RCGP Safeguarding toolkit

The following are key knowledge and capability principles to responding appropriately and effectively in general practice to concerns about abuse:

KNOWLEDGE

• Knowing the indicators of abuse:
  • If we do not know the indicators of abuse then we will not recognise it and not respond appropriately.
• Knowledge of local safeguarding referral processes:
  • Knowing your local safeguarding referral processes is fundamental to responding effectively to concerns about abuse. Not knowing how to make referrals can be a substantial barrier. You should know:
    • how to find the referral forms for child and adult safeguarding referrals
    • how to find phone numbers to use for safeguarding advice or making urgent safeguarding referrals, including outside of working hours
    • the process for Early Help referrals
    • how to make referrals to local domestic abuse agencies
    • how to make multi-agency risk assessment conference (MARAC) referrals
    • how to manage allegations against staff/persons in positions of trust
    • how and when to carry out the mandatory reporting duty of female genital mutilation (FGM) (England and Wales)
    • how to make Prevent referrals (England, Wales and Scotland) as these processes can vary from place to place.
• Knowledge that it is not the role of a GP or anyone in general practice to investigate allegations or concerns about abuse – that is the role of other agencies such as social care and the police.
• Knowing when and how to ask for help.
• Knowing how and when to challenge:
  • Critical thinking and challenge within and between agencies is essential to safeguarding work. The lack of this was highlighted as a factor in the National review into the murders of Arthur Labinjo-Hughes and Star Hobson.
• Knowing when and how to escalate safeguarding concerns:
  • Knowing how and when to escalate safeguarding concerns is essential. These situations can occur when you have concerns about the multi-agency response to your safeguarding concerns such as a safeguarding referral not being accepted or closed without further action. You should know:
    • who to seek advice from
    • how to escalate concerns.

CAPABILITIES

• Assessing risk and vulnerability:
  • If we only take situations at face value, we may significantly underestimate the risk of abuse that a child or adult may be facing. Any concern should not be viewed in isolation, but put into context, including by exercising our professional curiosity.
  • It is vital to understand personal or life characteristics which can make an individual more vulnerable to abuse. Understanding these characteristics help us to develop a more accurate picture of the risk of abuse that an individual might face.
• Seeing the wider picture:
  • A ‘think family’ approach when considering the needs of children. This approach means thinking about the needs of the whole family – as individuals and as a unit without losing sight of the need for individual care. For example, this may mean addressing the health needs of parents or involving other professionals and agencies to support the family with social needs.
  • When treating adults, it is important to always consider whether they have caring responsibilities for children or adults with care and support needs and what the impact of the adult’s health. ‘Seeing the child behind the adult’ is an important principle to follow.
  • This approach is also important when considering adults at risk of harm and how best to support and protect them. For example, considering and addressing the needs of carers for example is vital to supporting the adult they are caring for. This includes young carers.
  • Be aware that general practice only have one part of the safeguarding jigsaw puzzle.
• Being confident in issues surrounding consent and confidentiality:
  • Concerns around consent and confidentiality can present some of the biggest challenges to responding effectively to abuse but should not be a barrier to sharing information in order to safeguard children, and adults at risk of harm, from abuse and neglect. Part 5 of this toolkit (Information sharing and multiagency working) provides further guidance on these difficult areas.
• Robustly assessing mental capacity:
  • Assessing capacity when there are safeguarding concerns can be challenging especially in situations when capacity fluctuates, where there are alcohol or drugs involved, when coercive control is suspected or there is self-neglect. Capacity can also be significantly impacted by previous experiences of trauma.
  • If we do not fully and accurately assess capacity, including executive capacity (ie the ability to not just make, but also carry out, a decision), then adults at risk of harm may not receive the protection and support they need.
  • The use of the phrase ‘lifestyle choice’ should be used with extreme caution as this risks professionals under-estimating risk. This phrase is often used for individuals who are self-neglecting, are homeless or who have alcohol or drug addiction. It is important to resist this narrative as the reality is usually complex. It is also important to guard against assumptions that individuals can protect themselves in these complex situations.
  • Differentiation between inability and unwillingness to care for oneself, and capacity to understand the consequences of one’s actions, are crucial determinants of response.