Intended for healthcare professionals

Rapid response to:

Feature Child Protection

After Baby P: can GPs follow child protection guidance?

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d707 (Published 02 March 2011) Cite this as: BMJ 2011;342:d707

Rapid Response:

Primary Care Child Safeguarding Forum response

Learner comments on the guidance available to doctors to help them
deal with the challenging area of Safeguarding Children and Young
People[1].

Specifically, she mentions five sets of guidance and claims that they
target General Practitioners. However, of the five guidance documents
which she cites [Working Together 2006, GMC 0-18years 2007, RCGP/NSPCC
Toolkit 2008, NICE Child Maltreatment 2009, BMA Toolkit 2009], only one -
the RCGP/NSPCC Toolkit - was specifically written by GPs for GPs. The
others offer guidance to very different groups: Working Together [first
written in 1989 and regularly updated since, most recently in 2010] is
statutory guidance for all agencies working with Children & Young
People. The NICE guidance is intended "to raise awareness and help
healthcare professionals who are not specialists in child protection to
identify children who may be being maltreated". The GMC and BMA guidance
[first produced in 2004] were both aimed at all doctors.

Learner raises the question of GP attendance at case conferences
without exploring the matter in detail. The majority of case conferences
are review conferences, for which a date may have been set 3-6 months
earlier, and notified in the minutes of the previous conference. The
remainder are convened urgently, and must be convened within 15 working
days [Working Together 2010]. Difficulties surrounding GP attendance have
been explored by Simpson et al[2] in the 1990's and Polnay[3] in 2000, and
suggestions for holding conferences in GP surgeries, or at times of day
which suit both professionals and families better may improve
participation. All guidance recommends that, whether or not doctors are
able to attend, they should send a written report, which is shared with
the child's family.

Dr Iona Heath PRCGP is quoted in the article expressing a desire to
be able to speak to senior social workers for advice; it may be that the
experience she seeks could be obtained better from Practice Safeguarding
Leads [recommended both in the RCGP Toolkit and in the Care Quality
Commission 2009 Report4] or from PCT Named Doctors and Nurses [recommended
in Working Together 2010].

Learner highlights the Care Quality Commission report in which lack
of level 2 training is mentioned[4], without balancing that with successes
in training, such as in Lincolnshire, where the Primary Care Trust has
commissioned 400 mandatory Level 3 training places for GPs and nurses in
2010/11, and a further 300 places for 2011/12. Half the courses have been
run at weekends to minimise impact on practice service commitment.

The article also raises questions about the changing role and
commission of Health Visitors: under reform proposals contained in the DH
Health Visitor Implementation Plan 2011-15, health visitors will work in
partnership with GPs, and commissioners may have a voice in deciding where
they should be based[5]. Health Visitors have a very different training
curriculum and skillset and, although they may communicate with and on
behalf of a GP, they cannot act as a substitute for them.

The most significant omission from the article is the lack of a wide
view of Safeguarding Children & Young People. Safeguarding must be
seen in the wider context of Child Health & multimorbidity: Ferguson
argues cogently that protection of children fits well with a Public Health
model of understanding[6]. The debate opened by Learner might more
productively be focussed on the continuing inequality illustrated by the
six-fold variance between highest and lowest prevalence of Children in
Need in England[7]. The protection of children, while it may involve GPs
centrally because of the enduring relationship between GP and family over
time and because of the comprehensive primary care record held by GPs,
needs a multi-agency solution involving public health professionals,
nurses, midwives and health visitors.

There needs to be a debate nationally on how the protection of
children from maltreatment is commissioned: at present, professionals are
expected to carry out their duty to safeguard in addition to their
everyday work. It is not a lack of guidance which currently hinders them;
it is a matter of resources.

Andrew Mowat FRCGP

1. Learner S. After Baby P: What next for GPs? BMJ 2011;342:d1015 [5
March]

2. Simpson CM, Simpson RJ, Power KG, Salter A and Williams GJ. GPs
and health visitors' participation in child protection case conferences
Child Abuse Review 1994;3: 211-30

3. Polnay JC. General Practitioners and child protection case
conference participation. Child Abuse Review 2000. 8:108-23

4. Care Quality Commission. Safeguarding Children: a review of
arrangements in the NHS for safeguarding children. 2009
http://bit.ly/eUaRbL
[accessed 11th March 2011]

5. Department of Health. Health Visitor Implementation Plan 2011-2015
http://bit.ly/hpXsQ8
[accessed 11th March 2011]

6. Ferguson L Proactive in Protection: A Public Health Approach to
Child Protection In Taylor J & Themessl-Huber M Safeguarding Children
in Primary Health Care 2009

7. Department for Education. Children in Need Census 2010
http://bit.ly/fhgO9G [accessed
11th March 2011]

Competing interests: AM is Managing Director of Mowat Medical Services Ltd, a company which delivers education and training in Safeguarding Children. JA and ID have been remunerated for teaching on MMS courses.

15 March 2011
Mowat
Past Chairman
Janice Allister, Danny Lang, Ian Dunn.
Primary Care Child Safeguarding Forum