Information Sharing

All staff working in primary care should be familiar with guidance on information sharing.

The Information sharing. Advice for practitioners providing safeguarding services to children, young people, parents and carers guidance (HM Government, July 2018) is an excellent guide to information sharing and has been updated in light of the GDPR (General Data Protection Regulation) and Data Protection Act 2018 (England).

It is important to note that GDPR and the Data Protection Act 2018 are not barriers to sharing information, the document states:

"Where there are concerns about the safety of a child, the sharing of information in a timely and effective manner between organisations can improve decision-making so that actions taken are in the best interests of the child. The GDPR and Data Protection Act 2018 place duties on organisations and individuals to process personal information fairly and lawfully; they are not a barrier to sharing information, where the failure to do so would cause the safety or well-being of a child to be compromised. Similarly, human rights concerns, such as respecting the right to a private and family life would not prevent sharing where there are real safeguarding concerns."

Other sources of guidance regarding information sharing:

• The GMC guide, Protecting children and young people: the responsibility of all doctors provides advice in relation to issues of consent and confidentiality:
• The GMC guide, Confidentiality: good practice in handling patient information, is another source of advice that practices will find useful.

If a GP has concerns about revealing sensitive information within medical records then advice may be sought from a child protection professional on an anonymised basis, but it must be remembered at all times that it is the child's safety which is paramount and central to the process (GMC, 2012).

What happens when a referral is received by Children's Social Care?

Children's Social Care should make a decision within one working day of receipt of a child protection referral and should provide feedback on the decisions taken both to the family, and to the referrer. If the referral is not accepted, they should indicate the reasons why, together with suggestions for other sources of help and support.

It is worth noting that when Children's Social Care receive a referral, they have very tight timeframes set down in statutory guidance to carry out further investigations and decide on further actions. Often these tight timeframes do not match our working practices in primary care which can be a source of frustration. It is important that practitioners from different professions gain an understanding of each other's working practices and duties to foster good working relationships which ultimately will serve to protect children and young people.

If a referral is not accepted

If a referral is not accepted or the practitioner feels there has been an inadequate response, the practitioner should take further action. Further actions may include:

• Reviewing the referral and ensuring all the relevant information is included and that they have outlined their concerns very clearly. If more information or explanation can be given, re-refer with this additional information.
• Review their local 'threshold' guidelines to see if there is a more appropriate 'early help' response.
• Consider contacting other professionals who are involved with the child/family for further information and collateral history in order to help inform further actions.
• Seek further guidance and discussion from the GP Practice Safeguarding Lead, Named GP, Designated Professionals or other similar colleagues.
• If despite this, the referral is still not accepted and the practitioner still feels the response has been inadequate, then the practitioner should follow their local safeguarding partnerships procedures for practitioners to escalate their concerns and manage professionals' disagreements.

The process of safeguarding referrals into Children's Social Care can be fraught with difficulty and practitioners can end up feeling demoralised when their referrals are repeatedly rejected and concerns seemingly dismissed and not acted on. This can be a time-consuming and stressful process.

The process of referral, re-referral and escalation of concerns can also cause considerable strain on the doctor-patient relationship. Practitioners may have already had difficult conversations with the family prior to making the initial referral, particularly if the family are not in agreement with the referral. Practitioners should not hesitate to seek support from their safeguarding colleagues in these situations.

It is paramount throughout this process that the needs and welfare of the child remain the central focus.