RCGP Safeguarding toolkit

Just as with children, adults with care and support needs who are not being brought to health appointments can be a sign of neglect or other abuse, a sign that a family or carers might need additional support, or a sign that an adult needs reasonable adjustments to be able to access healthcare. The term ‘was not brought’ is now widely used across health regarding children and is also now being used with regards to adults with care and support needs.

There are many reasons why an adult with care and support needs may need help and support to attend healthcare appointments.

Practices and organisations should have a process in place for whenever any adult does not attend an appointment or review (such as annual learning disability reviews) in general practice. This is in order to identify:

• adults with care and support needs who needed to be brought to the appointment
• adults with care and support needs who may need reasonable adjustments to be able to access general practice independently
• what the purpose of the appointment was and what is the subsequent impact of the missed appointment or review on that adult’s health and wellbeing
• reasons why the adult with care and support needs was not brought to the appointment or was not able to attend the appointment independently
• what follow up is required
• any reasonable adjustments that need to be made for the adult with care and support needs
• any additional support the adult or their families/carers may need such as a carer’s assessment
• any safeguarding concerns.

To identify whether this missed appointment is part of wider safeguarding concerns, the following questions should be considered:

• What is known about the level of severity of care and support needs the adult has?
• What is known about the capabilities of the adult?
• What was the purpose of the appointment (which may not be known)? If the purpose is known, what could the potential impact of the missed appointment be on the adult's health and welfare?
• Does the adult have any ongoing physical or mental health problems?
• Could this missed appointment indicate a worsening of the adult’s health issues such as dementia?
• Are there other health appointments that the adult has not been brought to/has not attended? Is there a pattern of missed appointments?
• Is there a high volume of emergency department and GP out of hours attendances?
• Are there any safeguarding concerns documented in the adult's records? If so, how does this missed appointment fit into the wider picture? If not, could this missed appointment be an indicator of emerging safeguarding concerns?
• Are there any other adults with care and support needs, or children, within the household/family/residence? If so, are there any safeguarding concerns relating to them? For example, if all the residents of a residential home for adults with learning disabilities are registered with your practice, are there any other safeguarding concerns about any of the other residents which might indicate a wider concern about abuse or neglect within the home?
• Are there any concerns about the family/carers that could impact on their ability to bring the adult to health appointments, for example physical or mental health problems, drug and alcohol issues, domestic abuse, safeguarding concerns?
• Is there evidence of carer strain?

If there are any safeguarding concerns about the adult, action needs to be taken proportionate to the level of concern. This could include:

• the practice contacting the adult/family/carers to arrange another appointment
• the clinician contacting the adult/family/carers yourself why the adult has not been brought and make a further assessment
• contacting other professionals who may be involved with the adult, such as the learning disability team or social worker, to share information and concerns to aid further decisions
• considering an adult safeguarding referral.

In all cases, it is important to document your actions and reasons for them.

Adults without documented care and support needs who do not attend appointments

It is important to also recognise the adults who may not have documented care and support needs but have known safeguarding concerns or vulnerabilities that should prompt further exploration and concern when they do not attend an appointment. For example, someone who is known to be a victim of domestic abuse or someone who is homeless.

Prevention of Adult Not Brought Strategy, North East and Cumbria Learning Disability Network

The North East and Cumbria Learning Disability Network’s ‘Prevention of Adult Not Brought Strategy’ has a wide range of resources to support general practice including Top Tips for Primary Care, a Reasonable Adjustments flowchart and a Reasonable Adjustments Level of Concern tool.