RCGP Safeguarding toolkit

Making a child safeguarding referral

The mechanism of referrals to children's social care may vary depending on locality. In some areas, referrals can be made by telephone in the first instance but should be followed up in writing within 24 hours. In other areas, referrals may be made by email or via the local authority website. In some areas, children’s social care, police, health and other services are working together to provide a 'front door' for referrals that may be known as a multi-agency safeguarding hub/team (MASH or MAST). Local authorities may have a proforma for inter-agency referrals; this can act as an aide-memoire and help to ensure that the referral is comprehensive and complete.

You must make a safeguarding referral if you are concerned that a child is at risk of, or is suffering, abuse or neglect. You should follow your local safeguarding referral processes.

Top tips for making a child safeguarding referral and writing safeguarding reports – The five Cs

The ‘five Cs’ are relevant to any referral or report written by general practice for the purpose of safeguarding children. This includes safeguarding/child protection referrals as well as reports for strategy meetings and child protection conferences. It is good practice to share the report with parents/carers (and the child/young person if relevant and appropriate) however this is not always possible within the short timescales required for a statutory report.

Clarity

Be clear about who you are, your role and relationship to the child, the source of your concern, what is fact and what is opinion, and what your concerns are.

Child

Include relevant information about the child’s health, wellbeing, especially any vulnerability factors. Where possible, include the child’s thoughts and feelings about what is happening to them – use their words as much as possible. Information to include (if known):

• Demographics of the child.
• Details of parents, carers, siblings.
• Is the child looked after or adopted?
• Details of nursery/school. Is the child home-schooled? Are there any documented concerns about school attendance?
• Known health issues.
• Known disabilities.
• Medication – consider if these are being requested and taken appropriately.
• Vaccinations – consider if these are up to date or if there are any missing.
• Outstanding general practice health reviews such as annual asthma reviews.
• Involvement of other healthcare providers such as paediatrics or child and adolescent mental health services (CAMHS). Provide details of these services so children’s social care can contact them for information.
• Number of ‘was not brought’ appointments.
• Engagement with health. Consider if health appointments are being attended or not, if appointments are frequently cancelled, if medical advice is being followed.
• If there is lack of engagement with health, what is the potential impact on the child, e.g if not being brought to appointments or following medical advice?
• If the child has been seen in general practice, has the child expressed their view on the current situation? If yes, please give details of what the child has said.

Concerns

Describe and explain your concerns in detail, explaining medical terminology. Be clear about the indicators of abuse that you have observed that have led to your concerns. Be explicit about what harm you believe has happened to the child or is at risk of happening.

Context

Include relevant information that general practice holds about the wider context of the child’s life. Be clear about any additional vulnerability factors that you are aware of, that add to your concern such as parental/carer factors, family/environmental factors, community/societal factors or previous safeguarding concerns.

• Relevant information about parents/carers might include:
  • Significant and relevant health issues including any mental health issues.
  • Any disabilities.
  • Medication – consider if it is being requested and taken appropriately. Also consider any addictive medication or any which would impact on their ability to safely parent their child.
  • Alcohol or drug misuse.
  • Outstanding general practice health reviews.
  • Involvement with other relevant healthcare teams e.g. mental health, drug and alcohol teams.
  • Engagement with health. Consider if health appointments are being attended or not, if appointments are frequently cancelled, if medical advice is being followed and what the potential impact is on the adult and on parenting.
  • History of experiencing abuse when they were a child.
• Previous and current safeguarding concerns including any domestic abuse.
• Known family situation/dynamics (consider any known family stresses, parental separation/conflict, conflict between parents and young people, significant family events, parent in prison).
• Known vulnerabilities (consider poverty, experience of racism, socio-economic factors, refugee/asylum status, housing instability, social isolation, English not their spoken language).
• Transitional safeguarding: if the child is 15 years or older, consider what needs they have approaching adulthood.
• Known family/carer strengths such as supportive family networks, child being brought to health appointments when needed, parents/carers seeking help and support for their own health needs.

Consent

You should be clear in your referral whether consent has been sought or not and whether the referral has been discussed with the child and/or parents/carers (which is expected practice, unless it is thought that doing so would place the child at additional risk).

The issue of whether information can be shared without consent can often be challenging. Consent can be a complex issue and there can be a lot of misunderstanding amongst all agencies about how it is used. In health, consent needs to be considered under the common law duty of confidentiality. Consent is used in a different way in the common law and in data protection law and it is important to understand the differences and how each should be used. Consent is generally not relied upon as the legal basis for information sharing under data protection law. Part 5 of this toolkit provides further explanation and guidance on this issue. The GMC gives clear guidelines on this issue in their guidance ‘Protecting children and young people: The responsibilities of all doctors’. Some excerpts from this guidance are below, but all doctors should have knowledge of the entirety of this guidance.

“Get advice if you are concerned about the possibility of abuse or neglect, but do not believe that the child or young person is at risk of significant harm.

You must tell an appropriate agency, such as your local authority children’s services, the NSPCC or the police, promptly if you are concerned that a child or young person is at risk of, or is suffering, abuse or neglect unless it is not in their best interests to do so. You do not need to be certain that the child or young person is at risk of significant harm to take this step. If a child or young person is at risk of, or is suffering, abuse or neglect, the possible consequences of not sharing relevant information will, in the overwhelming majority of cases, outweigh any harm that sharing your concerns with an appropriate agency might cause.

Ask for consent to share information unless there is a compelling reason for not doing so. Information can be shared without consent if it is justified in the public interest or required by law. Do not delay disclosing information to obtain consent if that might put children or young people at risk of significant harm. Do not ask for consent if you have already decided to disclose information in the public interest.

Tell your patient what information has been shared, with whom and why, unless doing this would put the child, young person or anyone else at increased risk.

Get advice if you are not sure what information to share, who to share it with or how best to manage any risk associated with sharing information.

You can share confidential information without consent if it is required by law, or directed by a court, or if the benefits to a child or young person that will arise from sharing the information outweigh both the public and the individual’s interest in keeping the information confidential. You must weigh the harm that is likely to arise from not sharing the information against the possible harm, both to the person and to the overall trust between doctors and patients of all ages, arising from releasing that information.

If a child or young person with capacity, or a parent, objects to information being disclosed, you should consider their reasons, and weigh the possible consequences of not sharing the information against the harm that sharing the information might cause. If a child or young person is at risk of, or is suffering, abuse or neglect, it will usually be in their best interests to share information with the appropriate agency.”