Safeguarding Children and Young People: The RCGP/NSPCC Safeguarding Children Toolkit for General Practice Enter contents >> Primary Care Child Safeguarding Forum Safeguarding Children and Young People: The RCGP/NSPCC Safeguarding Children Toolkit for General Practice Contents page Click box to go to section Foreword S1 The Toolkit 1 1.1 Objectives of the Toolkit 1 1.2 Introduction 5 1.3 Policy and Legislation 7 S2 Practice organisation 9 2.1 Practice policies and procedures 10 2.2 Role of the General Practice Lead(s) for Safeguarding Children and Young People 12 2.3 Practice records and coding 13 2.4 Training and Education for the Primary Healthcare Team 14 2.5 The Role of Regulators in inspecting General Practice Safeguarding Children arrangements 17 2.6 External Requests for Audits 19 2.7 Resources for Children, Parents, Carers, Survivors and the General Practice Team 21 S3 Working together with other Agencies 23 3.1 Information sharing (inter and intra agency) 26 3.2 The role of the Public Health Nurse in Safeguarding Children 28 3.3a Referral to statutory services: early help 30 3.3b Referral to statutory services: the Child in Need 31 3.3c Referral to statutory services: the Child at Risk of Significant Harm and the Child in need of protection 35 3.4 What comes after a Child Protection referral 37 3.5 Report writing in Child Safeguarding and Child Protection 38 3.6 Case conferences and recommendations 39 3. 7 Court Procedures relating to Children 42 3.7.1 The Child at Risk: Care proceedings 42 3.7.2 Marriage or Partnership breakdown 44 S4 Recognition, Presentation and Prevention 45 of Child Maltreatment in Primary Care 4.1 Presentation of Child Maltreatment in Primary Care 48 4.2 Prevention, Early Recognition and Early Intervention 54 S5 Parent, Carer and Family Risks 58 5.1 Exposure of children to domestic violence 60 5.2 Parental mental health problems 62 5.3 Parental or Carer substance misuse 63 5.4 Working with missing, non-engaging or hostile families 65 5.5 Multi-Agency Risk Assessment Conferences (MARAC) 66 5.6 Multi-Agency Public Protection Arrangements (MAPPA) 67 5.7 Domestic Homicide Review 68 Safeguarding Children and Young People: The RCGP/NSPCC Safeguarding Children Toolkit for General Practice Click box to Contents go to section page S6 Communication with children and families 69 6.1 Facilitating communication 70 6.2 How to manage disclosure 74 6.3 Barriers to disclosure and intervention 74 6.4 The role of the GP in managing disclosures of abuse 75 6.5 Working with parents 77 S7 Looked After Children (LAC) 80 7.1 Improving the Health of Looked After Children and Young People Leaving Care 81 7.2 Private Fostering 82 S8 Sexual Violence Against Children and 84 Young People 8.1 Child Sexual Exploitation 85 8.2 Female Genital Mutilation (FGM) 89 8.3 Forced Marriage 91 S9 Children in Special Circumstances 92 9.1 Children and Social Media 92 9.2 Gang abuse 93 9.3 Trafficking 94 9.4 Radicalisation as a form of abuse 95 9.5 Hidden Children 95 S10 Case Reviews 98 10.1 The Vulnerable Child and Family Meeting 99 10.2 Serious Incident Reviews and Root Cause Analysis 100 10.3 The Child Protection Review 100 10.4 The Child Death Review 101 S11 Commissioning Child Safeguarding 103 in the NHS 11.1 Safeguarding Children (and Adults): Responsibilities of NHS Commissioning Organisations 104 11.2 Case History: A Clinical Network 105 11.3 The role of the Named Safeguarding Children GP 106 S12 Adult Survivors and Disclosures of 108 Historical Abuse Safeguarding Children and Young People: The RCGP/NSPCC Safeguarding Children Toolkit for General Practice Click box to Contents go to section page S13 References 110 Downloadable Tools T1 Tips for Writing Practice Policies and Procedures T2 Specimen Safeguarding Policy for General Practice T3 Recommended Codes T4 Record Keeping Exercise for clinicians T5 Safeguarding Children Self-Assessment Tool T6 Reflective Tools 6a Child Registration 6b Record Keeping 6c Information Sharing for Child Safeguarding 6d Data Sharing Checklist 6e Section 11 Standards 6f Parental Risk Factors 6g Domestic Abuse 6h Serious Domestic Incident Meeting: When domestic abuse results in serious injury or death 6i Template for recording reflective Practice meetings on Child Protection Adverse Events such as Critical Incident Reviews, Serious Case Reviews and Sudden Unexpected Death T7 Specimen report for Section 47 Reports and Case Conferences T8 Specimen Form for Child Registration T9 Specimen form for vulnerable child leaving Practice T10 Named Safeguarding Children GP Skills, Competences and Role Description T11a Early Years Child Development T11 Poster Guide to Child Development T12 Information Sharing Poster T13 ChildSafe Trigger Tool T14 Health Visitor SAFER Tool T15 Responding to Domestic Abuse, Guidance for General Practices T16 Domestic Abuse Risk Assessment Tool for Named Safeguarding GPs T17 MARAC Toolkit T18 Brook Traffic Light Tool T19 Spotting the Signs of Sexual Exploitation: The BASHH proforma Safeguarding Children and Young People: The RCGP/NSPCC Safeguarding Children Toolkit for General Practice Foreword Children and young people are our future and it essential that we do whatever we can to ensure that they are safe and well. As the largest medical royal college in the UK, representing nearly 50,000 family doctors, the Royal College of General Practitioners (RCGP) is pleased to be again working in partnership with the NSPCC to update this essential toolkit to support GPs and their practices in managing this important duty. A quarter of a GP’s patients are under 19 years of age and more children and young people are seen in general practice than in any other part of the health service. As the world changes, our children and young patients increasingly become exposed to new and different risks to their health and well-being. This update comprehensively collates emerging and existing guidance in one place to ensure that general practices across the UK can operate an environment in which all staff feel confident in all their dealings with children and young people. It will also reassure parents, carers and our partner agencies that general practice teams are as up to date as they possibly can be with the latest developments in safeguarding and assure them of our total commitment to promoting the safety and welfare of children and young people. The toolkit is supported by the RCGP training curriculum that all potential GPs of the future must follow, as well as the RCGP Child Health Strategy 2010–15 and the Intercollegiate Guidelines (ICG) for Safeguarding Children and Young People 2014. The health of our young patients is a priority for the RCGP – yet only half of our trainee GPs currently get the opportunity to undertake a specialist paediatric placement during their training. We are currently campaigning to extend GP training from three to four years, with a particular focus on child health and mental health. The latest version of this toolkit adds further weight to our case for why this is necessary and so crucial. Dr Maureen Baker Chair, RCGP Disclaimer This [document] is a public resource of general information and not advice relating specific issues of its [readers]. It is intended, but not promised or guaranteed, to be correct, complete, and up-to-date at the time of its publication. The Royal College of General Practitioners does not warrant, nor does it accept any responsibility or liability for, the accuracy or completeness of the content or for any loss which may arise from reliance on information and material contained in this [document]. August 2014 < Back to main contents Safeguarding Children and Young People: The RCGP/NSPCC Safeguarding Children Toolkit for General Practice S1 The Toolkit Click box to page go to section 1.1 Objectives of the Toolkit 1 1.2 Introduction 5 1.3 Policy and Legislation 7 ‘Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health’ Sir Michael Marmot (2010) Fair Society, Healthy Lives 1.1 Objectives of the Toolkit This Toolkit aims to provide Practices in the UK with a framework for integrating safeguarding children and young people into existing practice systems and processes for delivering primary care. This is not intended to be a textbook of child safeguarding but a practical workbook for busy GPs and their teams, designed to help Practice staff to recognise when a child may be at risk of abuse, to know what to do if there are concerns and to ensure that as a Practice the team works with other disciplines and agencies to achieve the best possible outcomes for children by safeguarding and promoting their welfare. This 2014 update takes account of new policies, legislation and emerging evidence as well as the constraints of the 10 minute consultation and the pressures of 21st century general practice. It will help ensure that general practices across the United Kingdom operate a safe environment, in which staff possess the knowledge and skills to be comfortable working with children and young people and will reassure parents, carers and our partner agencies that general practices are committed to improving outcomes for children and young people. The Toolkit is devised to support GPs to improve outcomes for children and families by bringing together relevant guidance and information, focusing on good medical practice and signposting to existing safeguarding statutes, policies and tools. There is emphasis on the strong evidence base (Marmot 2010, Allen 2011) which supports the benefits of early identification of adverse factors and early intervention to improve life course. Most families are registered with a General Practice which gives GPs and their Teams a crucial role as possibly the only professionals in a position to identify emerging problems, unmet need and vulnerability in parents and families and to readily engage with pregnant women, infants and pre-school children in need of extra support or recognised as being at risk.