PUBLIC ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice This document is uncontrolled once printed. Please check on the Trust’s Intranet site for the most up to date version. Safeguarding Children Standards in General Practice 0-18 years Version 1.5 Issue Date 18.3.2012 Last Review 7.10.15 Next Review 7.4.2016 Impact Assessed Yes Document Owner Job title: Named GP for safeguarding Name: Dr Alison Davidson Email: [email protected] Lambeth CCG Lower Marsh Initial approval by & date Lambeth Clinical Commissioning Collaborative Board (LCCCB) 7.03.2012 Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 1 of 31 File Pathway: Issue date: Review date: Version No: PUBLIC ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice Document control Change History Version 0.1 Date 6.10.2011 Author Frances Wedgwood Frances Wedgwood Frances Wedgwood Frances Wedgwood Frances Wedgwood Frances Wedgwood Frances Wedgwood Alison Davidson /Avis WilliamsMcKoy Approver Reason New Policy 0.2 19.10.2011 0.3 14.11.2011 0.4 19.01.2012 1.0 07.03.2012 1.1 03.09.12 1.2 09.07.2013 1.3 4.4.2014 1.4 11.5.14 Alison Davidson Signs of Safety Template for Child Protection Conferences 1.5 7.10.15 Alison Davidson READ codes added for FGM and LAC Links to MARF form added Updated training schedules Updated referral contacts CRB updated to read DBS CRB section amended Additional appendices added LCCCB Changes as advised by LCCCB Final Version Case conference template adjusted Additional appendices added Additions to CO and RK sections in light of SCR H Filename Safeguarding Children Standards in General Practice Location S:\Lambeth BSU\CorporateAffairs\Governance\Safeguarding\ childrens\Lambeth policies Superseded documents None Changes summary Contact details As set out above Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 2 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 3 of 31 File Pathway: PUBLIC Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice PUBLIC Contents: Document control ............................................................................................................................. 2 Change History 2 1.0 Introduction & Background .................................................................................................... 4 1.1 Document statement and aim ................................................................................................. 5 1.2 Background ............................................................................................................................ 5 2.0 Scope of document ............................................................................................................... 5 3.0 Roles and responsibilities ...................................................................................................... 5 3.1 Named GP for Safeguarding ............................................................................... 5 3.2 Safeguarding Children Practice lead ................................................................... 6 3.3 All other practice staff .......................................................................................... 6 4.0 Safeguarding standards ........................................................................................................ 7 4.1 Registration procedures ...................................................................................... 7 4.2 Employment......................................................................................................... 9 4.3 Summarising...................................................................................................... 10 4.4 Record-keeping ................................................................................................. 11 4.5 Communication.................................................................................................. 13 4.6 Training.............................................................................................................. 14 5.0 Audit and monitoring criteria ................................................................................................ 15 6.0 Statement of evidence/references ....................................................................................... 16 7.0 Implementation and dissemination of document ................................................................. 16 8.0 Associated Documents and Information .............................................................................. 17 8.1 Parental responsibility...................................................................................................... 17 8.2 Information and guidance about requesting identity ........................................................ 18 8.3 Recommended safeguarding children READ Codes ....................................................... 19 8.4 Information sharing .......................................................................................................... 20 8.5 Sample Common Assessment Framework (CAF) form ................................................... 20 8.6 Guidance from NHS about CRB/DBS checks .................................................................. 20 8.7 Lambeth Safeguarding Team: Contacts and MARF form for referrals Error! Bookmark not defined. 8.8 Literature and Useful websites .......................................................................................... 21 9.0 Appendices.......................................................................................................................... 22 Appendix 1 Template for requests for information from social care ...................................... 23 Appendix 2 Template for case conference reports (Signs of Safety) ..... Error! Bookmark not defined. Appendix 3 Summary of Training schedule for Lambeth GPs…………………………………28 Appendix 4 Equality & Equity Impact Assessment Checklist ................................................ 30 Appendix 5 Consultation History ………………………………………………………………….30 Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 4 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice 1.0 PUBLIC Introduction & Background 1.1 Document statement and aim This document is based on the safeguarding Standards document originally produced in Lewisham by Dr Judy Chen, named GP for Safeguarding Children in Lewisham. It sets out clinical and administrative procedures which draw from published evidence and guidance as well as recommendations from local and national Serious Case Reviews. Although it is not a contractual requirement to follow them, it represents good practice for staff training, practice procedures, communication, information-sharing and record-keeping and practices are strongly encouraged to implement them. It assumes each practice has a Safeguarding Practice Lead (to be known as the practice lead – see section 3.2) who will ensure implementation of these Standards. In this document, children are defined as those aged 18 and below and for those with a learning disability, this extends to 25 and below. 1.2 Background Lambeth continues to have a growing population which includes many vulnerable children and families. There has been a steady increase in safeguarding activity across all areas of work since 2008 – the baby Peter effect. In particular the number of children subject to a Child Protection Plan has risen by 14% in 2010-2011. Neglect continues to be the category with the highest number of children. In addition, domestic violence and abuse (DVA) is a huge problem in Lambeth • Home Office estimates 6,439 women and girls in Lambeth (over 16 years) will have experienced domestic violence in the last year • 5000+ incidents of DV reported to the Police in 2010/2011 • 1000+ victim referrals to the Lambeth Gaia DV centre in 2010/2011 • There were 25 murders associated with DVA in London in 2010/2011, of which 2 murders were in Lambeth 2.0 Scope of document The publication of the Munro report in April 2011 with its emphasis on early intervention focuses the need of general practice to demonstrate robust standards. Many aspects of good practice in safeguarding start with robust administrative as well as clinical procedures and routines. Thus, in Lambeth, we have developed The Standards for Safeguarding Children in General Practice (to be known as The Standards) which covers a wide range of good practice, training and audit. This policy is relevant for all staff in general practice that have any kind of patient contact, including those involved in the administration of patient records. Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 5 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice 3.0 PUBLIC Roles and responsibilities 3.1 Named GP for Safeguarding The purpose of the named GP is to promote the care of vulnerable individuals both children and adults within all commissioned services and within general practice in particular. This is a new post that combines the previous post of named GP for child protection and the Primary Care Clinical Lead for safeguarding adults. It is based at NHS Lambeth and works closely with individual practices and primary care managers to improve safeguarding arrangements through training and facilitating the dissemination of best practice. Additionally the named GP will provide clinical advice and professional judgement on safeguarding issues. 3.2 Safeguarding Children Practice lead Each GP practice is responsible for ensuring they have a Safeguarding Children Practice Lead (to be known as the practice lead). This individual is responsible for ensuring there is an agreed standard of safeguarding children processes within each practice which will reduce risks to their registered child population. The Practice lead should be a GP, with some standing within the practice. In addition they should be available for training up to Level 3 as set out in the Intercollegiate Document Safeguarding children and young people: roles and competences for health care staff – Sept 2010 (1) The practice lead is responsible for the following: 1. Ensuring that all of the practice staff are trained in accordance with the Intercollegiate Document. 2. Ensuring that all staff are aware of The Standards for Safeguarding Children in General Practice and to ensure its implementation. 3. Awareness of all safeguarding issues and queries within the practice. This does not necessarily mean he/she deals with every child protection case as this is best dealt with by the usual doctor/nurse, but the Practice Lead will have been informed of the case and will be able to oversee and advise. 4. Ensuring that medical records of those families with safeguarding issues are kept updated and reviewed on a regular basis. 5. Working collaboratively with the Named GP for Safeguarding Children and perform audits on the Standards in line with recommendations to be made by the Named GP for Safeguarding Children 6. Cascading any information relevant to Safeguarding Children to the rest of the practice. 3.3 All other practice staff All other practice staff members are responsible for the following: 1. Attending relevant safeguarding training 2. Liaising with practice lead as relevant 3. Implementing the standards within this policy, including monitoring requirements Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 6 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice 4.0 PUBLIC Safeguarding standards 4.1 Registration procedures Principles 1. All children registering with the practice should have an adult with parental responsibility (see section 8.1) registered with them. However, do not decline to register a child if there is no-one with parental responsibility who can register as it is generally safer to register first and then seek advice from the Safeguarding Practice Lead and Practice Manager. This situation may alert you to a private fostering arrangement and, potentially, a trafficked child. 2. Children who are in a private fostering arrangement are more vulnerable to abuse. All private foster carers who look after a child for longer than 28 days need to be formally assessed for suitability by Children’s Social Care and need to be referred to them (1). 3. Although there is no requirement to confirm the identity of people wanting to register with a practice and practices cannot turn people away if they do not have sufficient ID evidence available, for purposes of safeguarding children, it is important that you make every effort to confirm the identity of those registering the child and their relationship to that child (2) (see case study below, and associated notes). 4. As much information as possible about the child’s household should be collected at registration. Adults and older adolescents living with the child have an impact on the care of the child, either in a positive way by providing support and resource within a household, or in a negative way if they pose a threat to the safety of the child. 5. Knowledge of where the child attends school is useful when information-sharing is required, and to know that a child is registered at a school. 6. The health visiting team should be informed of all newly registered children 5 years and below. A 4 year old boy attended to see a GP and the adult accompanying said she is his aunt. The GP verified her name and noticed from the child’s registration documents that she had put herself down as his mother. When asked she said he had been with her for 2 years and that his parents were in Sierra Leone. The GP discussed her duties to register as a private fosterer and advised that a referral had to be made for an assessment to Children’s Social Care. When the GP spoke to the social worker, it was apparent that the stories were inconsistent and the social worker decided to allocate the case for further investigation. Case Study 1 Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 7 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice PUBLIC Standards RP 1 Do not turn away families who cause concern. When there is a discrepancy arising during registration which causes concern, register first and then take advice from the Practice Lead. RP 2 The identity of both the adult registering and that of the child should be verified e.g. with a photo ID of the adult and birth certificate of the child. Failure to produce ID at the point of registering, while a concern that needs to be brought to the attention of the practice lead, should not be a barrier to registration. Seek to verify ID at the earliest possible opportunity. See section 8.1 and 8.2 for further information RP3 The adult registering the child should have parental responsibility (PR) for the child. If there are no adults with PR, register the child first but this needs to be brought to the attention of the Practice Lead. (2) RP 4 When children or adults have their notes requested because they have registered elsewhere, there should always be a check to see if the relevant carer or child is still registered or not and if they are still registered, then this needs to be flagged up in the records and passed to the attention of the Practice Lead. RP 5 Information collected at the time of registration should include all adult members and all children of the household, and whether the child has a social worker. RP 6 The address of the whole household should match exactly when entering details electronically so that all members of the household appear together when requested. RP 7 The child’s school (if school age) should be recorded on the electronic record. RP 8 The linked Health Visitor should be informed of all children registered who are 5 years and below. Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 8 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice 4.2 PUBLIC Employment Principles 1. Most practice staff have a privileged position in that they have access to confidential medical records and many work directly with patients. It is the responsibility of the Practice Providers to ensure their patients are safe. Good employment practice will go some way to ensure patients’ safety, particularly as patients rely on a trusting relationship with their GP surgery. 2. CRB/DBS checks provide some information on staff but these do not include past allegations if they did not lead to criminal proceedings. Standards EMP 1 All staff with any patient contact should be DBS checked at least once on joining the practice (3). EMP 2 Any disclosures as a result of DBS checks must be discussed with all Partners of the Practice and a decision made about continuing employment of the individual. This information has to be shared with NHS Lambeth if the staff member is a GP or Practice Nurse. EMP 3 Each Practice should have a Whistle-blowing policy and all staff should know what to do when concerns arise about a staff member or partner. All concerns must be fully recorded, together with actions taken, timescales, outcomes and review dates. In small practices, a clear route of reporting (to an external body if necessary) needs to be in place and all staff must be aware of it. EMP 4 The Practice must ensure all staff are familiar with Data Protection and Confidentiality issues and have a method of verifying this. EMP 5 The Practice must ensure all staff are familiar with the Chaperone Policy and have a method of verifying this. Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 9 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice PUBLIC 4.3 Summarising Principles 1. Well summarised records give a clear historical picture of the patient and ensure important information found in patient records is not lost when transferring between practices. Relying on previously summarised records is insufficient. 2. Ensure important child protection risk factors or history are transferred appropriately using recommended safeguarding READ codes and that this can easily be found on the summary page. 3. When doing reports for social services when there are concerns about a child, it is beneficial to have well summarised records. It is also recommended to look through all paper records to see if there may be relevant information not available on the electronic records. A newly registered family consisting of a woman and 3 children are noted by the practice summariser to have case conference minutes in the mother’s records but not in the children’s records. The children are noted to be on the at risk register in 2005 for neglect. There are 3 case conference reports dated 2001, 2002 and 2006. There are no further indications of how the concerns were dealt with or when the children were taken off the register. The summariser makes contact with the previous GP but they have no further information. She brings the case to the Safeguarding Practice Lead who suggests contact with Social Services to get further details. The children’s notes are coded using the recommended list of Safeguarding Children READ codes. Case Study Standards SU 1 GP2GP records should be checked by the summariser following practice protocol after it has been downloaded onto the recipient computer and when paper records are received. The code Notes summary on computer (9344) should only be entered after the Practice’s own summariser has summarised the records according to the protocol. SU 2 The summariser should pass records to the Practice Lead which contain Safeguarding Children READ codes or information which are important for safeguarding e.g. domestic violence, long-term mental illness or drug and alcohol dependency in a family with children. The information should also be passed to the health visiting team for children aged 5 years and below. SU 3 If the child is known to have a social worker, or the child is Looked After then the notes should be requested and summarised urgently. SU 4 It is suggested that summarised notes should audited regularly by the Practice Manager or clinical lead to ascertain that the notes have been summarised according to protocol. Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 10 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice 4.4 PUBLIC Record-keeping Principles 1. Many serious case reviews recommend better record-keeping. 2. Good record-keeping passes important information to the next healthcare professional looking after the patient. 3. Good record-keeping ensures that all aspects of the encounter have been recorded. If it is not written down, it did not happen. 4. A comprehensive and accurate record will help the practitioner when the patient’s care is scrutinised for whatever reason. 5. Be as accurate as possible in recording and do not make flippant or subjective remarks. Ensure records state whether the observations made are fact, impression or reported by the patient or a third party. Information in the medical records of any adult which may be a risk factor for child abuse e.g. severe long-term mental illness, drug and alcohol dependence, domestic violence, or a forensic history should alert the clinician to enquire about dependent children in the household. Similarly, the records should be looked at when you receive a Casualty letter about a child, particularly if it is about an injury or untoward event, or a DNA letter from Paediatrics Outpatients. If any encounter with a family makes you concerned, a quick look through the records and those of other family members gives you a fuller picture of the child and family. Standards RK 1 The recommended list of Safeguarding Children READ codes (see Section 8.3) should be known to all relevant practice staff and used consistently. This will ensure the Practice develops a register of vulnerable families. RK 2 The Practice Lead should review all records with Safeguarding Children READ codes every 3 months to update codes and review safeguarding issues. RK 3 All clinicians are aware of good practice in comprehensive and accurate record-keeping (4). RK 4 The relationship of the adult accompanying the child should be recorded (5). RK 5 The adult with parental responsibility giving consent for immunisations must be recorded, to include their name and relationship to the child (6). RK 6 The full set of case conference reports should be scanned into all affected children’s records and parents’ or carers’ records, under appropriate READ Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 11 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice PUBLIC codes*. The paper copies are kept in all the affected children’s paper records and parent’s or carer’s paper records, if these are mainly used. For practices mainly using electronic records, these reports must be printed out and included in the paper records when notes are transferred to the new practice (8). *For those practices where patients are allowed full access to their records or their children’s records electronically, it will suffice to scan in a brief summary of concerns and the list of action points and conclusions of the case conference, taking care to avoid identifying third parties. RK 7 The Practice should have a method of identifying records in which there are case conference reports as there will be third party information present which will need to be removed in the event these records are requested by patients. By using recommended Safeguarding READ codes this should be achieved. RK 8 The Practice should have a DNA policy which sets out a method of highlighting letters which indicate a child has not attended (DNA) for specialist review, and a system of follow-up (9). RK 9 The Practice should have a method of highlighting A&E attendances of children which may be of significance for safeguarding, and a system of follow-up and communication with the Health Visiting team for children below 5. RK 10 Meetings with health visitors should be minuted as they occur and the children’s, parents and carers clinical records updated accordingly. Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 12 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice 4.5 PUBLIC Communication Principles 1. Many serious case reviews recommend improved communication between and within agencies (10). Sharing information is vital to build up a picture of a child and family and this is necessary in order to support a family as well as safeguard the child. 2. Verbal communication is as important as written communication but all conversations should be recorded carefully afterwards. 3. Familiarity with the principles of information sharing in the context of the Data Protection Act will help healthcare workers decide when and how to share information(11). There was a consistent failure by doctors and nurses at both hospitals to record information comprehensively, to record and share concerns, and to record and complete the actions that the concerns prompted. Worst of all, nobody noticed when things were not being done. Extract from Victoria Climbie Inquiry Report, Lord Laming, 2003. Standards CO 1 The Practice has a policy on how to handle requests from outside agencies asking to share information about vulnerable children. Requests from Children’s Social Services should always be in writing (see fax proforma in Appendix 1). Further guidance on Information sharing is available at Section 8.4. CO 2 The Practice is represented at case conferences concerning children registered with the Practice, or if unable to attend, would send a report (even if this is to report that the Practice holds no relevant information). See Appendix 2. CO 3 All clinical staff are aware of how and when to refer to Children’s Social Care and when to expect feedback from their referral (12). See link to MARF form p21 CO 4 When making a referral to secondary care or community services, safeguarding concerns should be mentioned (13). CO 5 The Practice informs their practice population of their information sharing policy with regards Safeguarding Children. CO 6 The Practice meets with their linked Health Visitor to discuss vulnerable families every 6 weeks (14,15). CO 7 Independent telephone interpreters should be used if interpreters are needed and use of an interpreter should be recorded in the notes. Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 13 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice CO 8 4.6 PUBLIC Patients that require interpreting services should be flagged and preferred language recorded. Training Principles 1. All doctors working with children, parents and other adults in contact with children should be able to recognise, and know how to act upon, signs that a child may be at risk of abuse or neglect, both in a home environment and in residential and other institutions (16, 17).This is extended to all practice staff working in contact with patients. 2. A lack of awareness of child protection issues is a major factor in poor outcomes in many serious case reviews (18, 19). Standards TR 1 The Practice must be aware of NHS Lambeth’s Safeguarding Children Training Strategy (see appendix 3) and should implement the Strategy for all current and new staff. All GPs and Practice Nurses should be trained to Level 3, HCAs with clinical contact to Level 2 and all other staff to Level 1 (1). TR 2 The Practice should have a copy of the pan London Child Protection Policy and Procedures and ensure that all staff have access to it. TR 3 The Safeguarding Children Practice Lead should cascade any information received about Safeguarding Children to all relevant practice staff (see roles and responsibilities) TR 4 The Practice Lead should attend regular updates and group mentoring with the Named GP for Safeguarding Children. Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 14 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice 5.0 PUBLIC Audit and monitoring criteria Document Audit and Monitoring Table Monitoring requirements *What in this document do we have to monitor ( e.g. processes) Note specifically any monitoring needed to assure equality and equity of delivery Monitoring Method: (e.g. statistics, report) Monitoring prepared by:(name job titles) a) safeguarding training to the appropriate level b) regular meeting between the safeguarding leads and the Named GP c) practice visits by named GP on an annual basis a) Training report b) Audit by practice lead as directed by named GP a) Named GP for safeguarding b) Primary Care team Monitoring presented to:(e.g. Committees) a) Lambeth NHS Safeguarding Committee Meeting b) LCCCB Frequency of presentation:(e.g. annually, six-monthly etc) a) Annually Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 15 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice 6.0 PUBLIC Statement of evidence/references 1. The Intercollegiate Guidance Safeguarding Children and Young People: Roles and Competences for Health Care Staff April 2010 2. London Child Protection procedures, 2007, Section 5.34 3. Criminal record Checks: NHS Employers. Jan 2011 4. Serious Case Review J and L Executive Summary, London Borough of Lewisham, 2009: recommendation no.4.3.27 5. GMC, Good medical Practice, 2006. 6. Serious Case Review J and L Executive Summary, London Borough of Lewisham, 2009: recommendation no. 4.3.27 7. Serious Case Review J and L Executive Summary, London Borough of Lewisham, 2009: recommendation no. 4.3.27 8. Laming Report, Recommendation No. 78: Within a given location, health professionals should work from a single set of records for each child. (paragraph 11.39) 9. Serious Case Review K, London Borough of Lewisham, 2009, Health recommendation. 10. Beyond Blame: Child abuse tragedies revisited. Reder, Duncan, and Gray, 1993. Routledge. 11. Information Sharing: Guidance for Practitioners and Managers, DSCF, 2008 12. London Child Protection procedures, 2007, Section 4.5.6 13. Review of the involvement and action taken by health bodies in relation to the case of Baby P, Care Quality Commission, May 2009 14. Serious Case Review C, London Borough of Lewisham, 2009, Health recommendation. 15. CQUIN scheme - Effective communication between community and primary care, Lambeth and Southwark community Services, 2011-2012 16. Children Act 2004, Section 11. 17. GMC guidance 0-18 Guidance for Doctors 18. Serious case review K, London Borough of Lewisham, 2009, Recommendation Health no. 7 19. Beyond Blame: Child abuse tragedies revisited. Reder, Duncan, and Gray, 1993. Routledge 7.0 Implementation and dissemination of document The policy will be shared with all Lambeth practices via the safeguarding leads, highlighted via the GP bulletin and made available on the Lambeth intranet. In addition, training and discussion of The Standards will form an essential part of future training, aiding the implementation and dissemination of this policy. Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 16 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice 8.0 PUBLIC Associated Documents and Information 8.1 Parental responsibility What is parental responsibility? Parental responsibility (PR) is where an adult is responsible for the care and well-being of their child and can make important decisions about the following points for example: food, clothing, education, home, medical treatment. Who has parental responsibility? A married couple who have children together both automatically have parental responsibility. Parental responsibility continues after divorce. Mothers automatically have parental responsibility. Where the parents are not married, the unmarried father has parental responsibility if: His name is registered on the birth certificate - this is the case for births registered after 1 December 2003. Fathers can re-register if their names have not been placed on the birth certificate before this date. He later marries the mother. Both parents have signed an authorised parental responsibility agreement. He obtains a parental responsibility order from the court. He obtains a residence order from the court. He becomes the child's guardian. Others, such as grandparents and step parents, do not have parental responsibility. They can acquire it by: Being appointed as a guardian to care for a child if their parent dies. Obtaining a residence order from the court for a child to live with them. Adopting the child. FOSTER CARERS DO NOT HAVE PARENTAL RESPONSIBILITY Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 17 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice PUBLIC 8.2 Information and guidance about requesting identity Standards RP1, 2 and 3 relate to registration of patients and requests from patients for proof of identity. During discussions with clinicians there has been a lot of concern that this standard may be discriminatory and deter some patients from registering. The GMC have provided the following guidance. “Our advice on decisions about access to medical care is set out in paragraphs 7-10 of Good Medical Practice. This section makes clear that all patients are entitled to care and treatment to meet their clinical needs (paragraph 10). Whatever approach is taken to register patients, doctors must ensure that patients’ immediate healthcare needs are addressed.” Olivia Stapleton, Policy Officer, Standards & Ethics Section, GMC (Feb 2011) GMC Good Medical Practice states: Para 10. All patients are entitled to care and treatment to meet their clinical needs. You must not refuse to treat a patient because their medical condition may put you at risk. If a patient poses a risk to your health or safety, you should take all available steps to minimise the risk before providing treatment or making suitable alternative arrangements for treatment. *This includes your views about a patient's age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status. This guidance does not discuss the ethics of asking for patient identification but simply confirms the need for all patients to be treated without prejudice. RP1 confirms this principle. There is some confusion about providing good, non-discriminatory access to clinical care and asking patients to verify their identity. RP1 makes clear that patients who cause concern should always be registered first and concerns brought to the attention of the Practice Manager or Safeguarding Children Practice Lead. Verifying patient identity is important in safeguarding children because of the significant problem of child trafficking, private fostering and missing children. The following extracts provide advice and guidance on patient registration and what steps can be taken to verify identification: Practices may use their discretion as to whether to accept or decline a person’s application. If an application is declined, the practice must have reasonable grounds which do not relate to a person’s age, race, gender, social class, religion, sexual orientation, appearance disability or medical condition. When considering applications, practices may ask for proof of identity and address (for example a passport and utility bill) but in doing so must act in a non-discriminatory way. GP Registration, Department of Health Guidelines, 18.10.10 However there is clearly room for more clarity on registration and NHS Lambeth have asked the department of primary care within NHS SE London to look into this. Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 18 of 31 File Pathway: Issue date: Review date: Version No: PUBLIC ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice 8.3 Recommended safeguarding children READ Codes The following codes should be used within practices where possible. Recommended codes filed under Significant Active Problems: For children who are deemed to be vulnerable* 13IF-1(Vulnerable child) For the family members of that child 13IQ (Vulnerable child in family) For children with a protection plan 13Iv (subject to child protection plan) – preferred code or 13IM (child on protection register) For parents or siblings of child with protection plan Looked After Child FGM Family History of FGM 13Iy (family member subject to child protection plan) 13IB1 K578 12b *A child would be thought to be vulnerable to harm if there are 1 or more features in the child or the family which are known risk factors for abuse. These factors do not mean necessarily that the child is at risk but they alert professionals to be more vigilant. These risk factors include domestic violence in the family, mental illness affecting the carers, drug or alcohol abuse affecting the carers, frequent non-attendance for child or parent, poor immunization record, child or parent disability, families needing additional health visiting, past or current involvement with social services for safeguarding issues. Children with a protection plan should have both Vulnerable child code (13IF-1) as well as 13Iv/ 13IM codes as active significant problems. A brief description of the reason e.g. neglect, emotional abuse, should be put into the text. After the child has come off the protection plan, the Vulnerable child code should remain on the records as Active Significant Problem for at least 1 year and then moved to Significant Past problem thereafter if there are no further concerns. All family members should have 13IQ code for the same period. The 13IF-1 and 13IQ codes should be reviewed regularly to see if they need to remain filed as Active or to be moved to Past Significant problem. It is recommended that a list of patients with these codes be printed every 3 months and their records reviewed. Case conference reports These should be scanned onto all affected children’s records under the READ code 13Iv or 13IM as Problem Title, so that there is continuity under that problem title. Under “Additional”, use READ code 64c (child protection procedure) to locate case conference notes. The case conference reports should also be scanned into parents’ or carers’ notes. The paper copy should be copied into all affected children’s paper Lloyd George records (or when the records leave the practice, the scanned case conference reports should also be printed out). Contacts with Social Services Referrals to Social Services 8HHB (referral to social services) Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 19 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice PUBLIC Reports sent to social services 9b0k (social services report) Both of these codes to be filed under “Additional” and under 13IF-1 or 13IQ codes in the Problem Title. For children in Need who have a Common Assessment Form (CAF) Use Vulnerable child codes i.e. 13IF-1 and 13IQ. A vulnerable child template can be linked to the 13IF-1 code which will build up a picture of risk factors for the child and could be used to fill in a CAF form or referral to social services if the need arises. 8.4 Information sharing The link below provides helpful information and guidance on information sharing: http://www.education.gov.uk/childrenandyoungpeople/strategy/integratedworking/a0072915/ information-sharing 8.5 Sample Common Assessment Framework (CAF) form The link to download the form is: http://www.lambeth.gov.uk/Services/EducationLearning/SchoolsColleges/CAFReferralForm. htm 8.6 Guidance from NHS about CRB checks http://www.nhsemployers.org/SiteCollectionDocuments/Criminal%20record%20checks.pdf Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 20 of 31 File Pathway: Issue date: Review date: Version No: PUBLIC ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice 8.7 Lambeth Safeguarding Team: Contacts 1. Mary Sheridan centre for Child Health, Wooden Spoon House, 5 Dugard Way, SE11 4TH Name Karen Jones Avis Williams McKoy Rachel Lanlokun Alison Barnwell Ayanda Jolobe Duty Doctor for Child Protection Beverley Clarke OBE Sandra Grant Davina MacKenzie Vacant Efun Johnson Cathy Donoghue Alison Davidson 2. Title & Location PA to the Designated Professionals and CP Team, Mary Sheridan Centre Designated Nurse Safeguarding/Child Protection Lower Marsh Acting Named Nurse Safeguarding/Child Protection, Mary Sheridan Centre Designated Doctor Safeguarding/Child Protection,Mary Sheridan Centre Named Doctor Safeguarding/Child Protection, Mary Sheridan Centre Vulnerable Children Team, Mary Sheridan Centre Specialist Health Visitor International House within Referral & Assessment Team Specialist Health Visitor International House within Referral & Assessment Team Lead for Vulnerable Children / Designated Dr for Child Death, Mary Sheridan Centre Named Nurse for Child Death / Nurse Specialist for Child Protection, Mary Sheridan Centre Designated Doctor for Looked After Children & Young People, Mary Sheridan Centre Designated Nurse Looked After Children & Young People, Mary Sheridan Centre Named GP for Safeguarding Children Lower Marsh Direct Dial 020 3049 5998 [email protected] 020 3049 6109 [email protected] 020 3049 8081 [email protected] 020 3049 5997 [email protected] 020 3049 6039 [email protected] 020 3049 6013 020 7926 5921 [email protected] 020 7926 7076 [email protected] 020 3049 5994 [email protected] THIS POST NO LONGER EXISTS – Child death dealt with by SC Team 020 3049 6037 [email protected] 0203 049 6167 [email protected] [email protected] Lambeth Children and Young Peoples Service Referral and Assessment (FIRST RESPONSE) Team: Tel: 020 7926 6508, Fax:020 7926 6874,Mon to Fri 9.00am – 5.00pm Referrals : 020 7926 7856 / 6583 / 6010 / 6676 / 6586 / 1772 Or out of hours 020 7926 1000 PLEASE REFER USING THE MULTI AGENCY REFERRAL FORM (MARF) Via www.lambethscb.org.uk/worried_about_a_child_young and click on the link for MARF Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 21 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice PUBLIC 3 .For information regarding Lambeth CCG level 2 or 3 training dates please contact ; [email protected] 8.8 Literature and Useful websites Local information on safeguarding children: http://www.lambeth.gov.uk/Services/HealthSocialCare/ChildrenFamilyCare/ChildProtection. htm Lambeth safeguarding children board, information on training, policy and guidance: http://www.lambethscb.org.uk/professional_section_introduction Working Together to Safeguard Children 2010: https://www.education.gov.uk/publications/standard/publicationDetail/Page1/DCSF-003052010 Working Together To Safeguard Children 2015: www.workingtogetheronline.co.uk What to do if you are worried a child is being abused – Every Child Matters: https://www.education.gov.uk/publications/eOrderingDownload/6840-DfESIFChildAbuse.pdf London Child Protection procedures: http://www.londonscb.gov.uk/files/procedures/london_cp_procedures_v.3_print__10.01.08. pdf Child protection – a Toolkit for Doctors: http://www.bma.org.uk/ethics/consent_and_capacity/childprotectiontoolkit.jsp When to Suspect Child Maltreatment: http://www.nice.org.uk/CG89 Children’s Act 2004: http://www.opsi.gov.uk/acts/acts2004/ukpga_20040031_en_1 Royal College of General Practitioners’ Safeguarding Children Toolkit: http://www.rcgp.org.uk/clinical_and_research/circ/safeguarding_children_toolkit.aspx 9.0 Appendices Appendix 1 Template for requests for information from social care Appendix 2 Template for case conference reports Appendix 3 Summary of Training schedule for Lambeth General Practice Staff Appendix 4 Equality Impact Assessment Checklist Appendix 5 Consultation history Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 22 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice PUBLIC Appendix 1 Template for requests for information from social care Note this form should not be used in place of dialogue between professionals but is intended as a record of the information that has been exchanged Urgent Fax Section 47, Section 17 Enquiry (This fax is Private and Confidential and is only for the attention of the person detailed below) For the attention of: Fax number: Sender: Sender’s Fax number: Sender’s telephone no. : Further to our telephone discussion: We are currently carrying out a ……………enquiry into this child/family. This means that we need to ask all agencies who may have contact with this child/family for relevant information in order to decide whether further action is required to safeguard a child. It is the responsibility of any professional coming in contact with a child or family to fully participate in this process (see London Child Protection Procedures, Working Together to Safeguard Children, the BMA’s Doctor’s Responsibilities in child protection and the GMC’s Confidentiality: Protecting and providing information). Please provide relevant information on the person(s) detailed on the attached page(s). You need to only provide information which you feel is relevant in helping us decide about a child’s risk of harm or about parenting capacity. You may decide to first ask for written/verbal consent from the parent/carer/child(ren) involved if you felt this would not be detrimental to the well-being of the child(ren) in question or cause harmful delay. Social Services have included consent (where available) as attached: (tick one) Written/Verbal consent from the family/child concerned. Consent sought but refused. It is still our opinion that the child is at risk and that investigations must go ahead without consent. Consent not sought as it would increase risk for safety of the child. If there are any delays anticipated or if you wish to discuss further, please inform us by faxing back this form or telephoning us on the above number asking for ……………….. We need this information within the day for Section 47 enquiries and within 48 hours for all other enquiries. Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 23 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice PUBLIC Confidential Fax For attention of: Members of family we would like information on: 1. ……………………………………………..DOB…………………………. 2. ……………………………………………..DOB…………………………. 3. ……………………………………………..DOB…………………………. 4. ……………………………………………..DOB…………………………. 5. ……………………………………………..DOB…………………………. 6. ……………………………………………..DOB…………………………. Address: Our concerns are (reasons for this enquiry): We need this information: by end of the day/ within 48 hours (delete as appropriate) If you have any queries, contact …………………………………………… (social worker manager) on tel …………………………………………….. If we feel a child is at risk of significant harm we will convene a Child Protection Conference and you will be invited to this meeting. We always endeavour to give feedback to the professional that referred the family to Children’s Social Care. Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 24 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice PUBLIC Confidential Fax For attention of: Information required on: (Use a separate form for each member of family) Relationship to index child(ren): DOB: (Please write the information on the above person here and fax back to Sender. Use further sheets if required.) Faxed at …………………………………………………………………( date and time) Please confirm receipt of fax by phoning ………………………………. (insert tel no) Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 25 of 31 File Pathway: Issue date: Review date: Version No: PUBLIC ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice Appendix 2 Template for Case Conference Reports Multi-Agency Report for Child Protection Conference Lambeth SafeguardingChildren Board CONFIDENTIAL Notes for use: Please complete this form electronically; the text boxes will expand to fit your text. The completed form contains personal data to be protected and processed in line with the Data Protection Act 1998. AGENCY COMPLETING: Name of Worker: Agency: Date of report: Role of person completing report: FAMILY DETAILS: Child Forename(s): Date of Birth / EDD: Surname(s): Home address: FAMILY INFORMATION: Name: DOB: Relationship to the child: Overview of Agency Involvement with child/family including information of attendance/engagement with your service: Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 26 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice PUBLIC What are you worried about? please state the name of the child if you have any specific concerns about one particular child. Past Harm to children Action/behaviour-who what where when; severity; incidence and impact Future Danger for Children What are you worried is going to happen to the child if the current situation does not change? - related to past and future harm Complicating Factors Factors which make the situation more difficult to resolve What is working well? Existing Strengths Existing Safety /Protection The strengths sustained over time, directly related to the danger. What needs to happen? Future safety/protection/safety goals (When will things be safe enough, what do you want to see parents/carers doing to make the child safe ) Parent and child’s views Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 27 of 31 File Pathway: Issue date: Review date: Version No: PUBLIC ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice Next Steps What can you /your agency contribute to a plan to keep the child safe? What are the next steps to be taken to achieve the safety goals? Signature of person completing report: If applicable - Signature of designated CP person/manager for Agency authorising the report: Every effort should be made to share this report to those with those with Parental Responsibility if this is appropriate to do so. In circumstances where this is not possible, please state reason & make attempts to inform of content verbally: Have those with Parental Responsibility viewed/had verbal feedback of this report? ☐ No If possible, please obtain signatures of those with legal Parental Responsibility who have viewed/had verbal feedback of the report: …………………………………………………………… ☐ Yes How? …………………………………………………………… Date: It is the responsibility of all agencies who have participated in the enquiry or who have relevant information to make this available to the conference in the form of a legible and signed report. The report should be provided to parents at least 2 working days in advance of initial conferences and 5 working days before review conferences. The report must be sent to CP Administration via secure email [email protected] at least 2 working days before an initial conference and 5 working days before a review conference. Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 28 of 31 File Pathway: Issue date: Review date: Version No: PUBLIC ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice Appendix 3 Summary of Training schedule for Lambeth General Practice Staff All practice staff December 2015 Complete level 1 e-learning package April 2016 On-going updates Every 3 years to complete Level 1 training, either via elearning or multiagency LSCB Level 1 course. Or Annual updates via practice lead In-house training delivered by practice lead Complete level 1 e-learning package (if never had training) Attend level 2 training for Independent contractors organised by NHS Lambeth Or In-house training delivered by practice lead Complete level 1 e-learning package (if never had training) HCAs Practice Nurses Safeguarding Children Practice Leads Annual updates via practice lead Read NICE guidance When to suspect child maltreatment (2009). Every year to attend at least one multi -agency LSCB Level 3 course / equivalent e-learning Complete level 1 e-learning package (if never had training) Attend level 3 training for GPs and practice nurses organised by NHS Lambeth. Read NICE guidance When to suspect child maltreatment (2009). Every year to attend at least one multi -agency LSCB level 3 course / equivalent e-learning Attend level 3 training for GPs and practice nurses organised by NHS Lambeth Attend at least one multi -agency LSCB or LCH Level 2 or 3 course. Complete level 1 e-learning package (if never had training) Read NICE guidance When to suspect child maltreatment (2009). Attend level 3 training for GPs and practice nurses organised by NHS Lambeth Every year to attend at least one multi -agency LSCB level 3 course. Attend 3 out of 6 supervision meetings for Practice Leads to be facilitated by Named GP ([email protected]) Attend 3 out of 6 supervision meetings for Practice Leads to be facilitated by Named GP. Attend level 2 training for Independent contractors organised by NHS Lambeth GPs Every 3 years to complete Level 2 training, either via NHS Lambeth via or multiagency LSCB Level 2 course. Every year to attend at least one multi -agency LSCB level 3 course Attend 3 out of 6 supervision meetings for Practice Leads to be facilitated by Named GP for Safeguarding Children. For information regarding Lambeth CCG level 2 or 3 training dates please contact ; [email protected] Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 29 of 31 File Pathway: Issue date: Review date: Version No: PUBLIC ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice Appendix 4 Equality & Equity Impact Assessment Checklist 1. 2. 3. 4. 5. Challenge questions Yes/No/ DK/NA Does the document set out the health care needs of the groups intended to benefit from the proposal, including any differences in need in terms of the legally protected or other characteristics (such as socioeconomic position) Does the document set out any known existing inequality in access, quality, experience and outcome of care for populations relevant to the proposal (ie as defined in 1. and in relation to the existing health or care service)? Are there any particular public concerns about equality about the policy area that needs to be addressed? Has the policy described any gaps in knowledge about 1 -3, and any action taken to fill gaps (or recommendations for action) Yes Yes No 8. 9. Concerns re requesting ID. No Does the document set out risks to equity of access, quality, experience and outcomes including risk of direct or indirect discrimination, and risk to good relations between people of different groups? Yes Does the document describe any specific opportunities to promote equality and human rights, good relations between people of different groups, to enhance participation, etc? Yes Does the document describe how the proposal, policy etc will address the identified inequalities, and Does the document make recommendations to mitigate risks and enhance the opportunities to promote equality and equity? Does the document describe how monitoring and reporting will take place to assure equality and equity in the future including to stakeholders. [audit and monitoring table may be used] Age group for safeguarding children defined under section1.0 Lambeth identified as high risk for safeguarding children matters. 6. 7. Comments Yes Yes Concerns voiced that requesting ID is discriminatory. Nevertheless, confirming identity is important in safeguarding children; registration should not be denied but ID should still be sought. Based on Every Child Matters, which aims that every child, whatever their background or circumstances, to have the support they need to: be healthy stay safe enjoy and achieve make a positive contribution achieve economic well-being. See guidance from DOH which states that ID may be requested if done in a non-discriminatory way. See guidance from DOH and which states that ID may be requested if done in a non-discriminatory way. Yes See audit and monitoring table * Race/ ethnicity, gender (including gender reassignment) age, religion or belief, disability, sexual orientation, marriage or civil partnership, pregnancy and maternity. This will include groups such as refugees and asylum seekers, new migrants, Gypsy and Traveller communities; and people with long term conditions, hearing or visual impairments, mental health problems or learning disability Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 30 of 31 File Pathway: Issue date: Review date: Version No: ©NHS Lambeth Document Title: Safeguarding Children Standards in General Practice PUBLIC Appendix 5 Consultation History Stakeholders Name Ruth Wallis Alison Barnwell Avis Williams McKoy Rylla Baker Konstantinos Tsormpatzidis Fiona Mortlock Jenny Law Therese Fletcher Moira McGrath Abdu Mohiddin Gail Tarburn Area of expertise Director of Public Health, NHS Lambeth Designated Dr for child protection, NHS Lambeth Designated Nurse for child protection, NHS Lambeth Deputy Director of Primary Care, NHS SE London Head of GP Contracts & Performance (Lambeth) NHS SE London AD for Children and Maternity Commissioning NHS Lambeth Chair of Lambeth LMC Date sent AD Primary and community care Commissioning, NHS Lambeth Director of care pathway commissioning, NHS Lambeth Children and Young person’s Public Health lead, NHS Lambeth AD for HR 06.10.11 Date received Comments Changes made Discussion re registration requirements Changes tpo registration requirements 06.10.11 06.10.11 06.10.11 06.10.11 06.10.11 06.10.11 06.10.11 Already gave feedback to earlier draft 06.10.11 06.10.11 19.10.11 Operations Group meeting, NHS lambeth 14.11.11 Lambeth safeguarding Children’s Board LCCCB 28.11.11 04.01.12 Suggested change of wording to CRB requirements Needs sign off from primary care department, send to LSCB for information LSCB welcomed the policy Changes to CRB requirements Discussed at Board on 11.1.2012 Changes to registration requirements Document Title: Safeguarding Children Standards in General Practice Document Status: DRAFT Page 31 of 31 File Pathway: Issue date: Review date: Version No:
© Copyright 2025 Paperzz