RCGP Safeguarding toolkit
The aim of this toolkit is to enhance the safeguarding knowledge and skills that GPs already have to enable them to continue to effectively safeguard children and young people, as well as adults at risk of harm.
Part 3C: Responding to concerns about adult abuse
5. Is a safeguarding referral needed?
The table below summarises the steps 1 – 4 outlined above and provides guidance on making decisions about adult safeguarding referrals.
- If you are unsure, seek further advice from a colleague, your organisational safeguarding lead or local safeguarding professionals.
- Ensure the patient is safe and deal with any immediate medical needs.
Is the adult an 'adult at risk/adult at risk of harm'?
YES: consider an adult safeguarding referral and follow steps 4 & 5 below.
NO: consider:- other sources of support for the adult
- whether any others are at risk of harm and for whom a safeguarding referral needs to be considered, such as any children or other adults who are adults at risk of harm
- whether the level of harm is potentially so serious that a different type of referral is required such as a MARAC referral in the cases of high-risk domestic abuse
- reassess the situation if new relevant information comes to light
- continue to monitor the situation as risk and the ability to safeguard themselves may change over time.
Does the adult at risk of harm have capacity to make a decision about a safeguarding referral?
NO: proceed with an adult safeguarding referral.
YES and they consent to a referral: proceed with an adult safeguarding referral.
YES but they do not consent to a referral: consider:- whether they need more information on the safeguarding adult process, which might address any concerns they have
- what other sources of support are available
- whether any others are at risk of harm and for whom a safeguarding referral needs to be considered, such as any children or other adults who are adults at risk of harm
- whether the level of harm is potentially so serious that a different type of referral is required such as a MARAC referral in the cases of high-risk domestic abuse
- reassess the situation at appropriate intervals as risk can change as can an adult’s ability to protect themselves
- reassess the situation if new relevant information comes to light.
UNCERTAIN: discuss with a colleague, your organisational safeguarding lead or local safeguarding professionals.
NOTE FOR PRACTITIONERS WORKING IN WALES – all practitioners working in Wales should be aware of the statutory ‘duty to report’.
What should happen if an adult at risk of harm has capacity but does not want any safeguarding procedures and is unwilling to take steps to safeguard themselves?
These circumstances can bring high levels of professional anxiety and evoke feelings of helplessness. Here are some principles about managing these difficult situations.
- What does the adult want? Are there small actions that can be taken which might help the adult whilst also building trust in professionals?
- Reconsider if the adult is actually unable to safeguard themselves due the effects of trauma and/or adverse childhood experiences or coercion, rather than being unwilling. A referral can be done without consent, under these circumstances.
- Consider if there are others who are at risk of harm such as children or other adults and take safeguarding action as necessary.
- Are there other professionals already involved with the adult who you can discuss concerns with?
- Keep reassessing the situation – risk can be fluid and dynamic.
- Keep the door open – let the adult know they can change their mind at any time. Also let them know that you are still here to support and help them, regardless of any decisions they make.
- You are never alone in these situations – seek advice and support from your colleagues, your organisational safeguarding lead or your local adult safeguarding team. You can ask for advice without disclosing the name of the patient.
- Some areas have a MARAM process (Multi-Agency Risk Assessment and Management). This is a multi-agency approach to reduce risk in areas such as fire safety, alcohol/drug dependence, non-compliance or challenging behaviour, self-neglect, hoarding, failure to engage with services.
- If you believe the adult is at risk of serious harm you should always seek urgent advice if you are unsure what to do. Consider if a safeguarding referral would be justified in the wider public interest. The GMC advises: “You may be able to justify disclosing information without consent, where it is necessary to prevent a serious crime such as murder, manslaughter or serious assault or there is clear evidence of an imminent risk of serious harm to the individual and no alternative (and less intrusive) methods of preventing that harm. This is an uncertain area of law and, if you can, you should seek independent legal advice before making such a disclosure without consent.”
Wales Safeguarding Procedures: the statutory duty to report an adult at risk of abuse and/or neglect
A duty to report to the local authority will be taken to mean a referral to social services who, alongside the police, have statutory powers to investigate suspected abuse or neglect.
A report should be made whenever there are concerns for an adult at risk who:
- is experiencing or is at risk of abuse or neglect
- has needs for care and support (whether or not the authority is meeting any of those needs) and
- as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it.
(Section 126 of the Social Services and Well-being Act 2014).
The use of the term ‘at risk’ means that actual abuse or neglect does not need to have occurred, rather early interventions to protect an adult at risk of abuse should be considered to prevent actual abuse and neglect.
References
- Wales Safeguarding Procedures. Adults at risk. 2024.