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SAFEGUARDING CHILDREN:
SAMPLE POLICY, PROCEDURES AND GUIDANCE
FOR GENERAL PRACTICE
JUNE 2015
PLEASE READ THESE PROCEDURES IN CONJUCTION WITH THE LANCASHIRE
SAFEGUARDING CHILDREN BOARD MULTI-AGENCY PROCEDURES (LSCB):
http://panlancashirescb.proceduresonline.com/
YOUR PRACTICE SAFEGUARDING CHILDREN
LEAD IS:
YOUR PRACTICE DEPUTY SAFEGUARDING
CHILDREN LEAD IS:
This document was correct at the date of publication. It is the responsibility of the GP practice to check the contents and ensure that they
are updated as necessary in accordance with national and local guidance.
1
Title
Safeguarding Children:
SAMPLE Policy and
Procedures for General
Practice
Replaces
Safeguarding Children
Sample Policy for General
Practice 2011.
Author/originator
Pan – Lancashire Document
– reviewed and revised by C
Turner, BCCG
Designated safeguarding
children’s’ leads pan
Lancashire
Recommended
Version 1.0
Equality Analysis
Completed November 2014
Circulation
All GP Practices
Review
June 2017
Acknowledgements
Jean Rollinson, Designated Nurse, CSR CCG
Sue Clarke, Designated Nurse BwD CCG
Julie Adesanya, Designated Nurse, Trafford CCG
(Appendix One)
This sample safeguarding children guidance and procedures has been based on the
GP Toolkit: Safeguarding Children and Young People in Practice (NSPCC & RCGP
2014). It has been adapted to reflect the Guidance and Procedures of Lancashire
Safeguarding Children Board. It has been updated to reflect local and national
developments.
Page 2 of 51
CONTENTS
Section
1.0
Introduction
Page
5
2.0
Safeguarding Children Policy Statement
6
3.0
What is Safeguarding?
7
Definitions of child protection, children in need and significant
harm
4.0
Role and Responsibilities of :
 The LSCB,
 Children’s Social Care
 GP Practice (including implementation of policy)





All Doctors
GP
Practice Safeguarding Children Lead
Designated Professionals
Individual staff members including all partners etc
8
8
8
10
11
11
12
12
5.0
Recognition of Abuse
Definitions
13
6.0
Safeguarding in Special Circumstances
Children who are ‘Looked After’ by the Local Authority
Child Sexual Exploitation
Fabricated and Induced Illness
Domestic Abuse (including MARAC)
Honour Based Abuse/Violence
Forced Marriage
Female Genital Mutilation (FGM)
MAPPA
Private Fostering
PREVENT
Children who are not in school
14
14
15
16
17
18
18
18
19
19
19
21
7.0
What to do if you have concerns about a child’s welfare.
Acting on current concerns
Responding to a child who tells you about abuse
What to do if a member of the public raises concerns
22
22
23
23
8.0
Barriers to Safeguarding
24
9.0
Information Sharing
25
10.0
GP Attendance at Child Protection Case Conferences
25
11.0
Recording information
Identifying potential safeguarding concerns
25
27
Page 3 of 51
CONTENTS
12.0
13.0
Creating a safe environment
Safer employment
Staff behaviour and professional boundaries
Use of Internet, Mobile Phones and Electronic Equipment
Inappropriate types of sites
Managing allegations against staff/workers who have contact
with children
Whistleblowing
Complaints
Consent
Serious Untoward Incidents
Training
Supervision
27
27
27
28
29
29
Safeguarding Processes
Common Assessment Framework (CAF)
31
Domestic Homicide Reviews
Serious Case Reviews
Child Death Overview Panel (CDOP)
31
31
31
Practices
Safeguarding
30
30
30
30
30
30
14.0
Reviewing the
Arrangements
Governance 32
15.0
CQC Guidance
33
16.0
Equality Impact Assessment
34
17.0
References and Bibliography (including useful web links)
34
18.0
Appendices
Appendix One: Equality Impact Initial Assessment
Appendix Two: Safeguarding Children Training Guidance to
meet statutory requirements
Appendix Three: Useful Contact Numbers
Appendix Four: Signs of Abuse
Appendix Five: What to do if you are concerned about a
child – flowchart
Appendix Six: Information Sharing – Seven Golden rules
and flowchart
Page 4 of 51
1.0
INTRODUCTION
Effective safeguarding depends on a culture of zero tolerance of harm, where
concerns can be raised with confidence so that action will be timely, effective,
proportionate and sensitive to the needs of those involved.
Public awareness continues to improve and there is an increasing expectation
that service providers have systems in place to identify early indicators of
abuse, prevent harm and that they act quickly and effectively in partnership
with other relevant agencies to safeguard children when it is discovered that
they are experiencing harm, exploitation, coercion, neglect or abuse.
Children and young people are part of the general population – most are
registered with a GP. GP’s often see multiple family and household members
and are well placed to identify risk factors in parents and carers such as
domestic abuse, substance misuse and mental health issues. GPs remain the
first point of contact for most health problems. This sometimes includes
families who are not registered but seek medical attention. A GP may be the
first to recognise parental and/ or carer health problems, or someone whose
behaviour may pose a risk to children. The primary health care team may be
the only professionals to have contact with infants and pre-school children
and young people. Lack of sensitive responsive care from care givers in
infancy can seriously impact on the developing infant.
The long-term effects of abuse are widely documented and include a range of
physical, psychological, emotional and social effects. In order to achieve
optimum life chances for children and young people, early detection and
intervention is paramount. Depending on the circumstances of a particular
case, intervention may be an assessment of further support needed for a child
and family/carers (for example, a child or family in need of services), or a child
in need of protection.
It is crucial that a holistic approach is taken with families when treating a
parent/carer who may be experiencing domestic abuse, mental health or
learning difficulties or where there is substance misuse (including alcohol) –
professionals should always give thought as to how these parental factors
may impact on their ability to parent a child.
PREVENT (anti-terrorism and radicalisation), Domestic abuse, so called
“Honour Based Violence”, Forced Marriage, Human Trafficking and Female
Genital Mutilation fall within the scope of safeguarding children and young
people. These cases will often be co-worked with the Children’s Designated
and Named Professionals for Safeguarding, social care and police service
colleagues.
GP practices have a duty of care for children and young people to whom they
provide care and services. This includes ensuring their safety on GP premises
and minimising any risk presented by practice staff, including GPs, by having
in place safe recruitment practices and procedures for managing allegations
against workers.
Page 5 of 51
This local policy should be read in conjunction with the Lancashire
Safeguarding Children Board multi-agency procedures (LSCB):
http://panlancashirescb.proceduresonline.com/
This policy addresses the responsibilities of all members of the practice team
and those outside the immediate primary care team with whom we work. For
employees of the practice, failure to adhere to this policy and procedures
could lead to dismissal and/or constitute gross misconduct.
2.0
SAFEGUARDING CHILDREN POLICY STATEMENT
This policy and associated procedures demonstrate the commitment of the
practice to ensure that throughout our work we will safeguard and promote the
welfare of children. We aim to do this by ensuring that we comply with
statutory and local guidance for safeguarding and promoting the welfare of
children, and by creating a child-safe practice. The practice acknowledges its
duty to respond appropriately to any suspicions, allegations or reports of
harm, exploitation, coercion and/or neglect and abuse and to ensure that all
employees; including, volunteers, students and contractors / temporary /locum
workers, engaged in work at the practice know what to do if they have
concerns about a child or young person.
The practice is committed to implementing this procedure and the practices it
sets out for all staff and partners and will provide learning opportunities and
make provision for appropriate safeguarding children training to all staff and
partners.
This policy and procedure sets out for employees, volunteers, students and
contractors/temporary/locum workers what to do in the event of identifying
harm, exploitation, coercion and/or abuse. The term abuse includes Domestic
Abuse, which is both a children and adult safeguarding concern.
The practice recognise that safeguarding children is a shared responsibility
with the need for effective joint working between agencies and professionals
that have different roles and expertise if children are to be protected from
harm. In order to achieve effective joint working there must be constructive
relationships at all levels, promoted and supported by:






the commitment of all staff, at all levels within the practice to safeguarding
and promoting the welfare of children;
clear lines of accountability within the practice for work on safeguarding;
practice developments that take account of the need to safeguard and
promote the welfare of children, and is informed, where appropriate, by
the views of children and their families;
staff training and continuing professional development so that staff have
an understanding of their roles and responsibilities, and those of other
professionals and organisations in relation to safeguarding children;
Safer working practices including recruitment and vetting procedures;
Effective interagency working, including effective information sharing.
Page 6 of 51
This Policy and Procedure relates to the safeguarding of children. As defined
in the Children Act 1989 and Children Act 2004, a child is anyone who has not
yet reached their eighteenth birthday.
There are several other key documents written specifically for doctors and
General Practice including:
3.0

Safeguarding Children and Young People. A Toolkit for General Practice
2014 (Royal College of General Practitioners & NSPCC)
http://www.rcgp.org.uk/clinical-and-research/clinical-resources/childrenand-young-people-toolkit.aspx

Protecting children and young people. The responsibilities of all doctors.
July
2012.
(GMC)
http://www.gmcuk.org/guidance/ethical_guidance/13257.asp

Children
and
young people
tool kit.
Dec
2010. (BMA)
http://bma.org.uk/practical-support-at-work/ethics/children/children-andyoung-people-tool-kit

CQC registration Guidance for GPs. May 2012. (GPC, BMA).
http://bma.org.uk/practical-support-at-work/gp-practices/cqc-registration
WHAT IS SAFEGUARDING?
A child is anyone who has not yet reached their 18th birthday.
In England Safeguarding and protecting the welfare of children is defined
in both The Children Act 2004 (and Section 11 Guidance) and Working
Together to Safeguard Children (HM Government 2015) as:




Protecting children from maltreatment
Preventing impairment of children’s health and development; and
Ensuring that children are growing up in circumstances consistent with the
provision of safe and effective care and;
Undertaking that role so as to enable those children to have optimum life
chances and to enter adulthood successfully.
Child Protection (Children Act 1989 Section 47) is defined as being part of
safeguarding and promoting welfare. It is the term used to refer to activity
taken to protect children who are suffering or at risk of suffering significant
harm.
Child in Need (Children Act 1989 Section 17)
 A child whose vulnerability is such that they are unlikely to reach or
maintain a satisfactory level of health or development.
 A child whose health or development will be significantly impaired without
the provision of services.
 Those who are disabled
Page 7 of 51
3.1
Significant Harm
Some children are in need because they are suffering, or likely to suffer,
significant harm. The Children Act 1989 introduced the concept of significant
harm as the threshold that justifies compulsory intervention in family life in the
best interests of children, and gives local authorities a duty to make enquiries
to decide whether they should take action to safeguard or promote the welfare
of a child who is suffering, or likely to suffer, significant harm.
3.2
There are no absolute criteria on which to rely when judging what constitutes
significant harm. Consideration of the severity of ill-treatment may include the
degree and the extent of physical harm, the duration and frequency of abuse
and neglect, the extent of premeditation, and the presence or degree of
threat, coercion, sadism and bizarre or unusual elements as well as the
protective factors in the child’s life that may promote their resilience to
adverse factors. Each of these elements has been associated with more
severe effects on the child, and / or relatively greater difficulty in helping the
child overcome the adverse impact of the maltreatment. Sometimes, a single
traumatic event may constitute significant harm (e.g. a violent assault,
suffocation or poisoning). More often, significant harm is a compilation of
significant events, both acute and longstanding, which interrupt, change or
damage the child’s physical and psychological development. Some children
live in family and social circumstances where their health and development
are neglected. For them, it is the corrosiveness of long-term neglect,
emotional, physical or sexual abuse that causes impairment to the extent of
constituting significant harm.
4.0
ROLES AND RESPONSIBILITIES
4.1
The Local Safeguarding Children Board (LSCB) in Lancashire is
responsible for developing local procedures and ensuring multi-agency
training is available. It has a role in scrutinising the safeguarding
arrangements of statutory agencies and promoting effective joint working.
4.2
Children’s Social Care. It is the responsibility of children’s social care to
investigate cases of child protection in conjunction, and with the participation
of, other agencies. They also lead the Child in Need process. Social care
services work with health services, education, police, prison and probation
services, district councils and other organisations such as the NSPCC,
domestic violence forums, youth services and armed forces, all of whom
contribute and work together to share responsibility for safeguarding
children and promoting their welfare.
4.3
The Practice recognises that effective safeguarding systems are those which:




Put the child’s needs first;
Provide children with a voice;
Promote identification of early help;
Encourage multi-agency working and sharing of information.
All staff in our practice recognises their responsibility to protect children and
adults ‘at risk’ and keep them safe.
Page 8 of 51
Simplistically this is done by following the 4 R’s




Recognise – unmet needs, abuse and harm
Respond – alert the safeguarding lead and/or Social Care
Record – ensure records are kept up-to-date and secure
Refer – share information and refer to external agencies to safeguarding
and protect people from harm
There is also an expectation that the practice team contribute to the ‘early
help’ agenda.
4.4
Implementation of this policy
It is the role of the practice manager and the practice safeguarding lead to
brief staff and partners on their responsibilities under the policy, including
clinical and non-clinical members of staff, sessional GP’s and new starters.
In order to implement the policy and procedures the practice will:  Promote the rights, freedoms and dignity of the person who has or is
experiencing harm, exploitation, coercion and/or abuse. (Including
Domestic Abuse).
 Promote the rights of all children and young people to live free from fear of
harm
 Manage services in a way which promotes safety and prevents harm
 Ensure that all staff, employees, volunteers, students and others working
within the practice will keep up to date with national developments relating
to preventing harm, exploitation, coercion, abuse and the welfare of
children and
 Brief the staff and partners on their responsibilities under the policy,
including new starters, clinical and non-clinical members of the practice
team and sessional General Practitioners.
 Be fully conversant with the practice safeguarding children policy,
procedures and guidelines, the policies and procedures of Lancashire
Safeguarding Children Board; and the integrated processes that support
safeguarding including the CAF (Common Assessment Framework)
process and information sharing
 Ensure safe recruitment practices are implemented and executed for every
appointment, ensuring all necessary checks are made. For
agency/locum/temporary staff the responsibility to undertake due diligence
and check with the employer of the agency/locum/temporary employee
remains with the practice.
 Ensure that safeguarding responsibilities are clearly defined in all job
descriptions.
Page 9 of 51
 Work with other agencies and be compliant with the Lancashire Local
Safeguarding Children Board procedures
 Be responsible for proactively determining safeguarding children training
needs and facilitating meeting these needs. Appendix Two provides
guidance as to the levels of training required by individual staff groups.
 Maintain accurate records of staff training and review it on an annual basis
to provide assurances to NHS England and the CCG that practice staff are
compliant with local and national policy.
 Act within the requirements of the Data Protection Act, 1998 and the
Human Rights Act, 1998 as well as guidance issued by the GMC, NMC or
HCPC regarding confidentiality
 Inform patients (unless it is unsafe to do so) that where a child is
considered to be in danger, a child is at risk or a crime has (or may have
been) committed a decision must be taken to pass any such information to
another agency without the service user’s consent.
 Make a safeguarding referral to Children’s Social Care, using the
appropriate referral mechanism, as required.
 Ensure that the practice team completes the practices agreed incident
forms and analysis of significant events forms. [identify forms practice uses]
 Ensure that there is a system in place to identify children who do not attend
an appointment following a referral for specialist care, so that the referrer is
aware they have not attended and can take any follow up action considered
appropriate to ensure the child’s needs are being met.
 Ensure that there is a system in place to identify children who are subject to
a child protection plan or who are ‘looked after’ by the Local Authority
4.5
Responsibilities of all Doctors
This GMC guidance aims to help doctors to protect children and young people
who are living with their families or living away from home (e.g. children in
care). It covers some areas which can be difficult and challenging for any
practitioner encountering safeguarding concerns. These include:

Communicating with children and young people

Working jointly with other agencies

Confidentiality, consent and sharing information

Record keeping

Child protection examinations

Giving evidence in court
The BMA toolkit aims to help doctors identify the key factors that need to be
taken into account when facing ethical dilemmas and other complex decisions
regarding children including:

Assessing competence & mental capacity

Parental responsibility
Page 10 of 51






4.6
Role of the GP(part)






4.7
Best interests & disputes
Consent and refusal
Sexual activity
Child protection
Use of restraint
Compulsory treatment for mental disorder
Expected to take reasonable steps to identify the possibility of abuse and
prevent it before it occurs
Have a responsibility for raising concerns, sharing information and working
together with statutory agencies to contribute to ‘early help’, child
protection and children in need processes.
Have a statutory duty to co-operate with other agencies to improve the
wellbeing of children
Have a duty to respond appropriately to any allegation of abuse
Have a duty to refer children to social care when indicated
May receive requests from other agencies such as social workers and
police to share information about a child or family.
Practice Safeguarding Children Lead
Role Description

Ensures that the Practice child protection procedures are developed,
Implemented and regularly monitored and updated.

Ensure that the practice meets statutory and contractual responsibilities
and national and local regulatory requirements.

Ensures safer recruitment procedures and working practices are
followed including taking up references and Vetting and Barring checks
where indicated.

Act as a focus for external contacts on safeguarding children matters;

Disseminate information in relation to safeguarding children to all
practice members.

Act as a point of contact and advice for practice members to bring any
concerns that they have, to document those concerns and to take any
necessary action to address concerns raised.

Advise Practice members if they have concerns.

Have regular meetings with others in the primary health care team
including other agencies staff such as health visitors, school nurses and
social workers, to discuss particular concerns about vulnerable children
and families.

Supports reporting and complaints procedures including ‘safe’ whistleblowing.

Ensure the Practice meets medico-legal and regulatory requirements in
relation to information sharing and record keeping.

To seek appropriate advice and support from the local Designated
professionals and/or Named GP Safeguarding Children.

Lead on analysis of relevant significant events/root cause analysis.

Ensures safeguarding training needs of practice staff are identified and
are met in line with the intercollegiate competencies for health staff.
Page 11 of 51




4.8
Facilitate access to support and supervision for staff working with
vulnerable children and families and ensure they receive adequate
assistance when dealing with child protection matters.
Supports participation in Child Death Reviews
Ensure that national and local recommendations from statutory Child
Protection Case Reviews and Child Death Reviews and implemented.
Have protected time and resources for appropriate training and carrying
out the above duties.
Designated and Named Professionals
It is important that practices ensure that staff know who and how to contact
the Designated and Named Professionals for Adult and Children’s
Safeguarding for advice and support (see also Appendix Three for contact
details of CCG safeguarding children professionals)
4.9
Individual staff members, including all partners, employed staff and
volunteers.
Must:
 Be alert to the potential indicators of abuse or neglect for children including
the risk factors for abuse and be clear about how to act on concerns about
a child. They must follow the referral processes in line with local guidance
and be aware of and know how to access Lancashire Safeguarding
Children Boards (LSCB) policies and procedures for safeguarding children
which can be accessed at:
http://panlancashirescb.proceduresonline.com/chapters/p_safe_recruitment
.html
 Understand diversity, different beliefs and values and be able to treat
patients fairly and equally;
 Take part in training, including attending regular updates so that they
maintain their skills and are familiar with procedures aimed at safeguarding
children;
 Understand the principles of confidentiality and information sharing in line
with local and government guidance at:
http://www.education.gov.uk/consultations/downloadableDocs/EveryChildM
atters.pdf
 Contribute, when requested to do so, to the multi-agency meetings
established to safeguard and protect children;
 Understand what behaviour is acceptable when working with children (see
section 11);
 Minimise any potential risk to children.
Page 12 of 51
5.0
RECOGNITION OF ABUSE
Recognising child abuse is not easy and it is not our responsibility alone to
decide whether abuse has taken place. However, it is our responsibility to act
if we have any concerns.
5.1
Abuse and neglect: Abuse and neglect are forms of maltreatment of a child.
Somebody may abuse or neglect a child by inflicting harm, or by failing to act
to prevent harm. Children may be abused in a family or an institutional or
community setting, by those known to them or, more rarely, by a stranger for
example, via the internet. They may be abused by an adult or adults, or
another child or children.
(Please see the signs and indicators chart in Appendix Four.
Definitions as stated within Working Together to Safeguard Children (HM
Government 2010).
5.2
Physical abuse: May involve hitting, shaking, throwing, poisoning, burning or
scalding, drowning, suffocating, or otherwise causing physical harm to a child.
Physical harm may also be caused when a parent or carer fabricates the
symptoms of, or deliberately induces, illness in a child.
NB – Bruising in non-mobile babies –
‘All non-mobile children who are observed with injuries
/ bruises must be considered as possible
subjects of non-accidental injury and referred for immediate paediatric assessment’
http://panlancashirescb.proceduresonline.com/pdfs/nspcc_bruises.pdf
http://panlancashirescb.proceduresonline.com/chapters/p_recog_significant_harm.h
tml#physical_abuse
If a child presents with an injury it is important to note whether the injury is
consistent with:
 The history provided
 The child’s developmental age (remember that developmental age is
not always related to chronological age)
Be alert to multiple bruises with bruising in ‘protected’ areas or unusual
bruises.
‘Bruises on children’: www.nspcc.org.uk/core-info
5.3
Emotional abuse: The persistent emotional maltreatment of a child such as
to cause severe and persistent adverse effects on the child’s emotional
development. It may involve conveying to children that they are worthless or
unloved, inadequate, or valued only insofar as they meet the needs of another
person. It may include not giving the child opportunities to express their views,
deliberately silencing them or ‘making fun’ of what they say or how they
communicate. It may feature age or developmentally inappropriate
expectations being imposed on children. These may include interactions that
are beyond the child’s developmental capability, as well as overprotection and
limitation of exploration and learning, or preventing the child participating in
normal social interaction. It may involve seeing or hearing the ill-treatment of
another. It may involve serious bullying (including cyber bullying), causing
Page 13 of 51
children frequently to feel frightened or in danger, or the exploitation or
corruption of children. Some level of emotional abuse is involved in all types of
maltreatment of a child, though it may occur alone.
5.4
Sexual abuse: Involves forcing or enticing a child or young person to take
part in sexual activities, not necessarily involving a high level of violence,
whether or not the child is aware of what is happening. The activities may
involve physical contact, including assault by penetration (for example, rape or
oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and
touching outside of clothing. They may also include non-contact activities,
such as involving children in looking at, or in the production of, sexual images,
watching sexual activities, encouraging children to behave in sexually
inappropriate ways, or grooming a child in preparation for abuse (including via
the internet). Sexual abuse is not solely perpetrated by adult males. Women
can also commit acts of sexual abuse, as can other children.
5.5
Neglect: Neglect is the persistent failure to meet a child’s basic physical
and/or psychological needs, likely to result in the serious impairment of the
child’s health or development. Neglect may occur during pregnancy as a
result of maternal substance abuse. Once a child is born, neglect may involve
a parent or carer failing to:


Provide adequate food, clothing and shelter (including exclusion from
home or abandonment);
Protect a child from physical and emotional harm or danger;

Ensure adequate supervision (including the use of inadequate caregivers); or

Ensure access to appropriate medical care or treatment.
It may also include neglect of, or unresponsiveness to, a child’s basic
emotional needs.
For more detailed guidance on how to recognise abuse and neglect refer to
NICE guidance When to suspect child maltreatment accessed at:
http://guidance.nice.org.uk/CG89
6.0
6.1
SAFEGUARDING IN SPECIAL CIRCUMSTANCES
Safeguarding Children in Care (Children Looked After (CLA) by the
Local Authority)
It is well known that children and young people in care share the same health
risks and problems as their peers, but often to a greater degree due to the
impact of poverty, abuse and neglect. Children in care are among societies
most vulnerable in terms of safeguarding and have poor health outcomes.
The Designated Doctor and Designated Nurse for CLA hold responsibilities to
improve the health and wellbeing of children in the care system and ‘on the
edge of care’ e.g. care leavers.
Page 14 of 51
General Practitioners and Primary Care Teams have a vital role in the
identification of the healthcare needs of children and young people who are in
care. The primary care record may be essential in ensuring needs are met.
Practice role:
6.2

Accept any child in care as a registered patient seeking the urgent transfer of
the medical records.

Act as advocates for the child, contribute and provide summaries of the health
history of a child who is in care, including their family history where relevant
and appropriate.

Ensure that referrals to specialist services are timely, taking into account the
needs and high mobility of children who are looked after.
Child Sexual Exploitation
The recent report by the Children’s Commissioner into CSE found that over
the past 20 years evidence has shown that large numbers of children are
being sexually exploited in the UK. It called for urgent action to ensure
practitioners recognise the many warning signs that children display when
being subjected to sexual exploitation at the hands of gangs and groups and
that they know how to act.
Sexual exploitation of children and young people under 18 involves
exploitative situations, contexts and relationships where the young person (or
third person/s) receive ‘something’ (e.g., food, accommodation, drugs,
alcohol, cigarettes, affection, gifts, money) as a result of them performing,
and/or another or others performing on them, sexual activities. Child sexual
exploitation can occur through the use of technology without the child’s
immediate recognition; for example being persuaded to post images on the
internet/mobile phones without immediate payment or gain. Violence, coercion
and intimidation are common. Involvement in exploitative relationships is
characterised by the child’s or young person’s limited availability of choice as
a result of their social, economic or emotional vulnerability. A common feature
of CSE is that the child or young person does not recognise the coercive
nature of the relationship and does not see themselves as a victim of
exploitation.
Child sexual exploitation – recognised models:
1. Inappropriate relationships: Usually involving one abuser who has
inappropriate power or control over a young person (physical, emotional or
financial). One indicator maybe a significant age gap. The young person
may believe they are in a loving relationship.
2. ‘Boyfriend’ model of exploitation and peer exploitation: The abuser
befriends and grooms a young person into a ‘relationship’, then coerces or
forces them to have sex with friends or associates. Sometimes this can be
associated with gang activity but not always.
3. Organised/networked sexual exploitation or trafficking: Young people
(often connected) are passed through networks, possibly over
Page 15 of 51
geographical distances, between towns and cities where they may be
forced/ coerced into sexual activity with multiple men. Often this occurs at
‘sex parties’ and young people who are involved may be used as agents to
recruit others into the network. This serious organised crime and can
involve the organised ‘buying and selling’ of young people by perpetrators.
CSE is a form of sexual abuse. Act on your concerns in the same way as you
would for other safeguarding concerns.
6.3
Fabricated or Induced Illness (FII)
Fabricated or Induced Illness (previously referred to as Munchausen
Syndrome by Proxy) is a rare and potentially dangerous form of child abuse in
which the parent/carer fabricates symptoms in their child or induces them by a
variety of means. Research has shown that the way in which a case of FII is
managed can have a major impact on the outcome for the child. The key
issues are to assess the impact of FII on the outcome for the child’s health
and development and to consider how best to safeguard that child. This
requires a clear and sound multi-agency approach, ensuring that all
appropriate professionals are involved. Multi-agency guidance for managing
children where FII is suspected can be found at:
http://panlancashirescb.proceduresonline.com/chapters/p_fabricated_illness.html
There may be a discrepancy in the clinical presentation and one or more of
the following;

Reported signs and symptoms only in the presence of the carer

Multiple second opinions sought (other GP’s, secondary/tertiary
centres)

Inexplicable poor response to medication or excessive use of aids

Biologically unlikely history of events even if the child has a current or
past psychological condition
Where a GP has concerns that a child may be subject to FII they must discuss
their concerns with the Designated /Named Doctor for Safeguarding or where
relevant, with the consultant providing care for the child.
In all cases of suspected FII, professionals should not discuss the referral
with the parents/carers until a multi-agency action plan has been agreed.
A record of all discussions must be made, regardless of what action is taken,
and should include an explanation as to the reasons for the decision, who is
responsible for carrying out any actions agreed during the discussion and who
was spoken to.
Where the child is not under the care of a paediatrician, the child’s GP should
make a referral to a paediatrician, preferably one with expertise in the
specialism which seems most appropriate to the reported signs and
symptoms.
6.4
Domestic Abuse
Domestic Abuse is a complex issue. It is a serious crime that can occur
across all sections of society, in all social classes and cultures and is not age
specific. Although in the majority of cases it is perpetrated by men against
women, men can also be victims and it can occur in same sex relationships.
Page 16 of 51
The Home Office definition is:
“Any incident or pattern of incidents of controlling, coercive or
threatening behaviour, violence or abuse between those aged 16 or
over who are or have been intimate partners or family members regardless
of gender or sexuality. This can encompass but is not limited to the
following types of abuse;
Psychological
Physical
Sexual
Financial, or
Emotional.
This definition includes issues of Forced Marriage, Honour Based Abuse
and Female Genital Mutilation as well as elder abuse (Home Office, 2013).
It is known that prolonged or regular exposure to domestic abuse can have a
serious impact on the wellbeing and safety of children and young people.
Serious Case review analysis 2005 - 2007 has shown that domestic abuse or
a history of domestic abuse is a factor in 53% of serious case reviews. There
is significant risk to the unborn child. 30% of domestic abuse cases start in
pregnancy increasing the risk of miscarriage, stillbirth and premature birth and
foetal injury. The new-born baby is at risk of injury, poor bonding and
attachment and suboptimal development chances of a physical,
psychological, cognitive and social nature.
GP’s should be alert to the frequent inter-relationship between domestic
abuse and other issues such as drug and alcohol misuse, social exclusion,
homelessness, mental illness, child abuse or animal abuse. Also if signs of
child abuse are evident consider if domestic abuse is occurring. Further
guidance is available
http://www.rcgp.org.uk/pdf/DV_practice_guidance June 2012.pdf
Domestic abuse can have a devastating impact on children and young
people, affecting their health, well-being and development, as well as their
educational achievement. The Department of Health has undertaken
significant work to promote awareness, understanding and develop evidencebased practice on domestic violence for health professionals. A
comprehensive toolkit is available for frontline professionals:
http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov
.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digit
alasset/dh_116914.pdf
6.5
Multi-Agency Risk Assessment Conference (MARAC)
This is a multi-agency meeting where information is shared about high risk
victims of domestic abuse (those at risk of murder or serious harm) and has
the safety of these victims at the heart. This process may give rise to
safeguarding concerns for children and young people.
Page 17 of 51
6.6
Honour Based Abuse/Violence
In some cultural groups there may be added complexities related to domestic
abuse that are termed Honour Based Abuse/Violence. Cultural issues should
be recognised in situations when people from different racial groups disclose
domestic abuse. Added pressures may be evident for these victims e.g.
language barriers, dishonour of family, unfamiliarity with British culture, no
British citizenship, no recourse to public funds and professionals should be
mindful that there may be added safety factors to consider.
In no
circumstance should Honour Based Abuse/Violence be accepted as a cultural
norm and beliefs of some people within specific groups are not an excuse for
abuse. Safeguarding and protection of children and young people must still be
addressed in accordance with the Lancashire Safeguarding Children
procedures.
http://panlancashirescb.proceduresonline.com/chapters/p_forced_marriage.ht
ml
6.7
Forced Marriage
Forced Marriage is not an arranged marriage. A forced marriage is a
marriage where one or both parties do not give willing consent and where
there is duress involved. Forced marriage is not condoned by any major
religion and is considered a form of abuse. Forced marriage is recognised as
an abuse of human rights and it can be categorised as domestic abuse or
child abuse depending on age. Forced Marriage is not solely a problem that
occurs in South Asian families and it is known to occur in families from East
Asia, the Middle East, Europe and Africa. Most cases occur between the
ages of 13yrs and 30 yrs. and there are as many male victims as female.
Forced Marriage is abusive and when it occurs in children under the age of
18yrs it should be dealt with by following child protection procedures.
However extreme caution should be exercised and expert advice sought as
soon as possible by any professional dealing with cases of this nature.
Forced Marriage Unit - 020 7008 0151
6.8
Female Genital Mutilation (FGM)
FGM is illegal and is a form of child abuse and violates the rights of the child.
FGM is the collective term for procedures which include the partial or total
removal of the external female genital organs for cultural or other nontherapeutic reasons. FGM is typically performed on girls aged between 4 and
13 years of age but also at times occurs from birth or in young women before
marriage or pregnancy. The Prohibition of Female Circumcision Act 1985
made this practice illegal in this country. However it was not illegal for the
procedure to be performed out of the country. The Female Genital Mutilation
Act 2003 replaced the 1985 Act and it is now illegal to:
 Perform FGM in the UK
 Aid, Abet, counsel or procure a non UK National to carry out FGM on
girls (who are British Nationals or permanent residents of the UK)
abroad.
 Aid, Abet, counsel or procure a girl to carry out FGM on herself
Page 18 of 51
https://www.gov.uk/government/publications/female-genital-mutilation-multiagency-practice-guidelines
http://www.fgmnationalgroup.org
Female Genital Mutilation Prevention Programme: Requirements for NHS staff
6.9
Multi-agency Public Protection Arrangements (MAPPA)
These arrangements are designed to protect the public and previous victims
from serious harm by sexual and violent offenders. GP Practices may be
requested to provide health information to contribute to an up-to-date risk
assessment to ensure that the offender is managed appropriately.
6.10
Private Fostering
Private fostering is a private arrangement made between a child’s parents and
someone who is not a close relative to care for a child for 28 days or more;
where the child lives with the carer. Close relatives are an aunt, uncle,
brother, sister or grandparent but not a great aunt or uncle.
Private fostering covers arrangements made for children aged less than 16 or
less than 18 if the child is disabled. It does not mean arrangements made for
children who have been placed by Children's Social Care.
As private fostering is a private arrangement it can be hidden from agencies
that have a responsibility to safeguard the welfare of children. Privately
fostered children can be vulnerable as they may not see their families very
often. It is therefore important that their needs are assessed and their
situation monitored to safeguard their wellbeing.
Professionals should encourage parents/carers to notify Children's Social
Care of private fostering arrangements. If they feel Children's Social Care has
not been made aware by parents/carers, then they should notify Children's
Social Care themselves.
6.11
PREVENT
‘Prevent’ is part of the Government’s counter-terrorism strategy CONTEST,
which is led by the Home Office. The health sector has a non-enforcement
approach to Prevent and focuses on support for vulnerable individuals and
healthcare organisations. The Department of Health and the health sector are
key partners in working to prevent vulnerable individuals from being drawn
into terrorist-related activities. Prevent is about recognising when vulnerable
individuals are being exploited for terrorist-related activities, it follows that it is
most appropriately managed within existing safeguarding structures, working
closely with emergency planning.
CONTEST is primarily organised around four key principles each with a
specific objective:
•
Pursue: to stop terrorist attacks
•
Prevent: to stop people becoming terrorists or supporting terrorism
•
Protect: to strengthen our protection against a terrorist attack
Page 19 of 51
•
Prepare: to mitigate the impact of a terrorist attack.
The Department of Health is a long-established partner in CONTEST through
Prevent, Protect and Prepare. Responsibility for Pursue lies with the
enforcement agencies.
Prevent objectives Three national objectives have been identified for the
Prevent strategy:
Objective 1: respond to the ideological challenge of terrorism and the threat
we face from those who promote it
Objective 2: prevent people from being drawn into terrorism and ensure that
they are given appropriate advice and support
Objective 3: work with sectors and institutions where there are risks of
radicalisation which we need to address.
Prevent strategy (HM Government, 2011)
www.homeoffice.gov.uk/publications/counter-terrorism/prevent/preventstrategy
Vulnerability. In terms of personal vulnerability, the following factors may
make individuals susceptible to exploitation. None of these are conclusive in
themselves and therefore should not be considered in isolation but in
conjunction with the particular circumstances and any other signs of
radicalisation.





Identity crisis
Personal crisis
Personal circumstances
Unemployment or under-employment
Criminality
Evidence suggests that:
 There is no obvious profile of a person likely to become involved in
terrorist related activity, or single indicator of when a person might move
to support extremism
 Vulnerable individuals who may be susceptible to radicalisation can be
patients and/or staff
 Radicalisers often use a persuasive rationale or narrative and are
usually charismatic individuals who are able to attract people to their
cause which is based on a particular interpretation or distortion of
history, politics or religion
Raising concerns:
Should any staff member have a concern relating to an individual’s behaviour
which indicates that they may be being drawn into terrorist-related activity,
they will need to take into consideration how reliable or significant these
indicators are. Indicators may include:
Page 20 of 51

graffiti symbols, writing or artwork promoting extremist messages or
images

patients/staff accessing terrorist-related material online, including
through social networking sites

parental/family reports of changes in behaviour, friendships or actions
and requests for assistance

partner healthcare organisations’, local authority services’ and police
reports of issues affecting patients in other healthcare organisations

patients voicing opinions drawn from terrorist-related ideologies and
narratives

use of extremist or hate terms to exclude others or incite violence.
It may be that a patient or staff member is facing multiple challenges in their
life, of which exposure to terrorist-related influences is just one. Healthcare
workers will need to use their judgement in determining the significance of
any changes in behaviour where sufficient concerns are present. These
should be reported in accordance with the Practices policies and
procedures.
Concerns that an individual may be vulnerable to radicalisation, does not
mean that you think the person is a terrorist, it means that you are concerned
they are prone to being exploited by others, and so the concern is a
safeguarding concern.
If a member of staff feels that they have a concern that someone is being
radicalised, then they should discuss their concerns with their manager and
the safeguarding lead.
If staff suspect any such incidents they must discuss with their line
manager/CCG designated nurse for safeguarding and make arrangements to
report their suspicions accordingly:

In an emergency 999

National Anti-Terrorist Hotline -0800 789 321

Crime stoppers - 0800 555 111

Lancashire Prevent HQ team – 01772 - 413366 /412604 / 412967
https://www.gov.uk/government/policies/protecting-the-uk-against-terrorism
Further information (Toolkit):
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/
215251/dh_131934.pdf
6.12
What to do if a child is not accessing education.
Where it is discovered that a child is not receiving any form of education a
referral must be made to the local authority in which the child lives. For
children resident in Lancashire this is to the Nominated person for Children
Missing Education.
Page 21 of 51
7.0
WHAT TO DO IF YOU HAVE CONCERNS ABOUT A
CHILD’S WELFARE
7.1
ACTING ON CURRENT CONCERNS
(Please see flow chart Appendix Five.)
You have a concern about a child:

Is this a child protection issue?

Do you suspect maltreatment?

Has the child experienced or likely to experience significant harm?
No: the child and family may still be in need of additional support. Consider,

A referral to Children’s Social Care as a ‘child in need’ (Section 17)

Initiating ‘CAF(Common Assessment Framework) process’
Not sure: Discuss with a senior practitioner, Safeguarding Lead or the
Safeguarding Children Health Team. You can also discuss your concerns with
Children’s Social Care. Ask for a “what if” (or ‘no name’) conversation with the
duty social worker.
Yes: A referral must be made to Children’s Social Care. Delay should be
avoided.
Referrals can be made by phone but must be followed up in writing within 48
hours. The link below provides more detail on the referral process.
http://panlancashirescb.proceduresonline.com/chapters/p_referral_social_car
e.html
It is good practice to discuss your concerns with the parents at this stage
unless there is a good reason for not doing so. Research shows that parents
will find it easier to work with professionals to ensure the welfare of their child
if they are dealt with openly from the outset. There are circumstances when
speaking to parents about the concerns would place a child at increased risk
of further harm. This includes:

Suspected sexual abuse

Suspected fabricated or induced illness

Increased risk to the child

Risk to workers own personal safety

Female genital mutilation

Forced marriage (under 18’s)
Where a decision is taken not to seek parental permission before making a
referral to Children’s Social Care the decision must be recorded in the child’s
record and include reasons for that decision, and confirmed in the written
referral.
Page 22 of 51
It is the responsibility of social care to acknowledge the receipt of your referral
and decide on the next course of action within one working day. This may
include an assessment or they may decide that Children’s Social Care has no
role at this stage. In either circumstance you should be informed of their
decision. If you have not heard anything from social care it is your
responsibility to chase this up.
If you have a disagreement with another agency (e.g. Children’s Social Care),
consider escalating your concerns. The CCG Safeguarding professionals can
help with this. The link below takes you to the LSCB Escalation procedures.
http://panlancashirescb.proceduresonline.com/chapters/p_resolving_prof_disa
gree.html
Other than in cases where it is immediately clear that a child is, or is likely to
be, at risk of significant harm, you should consider discussing these concerns
with the Health Visitor and/or School Nurse as they may have additional
information about the child/family. The School Nurse or Health Visitor may be
able to assist you in completing the CAF (Common Assessment Framework)
process.
7.2
Responding to a child who tells you about abuse
Whenever a child reports that they are experiencing abuse or neglect, or have
caused or are causing physical or sexual harm to others, the initial response
from all professionals should be limited to listening carefully to what the child
says to:

Clarify the concerns;

Offer re-assurance about how the child will be kept safe;

Explain what action will be taken.
The child must not be pressed for information, led or cross-examined or given
false assurances of absolute confidentiality, as this could prejudice police
investigations, especially in cases of sexual abuse.
If the child can understand the significance and consequences of making a
referral to Children’s Social Care, they should be asked their view.
However, it should be explained to the child that whilst their view will be taken
into account, the professional has a responsibility to take whatever action is
required to ensure the child’s safety and the safety of other children.
It is important to remember that other children in the family should always be
considered for assessment when abuse of one child is uncovered. (RCGP
Toolkit p74)
7.3
What to do if members of the public raise concerns
Members of the public may talk to GPs and their practice staff about the
abuse of children known to them. They may specifically allege incidents or
knowledge of abuse to a child or may refer to it when discussing other issues.
The child may be well known to them, or may be the child of neighbours or
others less well known. The type and nature of the abuse may be quite
specific or it may be described only in very general terms.
Page 23 of 51
It is important that all such allegations or references to abuse are taken
seriously and relevant details should be referred to Children’s Social Care for
further enquires to be made. In such circumstances, you should be clear with
that person that you have a duty to report any alleged abuse, and encourage
the person to make a direct referral to Children’s Social Care themselves:
remember, safeguarding is everyone’s responsibility. If the member of public
refuses to refer to Children’s Social Care, the professional to whom the
disclosure was made has a responsibility to refer if a disclosure in respect of
‘significant harm’ has been made. It is essential that clear notes of any such
allegation are kept within the child’s, parents or carers record if one is
available and if possible, clarify details. These may be required at a later
date.
If possible take the name and contact details of the person alleging the abuse
– it may be necessary for Children’s Social Care or the Police to talk to them
further. It is important to note that the identity of the worker referring the
concerns will be given to the family except in exceptional circumstances.
Members of the public can remain anonymous if they wish.
8.0
BARRIERS TO SAFEGUARDING
Safeguarding is a difficult area of practice which can present a range of
challenges, both emotional and practical.
Practitioners may fail to recognise, underestimate or even condone the
problem. Stemming from a desire to help, professionals can sometimes overidentify with the abusing parent to the detriment of the child or find it hard to
'think the unthinkable', seeking more comfortable explanations for what they
see (Rule of Optimism).
Often the needs of the child are overshadowed by those of the parents.
Parents can be very effective at deflecting the attention from the real problem
or presenting a picture of change when in fact there is none (disguised
compliance).
Decisions to act may be hindered by perceived or actual problems in the child
protection system. Disagreements can arise between agencies about the best
course of action for a child. Practice staff may lack confidence that concerns
will be taken seriously based on past experience.
If you encounter any barriers it is important to act to resolve them, either
through discussion within the team or by seeking advice. The CCG
Safeguarding Team can help you. For example, escalating cases with
Children's Social Care, tackling systemic problems or helping you to address
a practice issue.
9.0 INFORMATION SHARING
Keeping children and young people safe from harm requires professionals and
others to share information about their health and development and exposure
to possible harm. Often, it is only when information from a number of sources
has been shared and pulled together that it becomes clear that there are
concerns a child is in need of protection or services.
Sharing of information is vital for early intervention to ensure that children and
young people with additional needs get the services they require. It is also
Page 24 of 51
essential to protect children and young people from suffering harm from abuse
or neglect. It is essential that all practitioners understand when, why and how
they should share information.
It is important of course to keep a balance between the need to maintain
confidentiality and the need to share information to protect others. Decisions to
share information must always be based on professional judgement about the
safety and wellbeing of the individual and in accordance with legal, ethical and
professional obligations. Always consider the safety and welfare of the child or
young person when making decisions on whether to share information about
them. Where there is concern that the child may be suffering or is at risk of
suffering significant harm the child’s safety and welfare must be the overriding
consideration. Information may also be shared where an adult is at risk of
serious harm, or if it would undermine the prevention, detection, or prosecution
of a serious crime including where consent might lead to interference with any
potential investigation.
The 7 key points on information sharing and a flowchart are found in Appendix
Six. Further detailed guidance please refer to Information sharing: Advice for
Practitioners (HM Government 2015) accessed at:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/4
19628/Information_sharing_advice_safeguarding_practitioners.pdf
See also GMC ‘Protecting Children and Young People (2012).
10.0 GP ATTENDANCE AT CASE CONFERENCES
The contribution of GPs to safeguarding children is invaluable and priority
should be given to attendance wherever possible. A written report should be
made available for the conference, whether or not the GP will be in
attendance. (GMC, Child Protection Guidance 2012). The report will inform
the child protection decision making
The report should provide details of the GPs/Practices involvement with the
child and family, and their assessment of the capacity of the parents to meet
the needs of their child within their family and environmental context.
The report must make it clear the distinction between fact, observation,
allegation and opinion. When information is provided from another source, this
should be made clear. It is recommended that the report is shared with the
family prior to conference.
11.0 RECORDING INFORMATION
GMC 2013 Guidance Good Medical Practice
( http://www.gmc-uk.org/guidance/good_medical_practice.asp )
states: - ‘Documents you make (including clinical records) to formally record
your work must be clear, accurate and legible. You must make records of the
same time as the events you are recording or as soon as possible thereafter’.
Records must be written in compliance with the Race Relations Act, Equality
Act and Disability Discrimination Act and should provide evidence of history,
Page 25 of 51
examination and interventions including any management plans, medication
prescribed, other care delivered. If any information is shared the reason for
this, who it has been shared with and whether it has been shared with or
without consent must be recorded including the rationale for decisions made.
Where there are concerns about a child’s welfare, all concerns, discussions
about the child, decisions made and the reasons for those decisions must be
recorded in writing in the child’s records, and where appropriate, the notes of
siblings and significant adults. Any bruises, marks and/or injuries observed
should be clearly documented on a body map within the records.
To assist in recording information about vulnerable children the following
additional guidance is given: Information that must be recorded in the notes includes:
 That supplied by all members of the primary care team, including
the Health Visitor/School Nurse, should be recorded in the notes.
 Conversations with, and referrals to, outside agencies are
recorded in the notes of the child and relevant adults.
 Legal status of the child – such as a child subject to a Care Order
under the Children Act 1989
 Where it is considered that a child is subject to fabricated or
induced illness (FII)
 If a child is subject to a child protection plan. All child protection
conference notes are to be retained, although it is up to individual
practices to determine the most practicable way to retain this
information it is suggested that it is scanned into the notes of all
children and adults (where registered with the practice).
 If a child is no longer subject to a child protection plan. This
information should also be recorded in the notes of the
parents/carers where they are registered with the practice.
 Recording when a child is considered to be a ‘vulnerable’.

It is good practice to always record:
 The name of the professional seeing the patient as well as the
date and time
 Who attends with the child and their relationship with that child (if
any)
The use of email or unlinked correspondence is discouraged other than for the
purpose of alerting individuals to new information in notes.
Records, storage and disposal must follow national guidance, for example
Records Management, NHS Code of Practice 2006.
For electronic records see also
https://www.gov.uk/government/publications/the-good-practice-guidelines-forgp-electronic-patient-records-version-4-2011
If information is about a member of staff this is recorded securely in the staff
personnel file in line [insert practice guidance]
Page 26 of 51
 Regulated practitioners must also have regard to their regulatory body
guidance, for example, Nursing & Midwifery Council Record Keeping
Guidance 2009; General Medical Council , Good Medical Practice (2013).
11.1
Identifying those with Potential Safeguarding Concerns - Coding
Practice computer systems are used to identify those patients and families
with risk factors or concerns and especially when the patient or their family
consults a range of practitioners.
The Practice will:
 Have someone who is responsible for putting the alerts on the computer
 Use the computer alert system
 Use a standard set of Read codes
It is important to be alert to the siblings and other members of the household
as the child there are direct concerns about.
Detailed instructions from EMIS on how to set up alerts are available:
Title: TH869 EMIS Web Patient warnings
Details on practice records and coding can be found in the RCGP/NSPCC
Toolkit 2014.
http://www.rcgp.org.uk/clinical-and-research/clinicalresources/~/media/54D5AE22B3A14BAF9A92DB25D125DBAF.ashx
12.0 CREATING A SAFE ENVIRONMENT
12.1
Safer Employment
The aim of creating a safe environment is to minimise risks to children and
young people from abuse in practice. We sometimes need to be mindful that
there may be people who work, or seek to work, in organisations who pose a
risk to children and young people. The following is intended to further support
practices in creating a safer environment by setting out key safeguarding
arrangements that help to protect patients as well as protecting individuals
against false allegations of abuse and the reputation of the practice and
professionals.
The Criminal Records Bureau (CRB) and Independent Safeguarding Authority
(ISA) functions have now merged to create the Disclosure and Barring
Service (DBS).
All GPs applying to join the medical performers list under Performers List
Regulations have to provide an enhanced disclosure as part of their
application.
General practices also have a responsibility to ensure that they carry out
appropriate criminal record checks on applicants for any position within their
practice that qualifies for either an enhanced or standard level check. Any
Page 27 of 51
requirement for a check and eligibility for the level of check is dependent on
the roles and responsibilities of the job.
NHS employers also have a legal duty to refer information to the DBS if an
employee has harmed, or poses a risk of harm, to vulnerable groups and
where they have dismissed them or are considering dismissal. This includes
situations where an employee has resigned before a decision to dismiss them
has been made.
For further information:
 http://www.homeoffice.gov.uk/agencies-public-bodies/dbs
 or
http://www.nhsemployers.org/RecruitmentAndRetention/Employmentche
cks/Pages/Employment-checks.aspx
Safer employment extends beyond criminal record checks to other aspects of
the recruitment process including:




12.2
Making clear statement in adverts and job descriptions regarding
commitment to safeguarding
Seeking proof of identity and qualifications
Providing two references, one of which should be the most recent
employer
Evidence of the person's right to work in the UK is obtained
Staff Behaviour and Professional Boundaries:
The practice should have clear expectations for staff behaviour e.g. attitude.
The following list is by no means exhaustive and all staff should remember to
conduct themselves in a manner appropriate to their position.
Wherever possible, you should be guided by the following advice. If it is
necessary to carry out practices contrary to it, you should only do so after
discussion with, and the approval of, your manager/General Practitioner.
You must:
 challenge unacceptable behaviour and report all allegations;
 provide an example of good conduct you wish others to follow;
 respect a young person’s right to privacy and encourage children, young
people and adults to feel comfortable to point out attitudes or behaviours
they do not like;
 involve children and young people in decision-making as appropriate;
 be aware that someone else might misinterpret your actions;
 not engage in or tolerate bullying of a child, either by adults or other
children;
 never promise to keep a secret about any sensitive information that may
be disclosed to you but follow the practice guidance on confidentiality and
sharing information;
 never offer a lift to a young person in your own car unless in an
emergency;
 never exchange personal details, such as your home address with a
young person;
Page 28 of 51

not engage in or allow any sexually provocative games involving or
observed by children, whether based on talking or touching.
Detailed guidance on safe working practices for adults who work with children
can be accessed at: http://www.dcsf.gov.uk/everychildmatters/resources-andpractice/IG00311/
12.3
Use of Internet, Mobile Phones and Electronic Equipment
You must always act responsibly with regard to internet, electronic and
telecommunications equipment (including use of mobile phones), using them
in a professional, lawful and ethical manner.
12.4
Inappropriate types of Web sites
Accessing or downloading data from inappropriate websites (e.g.
pornographic websites or emails, racist, sexist or gambling websites or
emails, sites promoting violence and illegal software) at any time is forbidden
and may lead to disciplinary proceedings.
12.5
Managing allegations against workers who have contact with children.
Children can be subjected to abuse by those who work with them in any and
every setting. All allegations of abuse or maltreatment of children by an
employee, agency worker, independent contractor or volunteer will be taken
seriously and treated in accordance with the Safeguarding Children Board
(LSCB) procedure for Managing allegations against people who work with
children and young people, accessed at:
http://panlancashirescb.proceduresonline.com/chapters/p_allegations.html
The procedure must be followed when there are concerns that any person
who works with children, either in a paid or unpaid capacity i.e. any employee,
independent contractor, or volunteer, where the adult is in a position of trust in
relation to the child and family, has: 


behaved in a way that has harmed a child, or may have harmed a child
possibly committed a criminal offence against or related to a child
behaved towards a child or children in a way that indicates s/he is
unsuitable to work with children.
These behaviours should be considered within the context of the four
categories of abuse i.e. physical, sexual and emotional abuse and neglect
and includes concerns relating to inappropriate relationships between
members of staff and children or young people.
Compliance with the above procedure allows for consideration of the adult’s
behaviour at the earliest opportunity when a concern or allegation arises.
Compliance also helps to ensure that allegations of abuse are dealt with
expeditiously and in a manner that is consistent with a thorough and fair
process.
If a serious allegation is made against a member of practice staff and it relates
to conduct towards a child, you must inform the Local Area Designated Officer
(LADO) who is employed by the Local Authority after taking immediate action
in line with your practice policy. This person assumes oversight of your
investigation process from beginning to end and will give you advice. They will
also liaise with the police and social care if necessary.
Page 29 of 51
LADO for Lancashire
Is: Tim Booth:
Tim.booth@lancashire.gov.uk
Tel: 01772 536694 or
07826902522
12.6
Whistle-Blowing
It is important to build a culture that allows practice staff to feel comfortable
about sharing information, in confidence and with a lead person, regarding
concerns about quality of care or a colleague’s behaviour. This will also
include behaviour that is not linked to child abuse but that has pushed
boundaries beyond acceptable lines.
http://proceduresonline.com/panlancs/scb/chapters/p_whistle_blowing.html
12.7
Complaints procedure
The practice has a robust mechanism for of dealing with complaints from all
patients (including children and young people), employees, accompanying
adult or parent. Please refer to [insert link or cite practice document].
Consideration should always be given to whether a complainant meets the
criteria for managing allegations procedures.
12.8
Consent Guidance and Procedure
The practice has a clear consent guidance and chaperone procedure which all
practitioners are aware of. Please refer to (insert links or cite practice
documents). If a child refuses treatment, consideration should be given as to
whether the child is ‘Fraser competent’ see practice consent guidance (cite
appropriate section in practice consent guidance) for further detail. Under
no circumstances should children be restrained by practice staff in order to
administer medication / treatment.
12.9
Serious Untoward Incidents
The practice has a robust system for recording serious untoward incidents
and procedures for undertaking investigations. These may be in the form of a
significant event analysis.
12.10 Training
To protect children and young people from harm, all health staff must have the
competences to recognise child maltreatment and to take effective action as
appropriate to their role. The training framework at Appendix Two indicates
the level of training required by different members of the practice.
All staff undergoing training are expected to keep a learning log for their
appraisals and/or professional development.
12.11 Supervision of staff
Staff working with children, young people and families to have access to
support and supervision; this will provide an opportunity for practitioners to
share their concerns and to enable them to manage the stresses inherent in
this work. It also promotes good standards of practice, which are soundly
Page 30 of 51
based and consistent with local and national guidance for safeguarding
children.
It also provides an opportunity to ensure there is an understanding of roles
and responsibilities, as well as the scope of professional discretion and
authority. Key decisions taken during supervision must be recorded in the
child’s records.
13.0 Safeguarding Children Processes
13.1
Common Assessment Framework (CAF)
The Common Assessment Framework is a key tool in the early identification
of children and young people and families who may experience problems,
require additional support or who are vulnerable to poor outcomes and
underpins the work of Early Support. Further details can be found via the link
below which also links to the current Lancashire Thresholds Guidance
http://lancashirechildrenstrust.org.uk/resources/?siteid=6274&pageid=45056
13.2
Domestic Homicide Reviews
Domestic Homicide Reviews (DHRs) were established on a statutory basis
under section 9 of the Domestic Violence Crime and Victims Act 2004. This
provision came into force on 13th April 2011. All heath organisations are
obliged to participate in these reviews. Therefore, this practice acknowledges
this obligation and will contribute in the same way as it does during the
serious case review process.
13.3
Serious Case Reviews
Regulation 5 of the Local Safeguarding Children Boards Regulations (2006)
sets out the functions of LSCB’s including a requirement to carry out serious
case reviews in specific circumstances. This includes undertaking a serious
case review for every case where abuse or neglect is known or suspected
and either:


A child dies; or
A child is seriously harmed and there are concerns about how
organisations or professionals worked together to safeguard the child.
The Regulation can be read in full by following the link below.
http://www.legislation.gov.uk/uksi/2006/90/regulation/5/made
The GP Practice will work with the Local Area Team (LAT) and Designated
professionals to contribute in full to the serious case review process.
13.4
Child Death Overview Panel (CDOP)
The Child Death Overview Panel (CDOP) is a multi-agency group which
reviews all child deaths up to the age of 18 years. It is a sub-group of the
Local Safeguarding Children Board.
Since April 2008 it has been a statutory requirement to notify all child deaths
to a central point, regardless of the age of the child or the cause of death.
Page 31 of 51
Anonymous data is collected on all child deaths including expected deaths.
The information collected needs to be as complete as possible (particularly
when the death was unexpected) in order to ascertain whether there are any
modifiable factors. The CDOP makes recommendations when there are
lessons to be learned, and informs local planning on how best to safeguard
and promote the welfare of children in their area. The panel is also
responsible for ensuring that follow-up and support for families is in place.
When a child’s death is Unexpected (i.e. the death was not anticipated as a
possibility 24 hours before the death or the event that preceded the death),
there is an immediate information sharing and planning discussion between
the lead agencies (Health, Police and Social Care) and usually there will be a
joint home visit between a police officer and a senior health professional
(Rapid Response Team) to take a detailed history from the family and also to
keep the family informed about the next steps. This visit is made as soon as
possible within working hours and the information is passed onto the
pathologist when a post mortem is to be held.
A multi-agency professionals meeting is then held, usually within a few days
of the death, involving relevant agencies (e.g. primary health care, midwives,
coroner’s office, police, paediatrician, education). The purpose of this meeting
is to share information, to raise concerns about whether there is a possibility
of abuse or neglect having contributed to the child’s death and to ensure that
the family are supported.
GPs are expected to contribute to the CDOP process by completing a ‘Form
B’ on request.
14.0 REVIEWING THE PRACTICE SAFEGUARDING GOVERNANCE
ARRANGEMENTS
There are several ways in which the practices safeguarding arrangements can
be reviewed.
The RCGP/NSPCC toolkit suggests steps to help you prioritise tasks based
on self-audit and/or risk assessment. It includes information on many of the
areas key to establishing effective arrangements, including an audit tool and
templates for reviewing significant events.

Be aware of, understand and recognise child abuse

Develop and maintain a culture of openness and awareness

Identify and manage the risks and dangers to children and young people in
your practice and activities: Health & Safety Executive.
http://www.hse.gov.uk/index.htm

Develop a child protection policy: Toolkit for GPs, p10

Create clear boundaries, for example, with the limits to confidentiality: BMA
Toolkit, p7 &15
Page 32 of 51

Follow safe recruitment practice including obtaining references for all team
members

Support and supervise staff and volunteers

Ensure there is a clear procedure for addressing concerns

Know your legal responsibilities: Toolkit for GPs, p7, GMC Guide, p6-8

Have a practice policy which welcomes and encourages children and young
people to participate in your practice: “Involving children and young people in
health services”. NHS Confederation & RCPCH 2011.

Provide safeguarding education and training to all members of the team.
15.0
CQC GUIDANCE
Outcome 7 of the essential standards relates to safeguarding patients
(children and adults) from abuse. Staff should be in a position to identify
abuse and act appropriately in cases of alleged or suspected abuse.
Your practice is likely to be compliant if it does the following:

Ensures that staff have safeguarding training, appropriate to their role, so that
they can recognise the signs of possible abuse.

Takes appropriate action to protect patients in the event that any member of
staff exploits a vulnerable adult or child in any way. Healthcare professionals
in GP practices should be reported to the GMC/Nursing Midwifery
Council/HPC in cases where they are in possible breach of their professional
guidelines. Performers should be reported to the relevant CCG/LAT.

Ensures that patients can raise concerns and make complaints related to
abuse. The practice should have a mechanism for patients to make
comments and a publicised complaints procedure.

Shares relevant information with other providers, in accordance with local
safeguarding procedures, when there are safeguarding concerns about a
patient.

Complies with the Vetting and Barring Scheme:
o
Practices that knowingly employ someone who is barred to work with
children or vulnerable adults will be breaking the law.
o Practices that dismiss or remove a member of staff/volunteer from
working with children and/or vulnerable adults (in what is legally
defined as regulated activity)
o Practices are under a legal duty to notify the DBA* of relevant
information, so that individuals who pose a threat to vulnerable groups
can be identified and barred from working with these groups.
Page 33 of 51

Your practice has the following:
o A safeguarding children (child protection) policy
o A safeguarding adults policy
o A patient information leaflet about abuse, containing information on
what patients should do if they have suspicions that another person
has been abused and what they might expect to happen under
safeguarding procedures, is available in your practice.
o A range of patient information leaflets can be accessed at:
http://www.safenetwork.org.uk or the NSPCC
16.0 EQUALITY IMPACT ASSESSMENT
On initial screening no issues were identified that would indicate the need for
a full Equality Impact Assessment. Please see Appendix One.
17.0 REFERENCE /BIBLIOGRAPHY AND USEFUL WEB LINKS
In developing this guidance and procedures account has been taken of the
following statutory and non-statutory guidance, best practice guidance and the
policies and procedures of Blackpool Safeguarding Children Board.
Statutory Guidance
Department of Health et al (2000) Framework for the Assessment of Children
in Need and their Families, London, HMSO
Department of Health et al (2009) Statutory guidance on Promoting the Health
and well-being of Looked After Children, Nottingham, DCSF publications
HM Government (2010) Working Together to Safeguard Children, London,
DCSF Publications
HM Government (2013) Working Together to Safeguard Children, London,
DCSF Publications
HM Government (2015) Working Together to Safeguard Children, London,
DCSF Publications
HM Government (2008) Safeguarding Children in whom illness is fabricated
or induced, DCSF publications
HM Government (2009) The Right to Choose: multi-agency statutory
guidance for dealing with Forced marriage, Forced Marriage Unit: London
Non-statutory guidance
BMA Child Protection Toolkit
DH (Nov, 2011), Building Partnerships, Staying Safe. - The Health Sector
Contribution to HM Governments Prevent Strategy. Guidance for Healthcare
organisations.
Page 34 of 51
https://www.gov.uk/government/publications/building-partnerships-stayingsafe-guidance-for-healthcare-organisations
GMC (2012) Protecting Children and Young People. GMC
HM Government (2008) Information Sharing: Guidance for practitioners and
managers, DCSF publications
HM Government (2015) What to do if you’re worried a child is being abused,
DSCF publications
RCGP/NSPCC (2014) Safeguarding Children and Young people: The
RCGP/NSPCC Safeguarding Children Toolkit.
Royal College Paediatrics and Child Health et al (2014) Safeguarding
Children and Young people: Roles and Competencies for Health Care Staff.
Intercollegiate Document.
http://www.lscbchairs.org.uk/sitedata/files/Safeguarding_Children_Heal.pdf
Best practice guidance
NICE
National Institute for Health and Clinical Excellence (2009) When to suspect
child maltreatment, Nice clinical guideline 89
http://www.nice.org.uk/guidance/cg89
Guidelines Domestic Abuse
http://www.nice.org.uk/guidance/ph50
Lancashire Safeguarding Children Board
Policies, procedures and practice guidance and
Recommendations from Serious Case Review accessed at:
Website: http://www.lancashiresafeguarding.org.uk
learning
and
Care Quality Commission
BMA (2012) what is CQC Registration?
Care Quality Commission (2009) Guidance about compliance: Essential
Standards of Quality and Safety
NHS Employment Check standards (2013)
http://www.nhsemployers.org/recruitmentandretention/employmentchecks/employment-check-standards/pages/employment-checkstandards.aspx
Useful links
Victims of human trafficking
www.gov.uk/government/publications/identifying-and-supporting-victims-ofhuman-trafficking-guidance-for-health-staff
Page 35 of 51
Forced marriage
www.gov.uk/forced-marriage
Female genital mutilation
https://www.gov.uk/government/publications/female-genital-mutilation-multiagency-practice-guidelines
Advice and links for young people, parents, teachers, and organisations:
www.childnet.com/sorted - a site designed by young people.
www.ceop.gov.uk
– Child Exploitation and Online Protection. Linked to a
Virtual Global Taskforce, enabling police to investigate reported, actual or
attempted abuse.
www.iwf.org.uk – the Internet Watch Foundation. Hotline for reporting illegal
online content.
www.digizen.org – information about the safe use of social networking sites
The responsibility for ensuring policies are reviewed belongs to the partners, who
may delegate this responsibility [insert name here].
We have reviewed and accepted this guidance and procedure.
Signed:
Dated:
Signed by on behalf of the partnership
The practice team have been consulted on how we implement this guidance and
procedure.
Signed:
Dated:
Appendix One
Page 36 of 51
CHCT/Safeguarding Business Case 2014
Yes
Equality Analysis Checklist
Does the ‘Activity’ being considered for equality analysis affect
service users, employees or the wider community and therefore
potentially be highly significant in terms of equality?
(Relevance will depend not only on the number of those affected but also
by the significance of the effect on them)
Is it a major ‘Activity’ with significant implications for equality?
E.g. a strategy, commissioning large scale programmes, care pathway redesign, building development etc
No
X
X
Has previous engagement highlighted important inequalities
x
for protected groups?
X
Does or could the ‘Activity’ affect different protected groups
differently?
Does the ‘Activity ‘relate to a known area of inequalities?
x
E.g. access issues for disabled people, services for vulnerable
people.
If you have answered yes to any of the questions above you need to complete
an Equality Analysis.
Focus attention on those aspects most relevant to equality. Which protected groups is
it most relevant to?
If you answered no to all of the questions above then you don’t need to undertake an
Equality Analysis.
*When you decide an ‘Activity’ is not relevant to equality and therefore does not
require an Equality Analysis it is important to document the decision and reason
for the decision. This ensures that you have not overlooked potential issues
relevant to equality which could leave you vulnerable to legal challenge.
Decision:
Reason:
This document applies to all.
An equality
analysis is not
required.
Name:
Date: 27.11.14
Cathie Turner
Page 37 of 51
Appendix Two
Safeguarding Children and Adults Training for GP practices /
Requirements and accessibility within Lancashire
Introduction
All Healthcare staff have a duty to safeguard and protect the welfare of children and vulnerable adults. Safeguarding children and adults training is therefore essential for all staff engaged in services for children
and vulnerable adults. This document aims to provide guidance on the requirements and resources available for training in general practice.
The responsibility for ensuring staff are properly trained rests with their employers.
The list of individuals to whom this guidance might apply includes GP’s (Partners, Salaried GP’s, Retainers, Locums), Nurse Practitioners, Practice Nurses, Healthcare Assistants, Receptionist and Administrative
Staff, Practice Managers and any other staff employed by the practice.
The guidance draws on national guidance found in Working Together to Safeguard Children: A guide to interagency working to safeguard and promote the welfare of children (2013). The Intercollegiate Document
Safeguarding Children and Young people: roles and competencies for healthcare staff (2014) and GMC Protecting Children and Young People: the responsibilities of all doctors (2012).
GMC Guidance states General Practitioners must develop and maintain their knowledge and skills to protect children and young people at a level appropriate to their role. As per Safeguarding Children and
Young People: Roles and Competencies for Healthcare Staff Intercollegiate Document (2014), all Clinical Staff working with children, young people and/or their parents/carers and who could potentially contribute
to assessing, planning, intervening and evaluating the needs of a child or young person and parenting capacity where there are safeguarding/child protection concerns should be trained to level 3 competency.
GP’s should make sure they are able to identify risk factors that might raise concerns about abuse or neglect of children or vulnerable adults and take the required action. All providers need to be compliant with
CQC essential standards of quality and safety. Outcome 7 is safeguarding people who use services from abuse, ensuring people are protected from abuse and staff respect their human rights.
The decision on the competency required of a particular staff member, employed by any GP practice, is one for each practice to take dependent upon employee roles and responsibilities, for example a Practice
Nurse who works a lot with children such as administering childhood immunisations, might be required to complete level 3 training.
Reaching and maintaining Safeguarding Children competencies is a statutory requirement.
The following table provides detail of the recommended training options to achieve required levels of competency. The available resources are detailed on the following pages
of this document.
Staff Training Level
Level 1 e.g Reception/Admin
staff
Level 2 e.g HCA, Practice
Nurse
Level 3 e.g GP, Nurse
Practitioner, Practice Nurse
Type of training recommended to achieve required levels of competency
Multi Agency Training via
Single Agency Training e.g
E-Learning
LSCB
via national/local
events/NSPCC/BASCPAN
NO
NO
YES
Reading/Reflective Practice
NO
NO
NO
YES
NO
YES
YES
YES
YES
Page 38 of 51
Safeguarding Children and Adults Training for GP practices /
Requirements and accessibility within Lancashire
Children
Target Group
Level/Group and suggested content
Training opportunities available
Level/Group 1 Safeguarding Children Training
All non-clinical staff
working in health
care settings



Staff groups
Include receptionists,
administrative staff,
and maintenance staff

To access training
within 6 weeks of
taking up post

What is abuse and neglect
How to recognise abuse and neglect
To be able to understand the impact a
parent/carers physical and mental health can have
on the well-being of a child or young person,
including the impact of domestic violence
To be able to understand the risks associated with
the internet and online social networking
Appropriate action to take if an individual has
concerns
National Skills academy for Health Level 1 and 2 E Learning Children www.skillsforhealth.org.uk
LSCB e-learning level 1 and level 2 (1 hour max) accessed via:
http://www.lancashire.gov.uk/corporate/web/view.asp?siteid=3829&pageid=20832&e=e ( you will need
to register on ISA training to do this)
RCGP e-GP accessed at http://e-lfh.org.uk/projects/egp/index.html this training is free to all staff
working in primary care, not just RCGP members
Competencies should be reviewed annually as part of
staff appraisal in conjunction with individual learning
and development plans. Staff should receive refresher
training every three years as a minimum equivalent to a
minimum of 2 hours. The e-learning programme can
also be accessed as part of refresher training.
Level/Group 2 Safeguarding Children Training
All clinical staff who
have any contact with
children, young
people and/or
parents/carers
Staff groups
Includes Practice
Nurses / health care





Documentation and information sharing
Professional roles and responsibilities
Impact of parent/carers physical and mental health
on the wellbeing of the child in order to be able to
identify a child/young person at risk
Using the common assessment framework
Using professional and clinical knowledge and
understanding of what constitutes child
maltreatment and how to recognise signs of abuse
and neglect
National Skills academy for Health Level 1 and 2 E Learning Children www.skillsforhealth.org.uk
LSCB e-learning level 1 and level 2 (1 hour max) accessed via:
http://www.lancashire.gov.uk/corporate/web/view.asp?siteid=3829&pageid=20832&e=e ( you will need
to register on ISA training to do this)
RCGP e-GP accessed at http://e-lfh.org.uk/projects/egp/index.html this training is free to all staff
working in primary care, not just RCGP members
Page 39 of 51
assistants etc.
Training should be
undertaken within six
months of coming into
post.
NB: Staff are also
required to have
accessed level/group 1
training




To be aware of the risk of Female Genital
Mutilation (FGM) and be able to refer appropriately
for further care and support
To be able to identify and refer a child suspected of
being a victim of trafficking and/or sexual
exploitation
To be aware of the risk factors for radicalisation
and know who to contact regarding preventative
action and support
Acting in accordance with statutory and nonstatutory guidance and legislation
Lancashire Safeguarding Children Boards LSCB policies and procedures accessed at:
http://www.lancashire.gov.uk/education/safe_child_board/safeguarding_children_procedures/index.asp
Competencies should be reviewed annually as part of
staff appraisal in conjunction with individual learning
and development plans. Staff should receive refresher
training every three years as a minimum and training
should be tailored to the roles of individuals. A minimum
of 3 to 4 hours over three years is required.
Level/Group 3 Safeguarding Children Training
All clinical staff
working
predominately with
children and or their
families who could
potentially contribute to
assessing, planning,
intervening and
evaluating the needs of
a child and parenting
capacity where there
are safeguarding /child
protection concerns
Staff groups include
GPs and practice
nurses
NB: Staff in this






To be able to identify possible signs of sexual,
physical, or emotional abuse or neglect using child
and family- focused approach
To be able to know what constitutes child
maltreatment including the effects of
carer/parental behaviour on children and young
people
Identify, assess and meet the needs of children
where there are safeguarding concerns
The impact of parenting issues such as domestic
abuse, substance misuse on parenting capacity
and the interagency response
Recognising the importance of family history and
functioning
Working with family members including the lack of
co-operation and superficial compliance within the
context of the role
Awareness of interagency policy and national

guidance, implications of legislation
Advice would be that for staff requiring level 3 competency the ideal route would be by accessing the
multi-agency training below.
The LSCB run an extensive training programme for staff working with vulnerable children, who need to
access training at levels 3 and above, details of which can be obtained via the following link:
http://www.lancashire.gov.uk/corporate/web/view.asp?siteid=3829&pageid=20832&e=e
The contact number for safeguarding training co-ordinator is 01772 538357
Additional resources for achieving level 3
National Skills academy for Health Level 3 E Learning Children www.skillsforhealth.org.uk
RCGP website – safeguarding children toolkit
ELearning for Healthcare.org.uk - in conjunction with the royal colleges.
Resources and examples of reading and reflective practice which can be used to achieve level 3
Page 40 of 51
group are also
required to have
accessed level/group
1 and 2 training
N/B Record
Safeguarding activity
in personal
development file and
practice development
file



Information sharing, confidentiality and consent;
Remit and role of Lancs Safeguarding Children
Board
Interagency frameworks for safeguarding including
the Common Assessment framework (CAF); Team
around the Child and the role of the Lead
Professional.
competency if linked to personal development plan and appraisal
Lancashire Safeguarding Children Boards LSCB policies and procedures accessed at:
http://www.lancashire.gov.uk/education/safe_child_board/safeguarding_children_procedures/index.asp
Common Assessment Framework CAF /Continuum Of Need CON training
www.lancashire.gov.uk/corporate/web/?siteid=5943&pageid=33997&e=e
Additional specialist competencies

Interagency working

Contributing to serious case reviews/critical
incidents/child death overview processes

Applying lessons learnt from audit and serious
case reviews to improve practice

Advising others on appropriate information sharing
Discussions with colleagues- e.g. health visitors/school nurses/midwives about safeguarding issues
can count towards level 3 training as long as the learning from this is documented (take out any patient
identifying information though) as can case discussions/ significant event analyses in practice meetings.
For the purposes of annual GP Appraisal and
revalidation, GPs should have all the competencies at
level 2 and be at or be able to demonstrate they are
working towards level 3. The GMC and RCGP state
that for the purposes of revalidation, GPs need to
demonstrate that they are up to date and fit to practise
in all aspects of their work. Level 3 describes the scope
of work of GPs in relation to safeguarding children and
young people. It is the responsibility of GPs to
demonstrate that they maintain their competence. A GP
may keep up to date in a variety of ways, for instance
completing an elearning module, attending a training
session in or out of practice or reading appropriate
guidelines.
In house training sessions arranged by practice safeguarding leads or bought into the practice is an
effective way of delivering training to a group. They could simply go through their practice policy,
discuss potential case scenarios or deliver a presentation. A session to discuss GMC guidance would
be a good way to ensure that everyone is aware of their responsibilities. Remember to invite any locum
or sessional doctors.
The updated intercollegiate Document (2014) no
longer defines level 3 competency as being
measured in hours, but by being able to
demonstrate on-going career long competence in
the areas listed above. As a general rule to
demonstrate you are keeping up to date will take as
a minimum of 2 hours update each year. It is the
responsibility of the GP, in their appraisal, to
demonstrate they are competent and up to date.
Case reviews and critical incident reviews can be
used to show how knowledge and skills are used in
Completing reports- for and attending multi-disciplinary meetings e.g. TAC meetings/ child protection
conferences can count towards level 3 training, again as long as this is documented and you can show
what you have learnt from it.
RCGP Toolkit children and young people- Good resource for practice leads wishing to run level 3
sessions in house.
Local and National Safeguarding Training Events.
NICE guidance 2009 CG89 - When to suspect child maltreatment
General Medical Council
2007 0-18 years: guidance for all doctors
2012 Protecting Children and Young People - the responsibilities of all
doctors
Information and guidance re working with children who are looked after “Promoting the health and
Well-being of Looked After Children” (DH 2009)
https://www.education.gov.uk/publications/standard/publicationDetail/Page1/DCSF-01071-2009
Information on domestic violence, forced marriage and honour based violence www.gov.uk
Information on working with sexually active young people accessed at
http://panlancashirescb.proceduresonline.com/chapters/p_sexually_active_yp.html
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practice.
GPs work to achieve level 3 competence within the
first twelve months of practice and refresher
training equivalent to a minimum of 6 hours over a
three year period.
Safeguarding Children and Adults Training for GP practices /
Requirements and accessibility within Lancashire
Adults
Target Group
Level/Group and suggested content
Training opportunities available
All clinical and nonclinical staff groups
Introduction to safeguarding adult training
The Lancashire Safeguarding Adults Board provide training for staff working with vulnerable adults
at level 1 via E learning to access www.lancashire.gov.uk/safeguardingadults follow information for
professionals then training



What is abuse and neglect
How to recognise abuse and neglect
Appropriate action to take if an individual has
concerns.
National Skills academy for health E learning at level 1 www.skillsforhealth.org.uk
Refresher training at a minimum every three years. The
e-learning programme can also be accessed as part of
refresher training.
All clinical staff
i.e. GP’s /nursing
staff / health care
assistants etc

What is abuse and neglect

Link to the Pan Lancashire and Cumbria multi agency Safeguarding adult procedures manual.
The manual provides information about safeguarding adults at risk of abuse and neglect and how to
make a safeguarding adult alert into social care http://plcsab.proceduresonline.com/
Understanding the terms ‘vulnerable’ and
adults ‘at risk’
RCGP Toolkit Vulnerable adults MCA and DOLS

How to recognise potential or actual abusive
situations
BMA Toolkit- BMA guide for Practitioners

An overview of the background legislation and
guidance
ELearning programme SCIE website http://www.scie.org.uk/publications/elearning/index.asp
Safeguarding Adults – What you need to know

Recognition of local pathways and
safeguarding structures
Understanding of CQC outcome 7 expectations
All clinical staff
Understanding the Mental capacity Act (MCA) and
the Deprivation of Liberty Safeguards (DOLS)
CCG Safeguarding and Mental Capacity Act standards for commissioned services appendix 4
safeguarding standards for GP member practices can be accessed on the CCG websites.
Practice safeguarding leads and deputies may wish to arrange in house training sessions as a time
effective way of delivering training to a group. They could simply go through their practice policy,
discuss potential case scenarios or deliver a presentation. Try to remember to invite any locum or
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All staff

Awareness of the legal framework
underpinning the mental capacity Act 2005
and the Deprivation of Liberty safeguards

Roles and responsibilities in respect of this
legislation

Guidance on completing capacity
assessments and applying the best interests
check list

What makes a restriction a deprivation?

Awareness of the role of the Independent
mental capacity Advocate (IMCA)
sessional doctors.
PREVENT Health WRAP training
Currently this is only available as face to face training:
LEARNING OUTCOMES

How to support and redirect individuals with
vulnerability

How to share concerns, get advice, and make
referrals
Please contact :
Regional PREVENT Coordinator (North West)
NHS England North
Rm 206, Preston Business Centre, Watling St Rd, Fulwood,
Preston, PR2 8DY
Mob: 07900 715497
Guidance- Building Partnerships, Staying Safe: guidance for healthcare organisations at
https://www.gov.uk/government/publications/building-partnerships-staying-safe-guidance-forhealthcare-organisations
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Appendix Three
Key contacts
Designated Doctor
CCG
Dr
(Designated Doctor)
Address:
Phone
(Sec)
Designated Nurse
Tel:
Mobile :
Tel:
Mobile :
CCG
Named
Safeguarding CCG
Professional Children and
Primary Care
Safeguarding Practitioner
CCG
Children and Primary Care
GP
Lead
Children
Chief Nurse
Safeguarding
Tel:
Mobile :
CCG
Dr
Dr
CCG
(Chief Nurse)
SecretaryTel:
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Appendix 5
What to do if you are worried a child is being abused
(Abuse may take the form of physical abuse, sexual abuse, emotional abuse or neglect)
Any member of staff who believes or suspects that a child may be suffering, or is likely to suffer significant
harm should always refer their concerns to Children’s Social Care. (There should always be an opportunity to
discuss concerns with a manager, named professional or qualified social worker, but never delay emergency
action to protect a child)
Are you concerned a child is suffering or likely to suffer harm, for example:
 You may observe an injury or signs of neglect
 You are given information or observe emotional abuse
 A child discloses abuse
 You are concerned for the safety of a child or unborn baby
Step One
Inform parents/carers that you will refer to Children’s Social Care
UNLESS
The child may be put at increased risk of further harm (e.g. suspected sexual abuse,
suspected fabricated or induced illness, female genital mutilation, increased risk to a child,
forced marriage) or there is a risk to your own personal safety.
Step Two
Make a telephone call to Children’s Social Care
Follow up the referral in writing within 24 hours
Document all discussions held, actions taken, decisions made including who was spoken
to (for physical injuries document injuries observed) and who was informed
Where a CAF or equivalent has been completed forward this with the written referral.
Step Three
Children’s Social Care acknowledges receipt of referral and decides on next course of action.
If the referrer has not received an acknowledgement within 3 working days contact
Children’s Social Care again.
Step Four
You may be requested to provide further reports/information or attend multi-agency
meetings
Who to contact in Children’s Social Care
Lancashire
Duty Social Worker (Mon – Fri 8.45am – 5pm) Tel 0300 123 6720
Emergency Duty Team (out of hours) Tel 0300 123 6720
Who to contact for local NHS advice:
Designated Nurse for Safeguarding
Children for the (-------------) Clinical
Commissioning Group:
Tel:
Who to contact in the Police Public Protection Unit
Tel: 0845 125 35 45 and request to speak to the PPU for
the area in which the person resides
In an emergency contact the police on 999
Staff should update their knowledge
by accessing regular training and be
familiar with local safeguarding
policies, including those of the Local
Safeguarding Children Board.
Possible signs and indicators of abuse
and neglect can be found overleaf.
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Appendix 6
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