SAFEGUARDING childREN:

SAMPLE POLICY, procedures and guidancefor general practice

June 2015

Please read these procedures in conjuction with theLancashire safeguarding children board multi-agency procedures (LSCB):

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.

Version Control

Title

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Safeguarding Children: SAMPLE Policy and Procedures for General Practice

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Version 1.0

Replaces

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Safeguarding Children Sample Policy for General Practice 2011.

Author/originator

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Pan – Lancashire Document – reviewed and revised by C Turner, BCCG

Recommended

/ Designated safeguarding children’s’ leads pan Lancashire

Equality Analysis

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Completed November 2014

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(Appendix One)

Circulation

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All GP Practices

Review

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June 2017

Acknowledgements

/ Jean Rollinson, Designated Nurse, CSR CCG
Sue Clarke, Designated Nurse BwD CCG
Julie Adesanya, Designated Nurse, Trafford CCG

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.

CONTENTS
Section / Page
1.0 / Introduction / 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
/ 8
8
  • GP Practice (including implementation of policy)
/ 8
  • All Doctors
  • GP
/ 10
11
  • Practice Safeguarding Children Lead
/ 11
  • Designated Professionals
/ 12
  • Individual staff members including all partners etc
/ 12
5.0 / Recognition of Abuse / 13
Definitions
6.0 / Safeguarding in Special Circumstances / 14
Children who are ‘Looked After’ by the Local Authority / 14
Child Sexual Exploitation / 15
Fabricated and Induced Illness / 16
Domestic Abuse (including MARAC) / 17
Honour Based Abuse/Violence / 18
Forced Marriage / 18
Female Genital Mutilation (FGM) / 18
MAPPA / 19
Private Fostering / 19
PREVENT / 19
Children who are not in school / 21
7.0 / What to do if you have concerns about a child’s welfare. / 22
Acting on current concerns / 22
Responding to a child who tells you about abuse / 23
What to do if a member of the public raises concerns / 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 / 25
Identifying potential safeguarding concerns / 27
12.0 / Creating a safe environment / 27
Safer employment / 27
Staff behaviour and professional boundaries / 27
Use of Internet, Mobile Phones and Electronic Equipment / 28
Inappropriate types of sites / 29
Managing allegations against staff/workers who have contact with children / 29
Whistleblowing / 30
Complaints / 30
Consent / 30
Serious Untoward Incidents / 30
Training / 30
Supervision / 30
13.0 / Safeguarding Processes
Common Assessment Framework (CAF) / 31
Domestic Homicide Reviews / 31
Serious Case Reviews / 31
Child Death Overview Panel (CDOP) / 31
14.0 / Reviewing the Practices Safeguarding Governance Arrangements / 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

1.0INTRODUCTION

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.

This local policy should be read in conjunction with the Lancashire Safeguarding Children Board multi-agency procedures (LSCB):

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.

2.0SAFEGUARDING CHILDREN POLICY STATEMENT

This policy and associated procedures demonstrate the commitment of the practice to ensure that throughout our workwe 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.

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:

  • Safeguarding Children and Young People. A Toolkit for General Practice 2014 (Royal College of General Practitioners & NSPCC)
  • Protecting children and young people. The responsibilities of all doctors. July 2012. (GMC)
  • Children and young people tool kit. Dec 2010. (BMA)
  • CQC registration Guidance for GPs. May 2012. (GPC, BMA).

3.0WHAT IS SAFEGUARDING?

A child is anyone who has not yet reached their 18th birthday.

In EnglandSafeguarding 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

3.1Significant 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.

3.2There 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 elementsas 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.

4.0ROLES AND RESPONSIBILITIES

4.1The 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.

4.2Children’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 responsibilityfor safeguarding children and promoting their welfare.

4.3The Practicerecognises 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.

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.

4.4Implementation 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 isexperiencing 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.
  • 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

4.5Responsibilities 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 toolkitaims 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
  • Best interests & disputes
  • Consent and refusal
  • Sexual activity
  • Child protection
  • Use of restraint
  • Compulsory treatment for mental disorder

4.6Role of the GP(part)