GPs often have the greatest chance of spotting behaviour patterns and risk factors that a child may be being abused. Charlotte Hudson presents some child safeguarding tips for locums on the steps they can take to recognise the signs.
The past year has seen high-profile media coverage about the maltreatment of children – from children groomed for sex by gangs of men, to cases of horrific abuse and neglect such as those of Daniel Pelka and Keanu Williams. GPs are well-placed to spot early signs of abuse or risk factors that may transcend into abuse. In primary care, GPs remain the first point of contact for most health problems. A GP partner or regular salaried GP is more likely to have a wider understanding of family dynamics. However, there are some general indicators that locum doctors should be aware of and look out for. These include (but would not be limited to):
- Family environment
- Frequency of attendances
- Avoiding certain carers/seeing a different GP at each visit
- Number of calls to OOH
- A+E attendances
- Presentation with unusual injuries and/or bruising patterns
- Behavioural problems
- Difficult interactions with parents/carers/adults/older children
- Age-inappropriate sexualised play/knowledge
- Developmental problems
One of the most effective ways of ensuring that children are safeguarded is by working in partnership with parents and carers. A GP may be the first to recognise parental and/or carer health problems, or behaviour in an individual that might pose a risk to children and young people. Locum doctors should be aware of possible parental risk factors including domestic abuse, drug and alcohol abuse, and a history of abuse or offending; all of which might impact on parenting quality and childcare abilities. GPs should be vigilant in identifying potentially vulnerable mothers and families in difficulty, for example, at the antenatal booking appointment.
The NSPCC’s How Safe are our Children? (2014) report highlights some statistics: “Children living in households where there is domestic violence are known to be more likely to experience abuse and neglect. Reviews of cases where a child has died or was seriously injured in England, Northern Ireland and Scotland show that domestic violence was present in the family in more than 50 per cent of these cases.”
Frequency of attendances
Both infrequency and frequency of GP attendances may raise the suspicion of risk. Children who are rarely or never seen may be at risk of abuse and neglect. Locums should always consider and rule out the possibility of abuse in these situations.
As a locum, you may not be made aware of patients who have not brought their child for screening or immunisations appointments, so it would be difficult for you to follow-up patients who fail to make or keep such appointments. You should, wherever you are aware of missed appointments, document this in the medical record and leave a handover note for the patient’s regular GP to follow this up.
Both infrequency and frequency of GP attendances may raise the suspicion of risk.
Parents bringing their child to the practice frequently can also be a potential risk factor for abuse. You should ensure you check the medical records of the child you are seeing as a locum GP, to see if previous attendances have been for the same reason and if other doctors have raised concerns. Also look out to see whether they have seen a different GP each time, as this may be a risk factor.
OOH and A&E attendances
The Safeguarding Children and Young People: Toolkit for General Practice (2011) states that children who don’t attend for routine appointments may frequently present at OOHs and A&E departments for care of acute conditions – this is a known potential indicator of risk. Some practices might have developed routine searches and flagging to identify such children. If you become aware, for example, on faxed summaries, that a child has presented to OOH or A+E instead of the usual GP, raise this with one of the regular GPs.
The NSPCC’s 2014 report, How safe are our children? provides a number of child abuse and neglect statistics and risk indicators. An interesting risk indicator discussed is poverty and poor housing, and its relationship with child abuse and neglect. The report states that an unsafe environment and the impact of parental stress have been found to be factors in some Serious Case Reviews and where children are subject to child protection plans.
The report states: “Research has found that children who live in the most deprived 10 per cent (decile) of neighbourhoods have a 10 times greater chance of being on a child protection plan and an 11 times greater chance of being taken into care than children in the least deprived 10 per cent (decile).”
NSPCC stats – over 43,000 children in England were identified as needing protection from abuse in 2013.
All GPs should know about child maltreatment in its different forms (physical, emotional and sexual abuse and neglect), and should draw on their clinical and professional knowledge and expertise to identify the risk factors associated with abuse or neglect. Locums should be aware of possible risk indicators and bear them in mind when seeing patients for the first time.
Writer and editor at MPS. MPS’s educational risk management workshops, ‘Mastering Professional Interactions’ and ‘Medical Records for GPs’ provide further information on the risks to patients and doctors when patient care passes between doctors, and on good record-keeping. They are free as a benefit of membership to MPS members too.