Child safeguarding in the private sector

Patients can choose to be seen via the NHS or via the private sector, or in combination with the private health appointments forming a 'complimentary service'.

GPs working in the private sector may be disadvantaged due to:

  • Limited access to patients' NHS GP and hospital health records leading to limited or no ability to decipher withheld truths.
  • Unverified information being provided such as demographic information which may not be genuine because it is not always cross checked. This means that patients can 'disappear' or be hard to trace.
  • Less reliable computer systems to code non-attendance or 'child not brought' and other issues that might raise safeguarding suspicions. Multiple non-attendances are unlikely to be flagged as a potential safeguarding issue.
  • Parents not being registered within the same private sector surgery or an NHS GP practice and therefore not visible.
  • Parents choosing not to share relevant information and no robust system to cross check with the more extensive NHS note keeping systems, such as hospital records or nursing and midwifery records that are often easily accessible within an NHS GP setting.
  • Lack of robust standardised systems to ensure referral outcomes are communicated back to the referring private GP from consultants and specialists.
  • No robust system being in place for sharing information with their patient's usual NHS GP. This may be a problem if parents and children are seen when on holiday or out of their usual catchment area for other reasons.
  • Potentially underused standardised pathways and protocols for safeguarding referrals in the private setting compared to regularly used protocols and pathways in the NHS.
  • A false perception that safeguarding issues are less common in private sector patients.
  • Parents' perceptions that they are paying for a ring fenced specific medical service for their child which does not invoke any safeguarding intervention by the private GP.
  • Potential differences in private patients' medical cultural background and their understanding of UK standards and the doctor's statutory duties under UK safeguarding regulations.
  • Private patient expectations of 'control' over the private consultation and GP.

What can private GPs do to improve safeguarding in the private health sector?

  • Attend regular safeguarding training and ensure training is up to date – GPs, regardless of whether they work in the NHS or private sector, require the same level of safeguarding training as set out in the Intercollegiate Document: Safeguarding Children: Roles and Competencies for Healthcare Staff. The RCGP supplementary guide to safeguarding training requirements for all primary care staff provides a brief summary of the safeguarding training requirements for all who work in a primary care setting (clinical and non-clinical staff).
  • Rehearse scenarios with private sector colleagues.
  • Check the safeguarding policies and know how these would work within the private sector organisation where the private GP is practicing.
  • Ensure there is good communication and information sharing between private GPs and other private sector staff and between private GPs and NHS sector staff including NHS GPs, hospital staff and CSC
  • Ensure effective communication to keep everyone in the loop. This requires consent and early communication with patients about the information sharing process.
  • Keep important safeguarding contact numbers (for example CSC) up to date and accessible for different catchment areas.
  • Make children visible and use a 'think family' approach in consultation. Have conversations with the parents that discuss their children at an early stage in the doctor patient relationship.
  • Understand the constraints of seeing families and children with limited access to full information and think about asking for more contextual information if necessary to support your 'think family' approach.
  • Work closely with colleagues and discuss concerns early.
  • Encourage families to also register with an NHS GP.