.gov.uk
Shiregreen / Burngreave MAST
Watermead
Barrie Crescent
Off Herries Road
Sheffield
S5 8RJ
Tel: 0114 205 3805
Fax: 0114 233 6270
Team Email: ParsonCrossEcclesfieldMAST@sheffield.gov.uk
Arbourthorne / Manor / Darnall MAST
Spring Lane Education College
Brimmesfield Road
Sheffield
S2 2JR
Tel: 0114 239 5872 / 253 0956
Fax: 0114 241 6531
Team Email: Arbourthorne-ManorDarnallMAST@sheffield.gov.uk
Mosborough / Handsworth MAST
Staniforth Road Site
Sheffield
S9 3GZ
Tel: 0114 205 3635
Fax: 0114 205 3639
Team Email: MosboroughHandsworthMAST@sheffield.gov.uk
Greenhill / Gleadless MAST
Bannerdale Centre
125 Carterknowle Road
Sheffield
S7 2EX
Tel: 0114 273 4625
Fax: 0114 2734635
Team Email: GreenhillGleadlessMAST@sheffield.gov.uk
Rivelin To Sheaf MAST
Old Sharrow Junior School
South View Road
Sheffield
S7 1DB
Tel: 0114 250 6865
Fax: 0114 250 6713
Team Email: RivelinSheafMAST@sheffield.gov.uk
Hillsborough Upper Don MAST
ZEST Centre
18 Upperthorpe
Sheffield
S6 3NA
Tel: 03333 210670
Fax: 03333 210671
Team Email: HillsboroughUpperDonMAST@sheffield.gov.uk
Final version Safeguarding Children and Adults protocol for GPs 13th May 2010
Cath Erine and Karen Bennett, Service Managers for Safeguarding Adults and Children respectively
13/05/2010
For Vulnerable Adults
 Phone call to adults access team – 2734908 (24 hours, 7 days a week
number) who will take the details of the concern over the phone and
forward to the appropriate team
 Email to the adults access team – adultaccess@sheffield.gov.uk
detailing the concerns (if helpful using the safeguarding adults form)
 If the case if open to a social worker/mental health worker in either
communities (social services) or SHSC (mental health trust) ring or
email them directly.
 If you have any problems making a referral or are not sure if it is
safeguarding contact the safeguarding adults’ office on 2736870 or
email safeguardingadults@sheffield.gov.uk
Following referral:
 Responsibility does not end with referral. Therefore it is necessary to
follow up referrals if a response is not received from the agency taking
the referral
 Be prepared to attend meetings if necessary
 GPs hold important information about families, so if unable to attend
meetings it is important to submit reports in order for this information to
be shared as appropriate
 Reports need to be well constructed, with relevant information and
analysis included to enable clear understanding for readers. A
template is attached to give a basis for good reports (see appendix
two)
Safeguarding is Everybody’s Business




GPs, along with all professionals, have a responsibility to safeguard
children, young people and vulnerable adults.
Where possible GPs should attend meetings in relation to
safeguarding, e.g. strategy meetings, child and adult protection
conferences etc
Where a GP is unable to attend a meeting, a salient report should be
submitted to the chair of the meeting
All actions taken in regard to safeguarding children or adults must be
clearly documented in the GP records
Final version Safeguarding Children and Adults protocol for GPs 13th May 2010
Cath Erine and Karen Bennett, Service Managers for Safeguarding Adults and Children respectively
13/05/2010
APPENDIX ONE
CONFIDENTIAL
GP Report to Child Protection Conference
This template is for guidance, please complete as fully as possible. This report is also
available for completion electronically at
http://www.safeguardingsheffieldchildren.org.uk/welcome/safeguarding-childrenservice/cpconferences
Are you attending the conference?
Yes
No
Details of the family:
Name of child(ren)
Date(s) of birth
Address of the
children
Name of Parents
Name of main
caregiver (if not a
parent)
Any other household
members
(living in the same
house as the children)
Your details:
Your name
Job title
Surgery Address
Has your agency’s
report been shared
with the family?
Yes
No
Please state why not:
Date ___/___/___
Your surgery’s involvement with the family
Date the child registered with surgery
Date ___/___/___
At the surgery: do the family frequent attend with minor ailments?
Details of any Non Attendance (e.g. immunisations, follow up appointments,
developmental checks)
Does the child attend with appropriate adults?
(If not the main caregiver then please explain who)
Final version Safeguarding Children and Adults protocol for GPs 13th May 2010
Cath Erine and Karen Bennett, Service Managers for Safeguarding Adults and Children respectively
13/05/2010
Details of calls to OOH and visits to A&E
Please describe the child(ren)s developmental needs:
Including health, education, emotional and behavioural development, identity, family and social
relationships, social presentation (e.g are they usually happy, withdrawn or angry?) and self care skills.
Please describe the parenting capacity of the parents/main caregivers:
Please include their ability to provide (for their children) basic care, emotional warmth and
stimulation, guidance and boundaries and to ensure the safety of the child(ren).
Are there any other adults that are involved in the children’s lives?
This includes relatives or friends that look after the children, regularly visit the house and/or
spend time with the family. Please include this information even if you don’t know their
names.
Family and environmental factors:
Including family history and functioning, wider family and close friends, housing
conditions and suitability for the family (and any other relevant information from home
visits), employment and income, family’s social integration (their involvement in their
immediate community) and community resources.
Final version Safeguarding Children and Adults protocol for GPs 13th May 2010
Cath Erine and Karen Bennett, Service Managers for Safeguarding Adults and Children respectively
13/05/2010
Additional information, including any recent involvement and any concerns you have:
The content of this report should be shared fully with the parents/carers and child/young
person (as appropriate), unless you believe this will place any person at serious risk of harm.
This report should be submitted to: Conference Convenors Team, Sheffield Safeguarding
Service, Floor 2, Redvers House, Union St, Sheffield s1 2JQ at least 2 days before the
Conference.
Signed……………………………………………Date………………………………
……
Final version Safeguarding Children and Adults protocol for GPs 13th May 2010
Cath Erine and Karen Bennett, Service Managers for Safeguarding Adults and Children respectively
13/05/2010
APPENDIX TWO
Report to a safeguarding adults case conference
Name of adult
DoB
Address
Initial concern
If you have any information about the initial concern/took the disclosure etc, please
summarise the information here or attach your referral information
Background information
Please summarise information about the situation – family composition, capacity(of adults),
relevant medical information – previous injuries, mental health issues etc)
Final version Safeguarding Children and Adults protocol for GPs 13th May 2010
Cath Erine and Karen Bennett, Service Managers for Safeguarding Adults and Children respectively
13/05/2010
Risk issues
Please summarise what risks you feel the adult faces, are there any factors in place
that reduce the risk. If none what do you feel should be in place and can you offer any
support – if so please detail
Your name
GP practice
Contact details – phone/email
If you are not able to attend the conference, you will receive copies of all the
papers – in possession of this entire information can you say “on a balance of
probabilities” if the abuse listed in the convenors report has been substantiated.
Abuse category
Substantiated in your opinion?
Please return to the Safeguarding Manager or Social worker involved with this
case.
Final version Safeguarding Children and Adults protocol for GPs 13th May 2010
Cath Erine and Karen Bennett, Service Managers for Safeguarding Adults and Children respectively