RCGP Safeguarding toolkit

What happens after a child protection/safeguarding referral has been made?

The referral will be reviewed often by a multi-agency team with representatives from social care, police and health – sometimes called multi-agency safeguarding team (MAST) or multi-agency safeguarding hub (MASH).

Across the devolved nations, there are different arrangements to investigate concerns about a child and assess the risk of harm.

Depending on the information in the referral, the next steps might be:

• Emergency action if the child is thought to be at immediate danger.
• Other agencies and professionals contacted for further information.
• If initial assessments suggest the child is at risk of significant harm, child protection procedures may commence which can include urgent gathering of information from other agencies, holding strategy meetings where professionals meet to share information and discuss concerns and arrange for a child protection case conference to be held.
• If initial assessments conclude that the child is not in immediate danger or at risk of significant harm, children’s social care and other agencies may offer other help and support such as Early Help services, family support workers, single agency-based support such as through school or the health visitor. These services all depend on parental consent.
• Close the referral without any further action.

If initial multi-agency assessments suggest that a child is at risk of significant harm, child protection procedures may commence which can include urgent gathering of information from other agencies, holding strategy meetings where professionals meet to share information and discuss concerns and arrange for a child protection case conference to be held.

A child protection case conference brings together family members (and the child/children where appropriate), supporters/advocates and those professionals most involved with the child and family to make decisions about the child's future safety, health and development.

The purpose of a child protection case conference is to:

• bring together information about the child and parents from multi-agency partners
• analyse parents’/carers’ capacity to respond to the child’s needs, ensure the child’s safety and promote the child’s health and development
• consider the family history, strengths, network, present and past family functioning to decide if the child is at risk of significant harm
• recommend what action is needed to safeguard and promote the welfare of the child, including the child becoming a subject of a child protection plan
• appoint a lead social worker and identify a core group of professionals and family members to develop, implement and review the progress of the child protection plan
• put contingency plans in place.

Conferences can also be held when the risk to the child is outside the family, e.g. child sexual exploitation/child criminal exploitation.

An initial child protection conference is convened when a child is suspected to be, or likely to be, suffering significant harm. At this meeting, professionals have to decide whether the child is, or is likely to be, suffering significant harm and if so, the child is placed on a child protection plan/child protection register. This multi-agency decision is based on the multi-agency information shared, along with the family and child’s views.

A review child protection conference (three months after the initial child protection conference and then six monthly thereafter) reviews the risk and developmental progress against the child protection plan outcomes.

Police, health and social care representatives attend, along with other professionals involved with the child or family. Health representatives can include health visitors, midwives, school nurses, paediatricians, mental health professionals, and GPs. Other professionals can include education, family support workers, support workers for the child/young person, youth justice workers and drug and alcohol teams. There may also be legal representatives for the family or social care.

What is the role of professionals in a child protection conference?

• Professionals who attend are usually senior within their organisation and/or are directly involved with the family.
• There are no passive roles – each professional who attends must actively engage, give opinions and be involved in the decision-making process.
• Professionals in attendance need to be able to respectfully challenge views.
• The role of the GP is to explain and interpret health information the implications for child’s safety and wellbeing. It is also, along with all the other professionals present, to analyse and assess risk to the child in light of all the information presented.

What happens at a child protection case conference?

• All reports from professionals are available to everyone present including parents/carers.
• Information will be shared, usually by the lead social worker, on what the concerns are, what harm to the child has already occurred or is likely to happen.
• Each professional will be asked to share their views on the strengths of the family as well as the risks and worries.
• Parents are given the opportunity to share their views and question professionals.
• The conference will focus on the child’s circumstances and what they mean for the child’s lived experience. In circumstances where the concerns are about harm within the home, the conference will ascertain whether parents/carers understand this and what needs to change.
• Professionals are asked to decide whether they think significant harm has occurred, or is likely to occur, to the child and whether the child should be on a child protection plan (England) or added to a child protection register (Northern Ireland, Scotland and Wales) and if so, under what category (physical abuse, emotional abuse, sexual abuse, neglect).
• A plan is then drawn up of next steps, what needs to happen to keep the child safe and which professional/agency is taking responsibility for each action. For general practice this may include arranging appointments at the practice for any outstanding health reviews or to address any physical and mental health needs for the child or parents/carers.
• The aim of a child protection plan is:
  • ensure the child is safe from harm (including inside and outside of the home, and online) and prevent them from suffering further harm
  • promote the child’s health and development
  • support the parents, family, and the family network to safeguard and promote the welfare of the child
  • set out the support and resources to be provided by each agency to safeguard and promote the welfare of the child.

Child protection conference reports

• General practice will be asked to provide a report on the child and parents/carers for all child protection conferences. General practice has specific and relevant knowledge relating to children and families in their care which is integral to the overall multi-agency assessment. Information that general practice has no concerns about a family is as important to the conference as a long list of concerns about a family.
• It is good practice the report is shared with the parents/carers prior to the conference. This can however be challenging for initial child protection conferences due to the very tight timescales involved.
• If you have concerns that the information you need to share is not suitable to be shared with all individuals at the conference due to its highly sensitive nature, discuss this with the chair of the conference prior to the conference.
• It may be that some information will only be shared with key partners, and not wider family members who may be present. For example, GP records about a parent containing a report detailing the parent’s forensic sexual offending behaviour as a teenager: this is likely to be very relevant information to ensure the safety of the child involved, however is too sensitive to share with everyone at the conference, which may include wider family members. This should be discussed with the chair of the conference. A possible solution would be that a very brief statement or summary about the concern is put into the conference report that is seen by everyone, but a more detailed summary ,or the report in full, is provided to the chair of the conference and the social worker.
• Other examples could include a parent’s HIV positive status or transgender status. In these examples, discussion should take place with the parent themselves to ascertain whether they are happy for this information to be shared (depending on the situation, it may not be relevant for this information to be shared). If the parent does not wish this information to be shared but the clinician believes it is relevant, proportionate and necessary, they should discuss this with the parent and also have a discussion with the chair of the conference and the social worker about limiting the sharing of the information.

What does the GMC say about participating in child protection procedures

• If you are asked to take part in child protection procedures, you must co-operate fully. This should include going to child protection conferences, strategy meetings and case reviews to provide information and give your opinion. You may be able to make a contribution, even if you have no specific concerns (for example, GPs are sometimes able to share unique insights into a child or young person’s family).
• If meetings are called at short notice or at inconvenient times, you should still try to go. If this is not possible, you must try to provide relevant information about the child or young person and their family to the meeting through a telephone or video conference, in a written report or by discussing the information with another professional (for example the health visitor), so they can give a verbal report at the meeting.