RCGP Safeguarding toolkit

The process of making an adult safeguarding referral can vary from place to place. Each local area will have their own agreed multi-agency referral pathway and many local authorities will have their own adult safeguarding referral form that all professionals should use.

It is essential that you are aware how to make an adult safeguarding referral in your area.

If the person you are concerned about is in danger and immediate action is required, you should ring the emergency services on 999.

Top tips for making an adult safeguarding referral and writing safeguarding reports – The five Cs

Clarity

Be clear about who you are, your role and relationship to the adult, the source of your concern, what is fact, what is opinion and what your concerns are.

Care and support needs

Include information about the adult’s care and support needs/personal and/or life characteristics as well as the reasons why the adult is unable to protect themselves from harm, therefore meaning they are an adult at risk of harm. Include relevant information about the adult’s health and wellbeing as well as their views on what is happening to them, what they would like to change and what help and support they would like/need.

Concerns

Describe and explain your concerns in detail – be explicit about what harm you believe has happened to the adult or is at risk of happening. Give as much detail as possible. Explain medical terminology. Highlight if you believe others to be at risk also.

Context

Include relevant information about the wider context of the adult’s life. Be clear about any additional vulnerability factors that add to your concern such as any experience of trauma and/or adverse childhood experiences, evidence of coercion, family/environmental factors, community/societal factors or previous safeguarding concerns. You should also include known personal/family/carer/environmental/community strengths.

Capacity

Be clear about whether the adult has capacity with regards to the safeguarding concerns and referral. Outline any mental capacity assessments that have been carried out and what the outcomes of these are. In addition, be clear whether consent has been given by the adult for the referral. If there is no consent, outline clearly the reasons for making the referral.

Adult safeguarding processes

There are different safeguarding arrangements in each UK nation to make enquiries and carry our investigations if an adult is, or is suspected to be, experiencing, or at risk of experiencing abuse or neglect. These arrangements are often multi-agency.

Adult safeguarding processes should be rights-based, person-centred, empowering, proportionate, collaborative, transparent and include prevention and protection.

Following receipt of an adult safeguarding referral, the local authority (Health and Social Care Trust in Northern Ireland) may first seek further information from safeguarding partners (including general practice) and seek to speak to the adult at risk of harm to ascertain their views.

Adult safeguarding/protection/support and protection/case conferences (terminology varies by nation) may then be convened. These conferences are multi-agency and often include the adult at risk of harm. Agencies may have been asked to prepare a report for the conference. The conferences are generally split into different sections:

• Setting the scene which includes background and summary of concerns.
• Information sharing from agencies.
• Wishes of the adult at risk.
• Outcomes of any investigations and implications for the adult at risk.
• Assessment of abuse and/or neglect including agreeing on severity.
• Decision making and agreement on outcomes which includes which agencies will be involved, whether legal advice is needed, whether any statutory and/or regulatory action is necessary and what plan is needed. There may be specific actions for general practice resulting from an adult safeguarding conference.

Outcomes from an adult safeguarding conference can include:

• No further action – this may happen if there is no further risk of harm or if other support has been put in place that is keeping the adult safe.
• Ongoing Police investigations if a crime has been committed or is suspected of being committed.
• Further discussion with the adult at risk of harm by professionals involved to get to know them and their situation better so that a more in-depth understanding can be gathered about the adult and the risk. This may include capacity assessments.
• Referrals for further specialist input may be required. For example, arranging for a Home Fire Safety Visit if there is substantial hoarding and fire safety is a concern.
• Further adult safeguarding conferences may be held when there is ongoing risk. These conferences enable professionals to continue to share information and assess ongoing risk and support.

In complex adult safeguarding situations such as where there is self-neglect, drug and alcohol addiction, homelessness or concerns about capacity, the adult safeguarding process can continue for many months. In these situations, the GP may be one of the most trusted professionals within the process.