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RCGP Safeguarding toolkit

Part 3E: Responding to allegations of abuse regarding staff or persons in a position of trust (PiPoT)

The GMC guidance: Raising and acting on concerns about patient safety - professional standards states that:

  • You must take prompt action if you think patient safety, dignity or comfort is being compromised.
  • In this guidance we explore who the best person or organisation is for you to raise your concerns with. It also covers how to raise your concerns and how you can overcome any barriers that might be preventing you.
  • There is also a section on how to handle concerns that are brought to you.
  • If you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague, your defence body or us. If you are still concerned you must report this, in line with our guidance and your workplace policy, and make a record of the steps you have taken.

Why is this important?

GPs and all practice staff are in a unique and privileged position with access to children, young people and vulnerable adults as well as access to information about them. Whilst the vast, vast majority of staff would never abuse this position of privilege, we have to be alert to the possibility that some might.

Who are ‘persons in a position of trust’?

This term refers to adults who work/volunteer (including students) with children or adults with care and support needs. For example: doctors, teachers, social workers, care workers, faith group leaders, sports coaches.

Concerns can arise when a staff member or a person in a position of trust:

  • has behaved in a way that has harmed, or may have harmed an adult or child, possibly committed a criminal offence against, or related to, an adult or child
  • behaved towards an adult or child in a way that indicates that they may pose a risk of harm to children or adults with care and support needs.

It is important to note that the concern does not need to be about behaviour towards a child or adult with care and support needs that the adult has contact with within their work/volunteer/student role. For example, an allegation made about a doctor sexually abusing their own children would (along with the standard child protection procedures regarding those children) also need consideration as to whether the doctor may pose a risk to their patients.

In general practice, allegations and concerns about abuse by a person in a position of trust may arise from:

  • disclosures from patients
  • staff who raise concerns about a colleague
  • members of the public who raise concerns about a staff member
  • information from other agencies such as the local authority or police or Health and Social Care Trusts (Northern Ireland).

Allegations and concerns of abuse involving persons in a position of trust are complex to manage and may require three different parallel processes:

  • safeguarding processes around the child or adult at risk of harm
  • police investigations
  • employer investigations and procedures.

Each UK nation and each locality will have their own multi-agency processes for managing these allegations. This can include involvement of LADOs (Local Authority Designated Officer) who oversees the response to allegations made about people who work with children or equivalent roles who oversee the response to allegations made about people who work with vulnerable adults/adults at risk of harm.

Any allegations or concerns about abuse by a person in a position of trust must be taken seriously and acted on immediately. Reporting and acting on concerns and allegations does not infer guilt, it ensures that both patients and professionals are protected and supported as needed.

When an allegation or concern raised about a person in a position of trust who is not a member of the general practice team:
  • This should be acted on immediately by following the local multi-agency safeguarding processes in place. This may include making a child or adult safeguarding referral depending on the situation.
  • If unsure how to proceed, seek advice and guidance as soon as possible from the organisational safeguarding lead and/or your local safeguarding professionals in health or social care.
When an allegation or concern raised about a person in a position of trust who is a member of the general practice team (self-employed, employee, volunteer or student):
  • Follow practice/organisational procedures including whistle-blowing policy if necessary.
  • The safeguarding lead/practice manager/other relevant senior individual should take the following actions so that safe and proportionate responses are made dependent on the situation and the nature or the concern or allegation:
    • seek immediate advice from the LADO or equivalent individual within the local authority/health and social care trust/safeguarding team
    • seek immediate advice from the practice HR/employment advisors.
  • If there is uncertainty about how to proceed, seek advice from:
    • practice/organisational safeguarding lead/practice manager/partner
    • safeguarding colleagues such as Named GPs for Safeguarding or Designated Health Professionals
    • The professional in local safeguarding board/partnerships who has responsibility for overseeing allegations against those who work with children or adults at risk of harm e.g. the LADO (Local Authority Designated Officer)
    • medical defence organisations (MDO)
    • regulatory body.
  • All GPs should be aware of the GMC guidance: ‘Raising and acting on concerns about patient safety’ and adhere to these professional standards. 
  • The person about whom the concern/allegation is made should be treated fairly and signposted to support.