GP safeguarding spreadsheet resource – Dr Rob Howlett

Whilst the CQC will certainly be interested to ensure that practices and staff know how to recognise and respond to vulnerable adults, the safeguarding adults training requirements for GPs in this area (and for now, the appraisal requirements) are less clearly defined than they currently are for safeguarding children and young people.

What adult safeguarding training should GPs be doing?

In the absence of current clear guidance, you could consider translating the level 3 competencies required for child safeguarding across to safeguarding adults:

Level 3 competencies for safeguarding adults – GPs

Knowledge

• Aware of national guidance, professional duties of care
  • e.g. Mental Capacity Act 2005 which includes the Deprivation of Liberty Safeguards
• Aware of local adult safeguarding board arrangements
  • e.g. make it one of your appraisal supporting evidence items to study and reflect on local pathways and document this for your appraisal.
• The importance of information sharing and confidentiality.

Clinical knowledge

• Different forms of abuse and neglect and how these can manifest.
• How to share information appropriately, taking into consideration confidentiality and data-protection issues.

Skills

• Able to contribute to, and make considered judgements about how to act to safeguard/protect a vulnerable adult.
• Able to present safeguarding concerns verbally and in writing for professional and legal purposes as required (and as appropriate to role, including case conferences, court proceedings etc).

Recording your competencies

Document learning from significant events or case reviews involving vulnerable adults.

Adult safeguarding toolkits and e-learning for sessional GPs

• • The BMA’s Safeguarding vulnerable adults – a toolkit for general practitioners.
  • e-Learning for Healthcare has a Safeguarding Adults area.
  • NASGP’s advice on Oliver McGowan training.
  • Training organised by CCGs and other local organisations:
    • There will probably be more locally organised training as the Care Act 2014 requires Safeguarding Adults Boards to work with CCGs (and others) to provide this.
    • These are useful as they are often multi-agency and can give you a greater insight into how agencies such as social care, health care workers and police interact.

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We all know why safeguarding training is so necessary for safeguarding children.

After every high profile case of child neglect and abuse over recent years, the same failures and lapses emerge; poor communication and information-sharing between professionals and agencies, inadequate training and support for staff, and a failure to listen to children. So no-one begrudges getting skilled up in this key area.

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How should GPs get safeguarding children training, and what evidence will appraisers and practices want to see?

Thankfully, there is clear guidance in Safeguarding children and young people: roles and competences for health care staff, an intercollegiate document from March 2019.

GPs require level 3 competence

Highlighted quotes relevant to GPs from its 102 pages include:

• Over a three-year period, professionals should receive refresher safeguarding children training equivalent to a minimum of 12 hours (for those at Level 3 core this equates to a minimum of 2 hours per annum).
• Training in safeguarding children at level 3 will include the training required at level 1 and 2 and will negate the need to undertake refresher training at levels 1 and 2 in addition to level 3.
• Training, education and learning opportunities should be multi-disciplinary and inter-agency, and delivered internally and externally. It should include personal reflection and scenario-based discussion, drawing on case studies, serious case reviews, lessons from research and audit, as well as communicating with children about what is happening.
• Educational sessions could be a combination of e-learning, personal reflection and discussion in clinical meetings or attendance at internal or external outside training courses.
• Safeguarding children training can be tailored by organisations to be delivered annually or once every three years and encompass a blended learning approach.

In addition to appraisal requirements, the CQC also takes a view on this:

• The CQC reference the statutory guidance ‘Working Together to Safeguard Children’ which helps professionals understand what they need to do, and what they can expect of one another, to safeguard children. It focuses on core legal requirements and makes it clear what individuals and organisations should do to keep children safe.
• “GPs in particular have a responsibility to ensure that all staff across their organisations have the knowledge and skills to be able to meet this requirement.”

Safeguarding: GP appraisal and revalidation requirements

Note that this RCPH guidance is talking about minimum requirements, and there may well be variation in how appraisers in different areas apply this.

Indeed, it seems that some local area teams are piloting adding Safeguarding as an item in supporting information for appraisal, which may one day become nationally agreed.

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Essential info: GP safeguarding 

• Aim for minimum of 12 hours of refresher level 3 training over three years (with the exception of GP Practice Safeguarding Leads who will require 16 hours).
• Training and education can be a combination of various forms e.g. training courses, e-learning, personal reflections on cases or having read guidelines.
• Submit this evidence to your appraiser every year, and if working across different practices who ask for evidence from you that you satisfy the CQC’s requirements, provide a signed letter from you stating that you submit this and any other relevant evidence in your annual NHS appraisal.
• Ensure that the employing practice undertakes its responsibilities too by ensuring you have access to all its safeguarding information, ideally by giving you access to its Standardised Practice Information Portal.

Check with your appraiser. This guidance may be a useful reference if your appraiser’s requirements seem overly onerous or prescriptive.

Child abuse and child neglect – how to spot the signs

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This is something that more of us are being asked to provide proof of by practice managers. It’s generally not something that’s expected as part of our NHS appraisal evidence, but is something that the CQC are asking practices for proof of.

In 2011 the Dept of Health and the Information Commissioner’s Office wrote to all NHS staff:

All NHS organisations (and others with access to NHS patient information) should ensure all staff undertake appropriate information governance training annually as identified in the NHS Information Governance Toolkit.

If you’re a partner or a salaried GP, or work with a hospital or CCG etc, it’s likely that you already undertake annual online training with Health and Social Care Information Centre HSCIC, and can just provide evidence of that.

If you’re a locum, and are being asked for this

• speak to a friendly local practice, or insist* on your CCG adding you to their IG training account with HSCIC.
• and work for an agency, they will probably organise this for you.
• and in a chambers or sessional GP group, you may be able to organise this as a talk (from your CCG’s IG lead?).

If you’re not being asked for this

• If you personally feel it’s a learning requirement, discuss it with your appraiser at your next appraisal.

*seriously, if it’s so important that you’re being required to do it, your CCG needs to put its money where its mouth is and support its GPs.

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Although all GPs should have an annual Basic Life Support update, it is not mandatory.

In its framework for appraisal and data to Responsible Officers, NHS England says that evidence of annual BLS training should be expected from GPs. This is apparently a nationally agreed item that will be flagged to the responsible officer if it is absent, but confusingly, is “not necessarily directly relevant to the doctor’s revalidation recommendation.” Which goes with our interpretation is that it’s good to get BLS training annually, but it’s not mandatory.

So can you skip BLS training in your appraisal? Arguably yes, but since you can’t skip the mandatory 50 hours of CPD, you may as well include an hour of BLS, and allay any pre-appraisal anxiety about having any argument with your appraiser.

Here at NASGP we’ve tried a few accredited online training modules, and our favourite is the one from Blue Stream Academy. We’ve got an exclusive offer for NASGP members for a 20% discount of not just this, but over 60 other online practice-based modules, including BLS, child and adult safeguarding too.

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