RCGP Safeguarding toolkit

Talking to patients about your concerns about abuse and safeguarding referrals can seem daunting and at times uncomfortable, even for those who are experienced clinicians. However, many of the skills needed to have these conversations are skills we already have as GPs and general practice clinicians. Some good practice points to consider when talking about concerns about abuse are:

• Meet language and communication needs – this is particularly important when talking about abuse. If an interpreter is needed, this should be an independent interpreter, not family members or carers. Choice of interpreter is also important. Phone interpreters can allow anonymity which can be helpful.
• As far as is possible, communicate directly with the child/adult you are concerned about. This may include arranging to speak with them alone, dependent on age, maturity, communication needs as well as their care and support needs.
• Actively listen to the child/adult you are concerned about.
• Start the conversation by asking open questions.
• Listen without judging.
• Remain calm.
• Be honest and transparent about your concerns (as long as this will not increase the risk of harm to the child or adult at risk of harm).
• Offer support including signposting to any relevant external support.
• Don’t collude with, or excuse, any harmful behaviour.
• It is not the role of a GP or anyone in general practice to investigate allegations or concerns about abuse. 
• Be aware that you may have only have one part of the safeguarding jigsaw puzzle.
• Understand that for families and carers the realisation that their child or loved one may be being abused can be devastating news and that reactions can vary significantly.
• Be clear about your professional duties regarding safeguarding children and adults at risk of harm.
• Be clear about confidentiality and its limits.
• Be prepared to have more than one conversation.
• Focus on the rights of children and adults to live free from harm and fear.
• Reflect on your conversations, especially if it has been difficult – this could be with a colleague or organisational safeguarding lead for example.
• Take time for yourself.

References:

• GMC. Protecting children and young people: The responsibilities of all doctors. Communication and support. 2024.
• GMC. Leaflet: What to expect if your doctor is worried about your child’s safety. 2012.
• Ann Craft Trust. What should I say…? Advice for Starting Difficult Conversations. 2022.
• Age UK. How to have an open conversation. 2024.
• Open the Door Cheshire. Opening up the conversation. 2022.