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Nigel's surgery 33: Safeguarding children
We have updated this issue to include the intercollegiate guidance 'Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff'.
GP practices play an important role in safeguarding children and young people from abuse and neglect.
Safeguarding children and young people should be integrated into existing practice systems and processes for delivering general practice. This includes what we expect to see on our inspections. It relates to key line of enquiry S1: how do systems, processes and practices keep people safe and safeguarded from abuse?
The Department for Education published the updated version of Working together to safeguard children in July 2018. This is statutory guidance which helps professionals understand what they need to do, and what they can expect of one another, to safeguard children. It focuses on core legal requirements and makes it clear what individuals and organisations should do to keep children safe. Safeguarding children is defined as:
- protecting children from maltreatment
- preventing impairment of children’s health or development
- ensuring that children grow up in circumstances consistent with the provision of safe and effective care
- taking action to enable all children to have the best outcomes
Competence and training
All healthcare staff must be competent to recognise abuse, clearly understand their responsibilities and take effective action appropriate to their role. GPs and managers have a responsibility to ensure that all practice staff have the knowledge and skills to be able to meet this requirement.
When we inspect we need to see that GPs and all other practice staff can demonstrate their competence in safeguarding children and young people at risk.
Each practice should have a designated lead for safeguarding children and young people. This key role in the practice:
- promotes good practice
- provides advice and support for fellow staff
- makes sure that fellow staff are suitably trained in safeguarding
We need to see evidence that:
- the practice gives sufficient priority to safeguarding children
- staff take a proactive approach to safeguarding and focus on prevention and early identification
- staff take steps to protect children and young 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
The Royal Colleges give clear guidance about the appropriate competencies and levels of training in safeguarding children or child protection for different members of staff. The Royal College of Nursing published updated intercollegiate guidance Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff in January 2019.
The competency framework set out in the intercollegiate guidance identifies levels of competency ranging from level one to five (and board level). It also gives examples of which groups of staff fall within them.
- Level 1: All staff including non-clinical managers and staff working in healthcare services
- Level 2: Minimum level required for non-clinical and clinical staff who, within their role, have contact (however small) with children and young people, parents/carers or adults who may pose a risk to children.
- Level 3: All clinical staff working with:
- children, young people and/or
- their parents/carers
- and/or any adult who could pose a risk to children
- potentially contribute to assessing, planning, intervening and/or
- evaluating the needs of a child or young person and/or parenting capacity.
This is regardless of whether there have been previously identified child protection/safeguarding concerns or not).
This includes practice nurses.
- Level 4: Named professionals
- Level 5: Designated professionals
This updated intercollegiate guidance changes the level of competency indicated for practice nurses. We acknowledge that practice nurses will not immediately be able to achieve this competency but would expect to see that they were working towards level 3.
The Royal College of General Practitioners (RCGP) and The National Society for the Prevention of Cruelty to Children (NSPCC) Safeguarding children toolkit for general practice includes policies, legislation and supporting evidence. GPs and their teams can use this as a practical workbook .
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.
A mother visits with her 7-year-old daughter (patient N). N appears unkempt and is very dirty. During the examination, the clinician identifies bruising on the child’s face and neck. When asked about the bruising, patient N’s mother's response does not explain the cause. The clinician makes a referral to the local authority safeguarding children’s team.
Is statutory notification to CQC required?
No. The abuse:
- is not alleged to have occurred whilst the regulated activity was being provided (while at the surgery), and
- was not a result of the regulated activity.
Although we would not require a notification in this instance, the clinician must make sure that they follow the practice’s normal processes for safeguarding children.
Patient P visits his doctor with his child Q (a girl, aged 14). P is very upset and tells the doctor that the practice manager R has been contacting Q by telephone and tried to get to meet her. He has also written Q notes.
Is statutory notification to CQC required?
Yes. It is alleged that the abuse relates to one of the doctor’s employees and therefore relates to the doctor carrying on his regulated activity.
In our Safeguarding Handbook we clarify when we expect statutory notifications of abuse. See Appendix 10.
- Last updated:
- 04 September 2019