Safeguarding Standards lambeth

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©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
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©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Superseded documents None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
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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
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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.
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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
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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
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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.
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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.
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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.
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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
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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.
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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.
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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.
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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
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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.
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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
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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.
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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)
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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
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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
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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
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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.
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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.
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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)
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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:
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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
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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.
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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]
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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
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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
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