Frequently Asked Questions

A child has had a child protection medical but they have not had the case conference yet and are not currently on a child protection plan, how should we code them and how should we store the letters?

Code: ‘Child cause for concern’

Add an alert onto all household records.

Change the codes if the child becomes subject to a child protection plan or remove the code if the child is no longer cause for concern.

A mother attends the GP surgery with her 2 year old child and discloses domestic abuse. What should you do?

Refer to the safeguarding referral team due to potential risk to the child and contact the police regarding domestic abuse if the mother consents. The referral to the safeguarding team should be made regardless of whether the police are informed and mum should be made aware of this.  Also offer to facilitate a referral for her to the local domestic abuse service, New Era.  Many victims feel unable to access services themselves if just signposted.

A parent brings their child to the GP surgery. The child has a complex medical history, they are under many different specialists, they are frequently attending the surgery with new presentations, parent is difficult to manage. The GP has concerns about FII and wonders what to do?

A referral should be made to the Safeguarding referral team as the child meets the threshold for a section 47. Do NOT tell the parents that you are referring to safeguarding/suspecting FII.

A section 47 enquiry means that Children’s Social Care must carry out an investigation when they have ‘reasonable cause to suspect that a child who lives, or is found, in their area is suffering, or is likely to suffer, significant harm’ (https://www.scie.org.uk/publications/introductionto/childrenssocialcare/childprotection.asp) . The enquiry involves assessment of the child’s needs and the ability of those caring for the child to meet them. The aim is to decide whether any action should be taken to safeguard the child.

If the child is visibly upset by the visits and investigations and there is no illness found & others have voiced concerns e.g. physio re FII, what should I do?

Urgently refer the child to paediatrics with concerns for FII.

A mum presents to the surgery with her daughter and it evolves she is going abroad for a long period to Zimbabwe. You are concerned about the risk of FGM. What should you do?

Need to explore with the parent about FGM, is this something that is practiced in their community? Are they aware of the fact FGM is illegal and they could go to prison.

Some parents may assure you it is not practiced in their community and they would never subject their children to FGM. If you still suspect that there is a risk of FGM then you should make a referral to social care/safeguarding referral. If you think the child has been subject to FGM then you should phone the police on 101.

A 14 year old female presented to the GP with low mood and anxiety due to lockdown, they are being supported by CAMHS. They disclosed they had been talking to a 48 year old male on Instagram, there had been no sexual content, they had not met, he just discussed her interests. Mum had seen the messages and had contacted Instagram who shut down the account. Should you do anything else?

Make a safeguarding referral – they will/can involve the police, or you could do both. Contact the police child sexual exploitation unit and report this, as it may be a case of grooming.

A 14 year old female who was previously in care (older sister had been sexually abused & there was domestic abuse in the home), is now back living with mum. She has come, accompanied by mum, to ask for contraception. Boyfriend is 18 years old. Mum has no concerns and the social worker has no concerns regarding child sexual exploitation. What should you do?

Enquire about the nature of the relationship – consider doing this without mum being present. Could also consult the Brook Traffic Light tool which discusses expected and unexpected sexual behaviours in different age groups.

A practice wishes to cross reference their child protection register with social care to ensure the list is current. What should they do?

All children on a child protection plan should have minutes stating their child protection status. Data management processes at a practice level should be capturing this on individual’s records with appropriate coding of letters. If correspondence is missing then practices can contact children’s social care.

A parent attends with possible mania and appears agitated. Parents are separated and the other parent has custody of the children. The presenting parent alleged that the parent with custody over the children is physically and emotionally abusing them. What should you do?

Phone first response and check if the children are known to social care, through this discussion you can deem whether or not the children meet the need for referral – is the child being harmed or at risk of significant harm?

Concerns have been raised regarding a mum who is displaying deterioration in mental health, they appear withdrawn, talk to themselves and have self-harmed. They have also been seen holding knives for no obvious reason. They are often alone with the children in the house. It has been noted that all toys have been removed from the house and the bath plug has been destroyed so the children cannot bathe. What do you do?

Refer to the safeguarding referral team as there is a potential risk to the children. Referrals should also be made to the safeguarding referral team if a parent is noted to be intoxicated, have deterioration in mental health and a forensic history.  It is likely that the mum is unable to care for her own needs and will may not be attending to the physical & emotional needs of the children in the home.

An aunt attends the practice to register her nephew. The aunt informs you there is an ongoing court case regarding the residency of the child. What should you do?

Check whether the court case has been instigated by the local authority or privately. You should request to see the local authority paperwork or, if it has been instigated privately, you should request to see the court documents. The mother still retains parental responsibility, she could speak to the practice and give consent for registration at the practice.  It is good practice to gather parental responsibility information for each new patient registering.

A GP notices a child has multiple ‘was not brought’ to appointments and had not attended for their immunisations. The GP had liaised with the health visitor who also voiced concerns about the lack of engagement. The GP made multiple attempts to contact the parents but with no response. They made a safeguarding referral and shortly afterwards mum made a complaint to the practice about the referral. What should you do?

The practice had followed their ‘was not brought’ policy, they communicated well with other members of the multidisciplinary team and made various attempts to contact the parents prior to referring. The referral was appropriate given these circumstances, the GP has a duty of care to the child, no apology to the parent is required. However opening dialogue to allow us to understand the the reasons behind a lack of engagement can be helpful, and potentially facilitate future engagement, support and care as required.

A 16 week old baby has not attended for their immunisations. Mum initially said they had had them elsewhere but then was unable to provide details. The health visitors have no concerns, however, they have had little contact. Mum has parental responsibility and it is thought father is not present.

Mum has the right to decline immunisations, however, it is important to try and understand her reasoning in a non-coercive way.

• Are there other children in the household? Have they been immunised?
• Are there any concerns around mum’s ability to meet the child’s medical, social and emotional needs?
• Is the baby being brought/taken to other appointments?
• Is mum experiencing adversity herself? Substance misuse? Poverty? Abuse? Mental health issues? Learning disabilities?
• Neglect – often a symptom of adverse circumstances affecting adults in the home.
• Why is mum choosing not to engage with immunisations? Is it a fear of the immunisations causing pain? Misinformation? Feeling unsupported herself? Family beliefs? Physically unable to make appointments?
• Parental decision – their decision needs to be informed in a supportive manner and documentation should evidence this.
• Refer to safeguarding if the child’s health needs are not being met, rather than the option of the informed parental choice.

A parent presents to the GP surgery and explains that their 12 year old niece has been inserting objects into her 3 year old daughter’s vagina. They have informed the police who are meeting with the family. What should you do?

Explain that the police need to follow the referral, they will look to arrange a child protection medical at the sexual assault referral centre (SARC), it is not appropriate to refer children to CAU for such medicals. The police should also refer the child to the multi-agency safeguarding hub (MASH).