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Nigel's surgery 25: Safeguarding adults at risk
We have updated this issue to include information about the intercollegiate guidance 'Adult safeguarding: roles and competencies for health care staff' and updated one of the examples.
We are sometimes asked about our expectations for training in safeguarding adults at risk for people working in GP practices.
The support GPs offer their patients often extends beyond narrowly defined health needs to include wider welfare considerations. This is particularly important where they see those adults most at risk, either in their own homes or in a care home. This relates to key line of enquiry S1: how do systems, processes and practices keep people safe and safeguarded from abuse?
What to expect on inspection
When we inspect we need to see that all practice staff can demonstrate their competence in safeguarding adults at risk. They need to:
- demonstrate their understanding of the definition of an adult at risk and the types of abuse they may be subject to
- show awareness of the internal arrangements for recording a safeguarding adult concern and how this is included within the practice’s safeguarding adults policy
- show awareness of the external process for reporting the concern and how this is in line with local multi-agency policies and procedures.
Each practice should have a designated lead for safeguarding adults at risk. They should be aware of the respective safeguarding adults leads within the local clinical commissioning group (CCG) and the local authority safeguarding adults team.
We need to see evidence that:
- the practice gives sufficient priority to safeguarding adults at risk
- staff take a proactive approach to safeguarding and focus on prevention and early identification
- staff take steps to protect people where there are known risks, respond appropriately to any signs or allegations of abuse, and work effectively with other organisations to implement protection plans
- there is active and appropriate engagement in local safeguarding procedures, and effective work with other relevant organisations
Legislation and guidance
The Care Act (2014) clarifies expectations about safeguarding adults training.
Staff induction training should include awareness of how to identify an adult at risk of actual or potential abuse and how to report it. The Act requires safeguarding adults boards to make sure they work with their relevant partners, including CCGs, to provide this training. Practices must make sure that all staff have the appropriate level of competence for their role. Formal face-to-face training is one way that practice staff can develop their knowledge.
The Act notes that staff governed by professional regulation should understand how their professional standards and requirements underpin their roles to prevent, recognise and respond to abuse and neglect:
- for GPs, the General Medical Council (GMC) ‘Good medical practice code’ (2013) stresses the need for doctors to protect patients and take prompt action if “patient safety, dignity or comfort is or may be seriously compromised”.
- The Royal College of General Practitioners (RCGP) launched a toolkit for Safeguarding Adults in 2017.
- for nurses, the Nursing and Midwifery Council (NMC) code states that they must disclose information if they believe someone may be at risk of harm.
Intercollegiate guidance Adult Safeguarding: Roles and Competencies for Health Care Staff was published in August 2018. This sets out:
- A framework to support practitioners, employers and commissioners to understand the role and level of education and competence awareness for specific roles/job purposes.
- The minimum training requirements staff should complete. It acknowledges that not all staff will be able to access the training within the first year of publication, but expects that staff will be trained to achieve the appropriate competencies by 2021.
The competency framework set out in the intercollegiate guidance specifies six levels/competencies:
- Level 1: All staff working in health care settings; for example, receptionists and administrative staff.
- Level 2: All practitioners who have regular contact with patients, their families or carers, or the public; for examples, phlebotomists.
- Level 3: Registered health care staff working with adults who engaging in assessing, planning, intervening and evaluating the needs of adults where there are Safeguarding concerns (as appropriate to role); for example general practitioners and registered nurses.
- Level 4: Specialist roles – named professionals.
- Level 5: Specialist roles – designated professionals.
- Board level: Chief executive officers, trust and health board executive and non-executive directors/members, commissioning body directors.
For child safeguarding or child protection there is clear guidance from the Royal Colleges about the appropriate competencies and levels of training for different members of staff. See Nigel's surgery 33: Safeguarding children.
Notifying CQC of safeguarding incidents
Not all referrals the practice makes to the local authority need to be notified to CQC. Practices are only required to notify CQC of safeguarding incidents where the allegation of abuse is linked to their provision of care.
Ms L visits for treatment because of a cut on her cheek and bruising to her eye. She tells the doctor that her partner has hit her.
Is statutory notification to CQC required?
No. It is not alleged that the abuse relates to the doctor carrying on his regulated activity. However, the doctor must follow his practice’s normal processes for safeguarding adults and domestic abuse.
Patient G, an older patient with dementia, attends the practice and needs an injection. On seeing the needle, she becomes highly agitated. The nurse attempts to calm the patient, but when that fails, forcibly restrains her to allow the injection. Patient G’s arm is bruised. Her son makes a formal complaint to the practice manager.
Is statutory notification to CQC required?
Yes. It is alleged that the abuse was committed by a member of staff at the practice during the carrying on of a regulated activity. You should notify us even if the abuse is alleged and not yet proven to have taken place.
You must notify us as soon as possible.
In our Safeguarding Handbook we clarify when we expect statutory notifications of abuse. See Appendix 10.
- Last updated:
- 03 July 2019