Safeguarding Children

GMC guidance refers to an Intercollegiate document (see below). An updated version was released in January 2019. The ultimate statement to which we are beholden is:

“It is now recognised that the complexity of relationships with child and young people patients and their parents and carers in the primary care context (see MRCGP Curriculum Statement 8) requires level 3 competences. For the purposes of annual GP Appraisal and revalidation, GPs should have all the competences in level 2 and be at or be able to demonstrate they are working towards level 3. The GMC and RCGP state that for the purposes of revalidation, GPs need to demonstrate that they are up to date and fit to practise in all aspects of their work. Level 3 describes the scope of work of GPs in relation to safeguarding children and young people. It is the responsibility of GPs to demonstrate that they maintain their competence. A GP may keep up to date in a variety of ways, for instance completing an elearning module, attending a training session in or out of the practice or reading appropriate guidelines. There should not be a defined frequency of updates; the important point is that it is the responsibility of the GP, in their appraisal, to demonstrate they are competent and up to date. Case reviews and critical incident reviews can be used to show how knowledge and skills are used in practice.”

This is no change to the current view which we hold at Wessex LMCs. The real test is if you were unfortunate enough to have a child death in your practice and were challenged, could you face the Coroner or the GMC and defend your level of knowledge or training?

What are the  level 3 competencies I need to have?

Taken from the Intercollegiate document:

General Practitioners

Knowledge

• Aware of the implications of legislation, inter-agency policy and national guidance.
• Understand the importance of children’s rights in the safeguarding/child protection context, and related legislation.
• Understand information sharing, confidentiality, and consent related to children and young people.
• Aware of the role and remit of the LSCB/the Safeguarding Board for Northern Ireland and the safeguarding panel of the health and social care trust/child protection committee.
• Understand inter-agency frameworks and child protection assessment processes, including the use of relevant assessment frameworks.
• Understand the processes and legislation for Looked After Children including health assessments and after-care services.
• Have core knowledge (as appropriate to one’s role) of court and criminal justice systems, the role of different courts, the burden of proof, and the role of a professional witness in the stages of the court process.
• Understand relevance of multi-agency audits and own role in multi-agency inspection processes.

Clinical knowledge

• Understand what constitutes, as appropriate to role, forensic procedures and practice required in child maltreatment, and how these relate to clinical and legal requirements.
• Understand the assessment of risk and harm.
• Understand the effects of parental/carer behaviour and family factors on children and young people, and the inter-agency response.
• Know the issues surrounding misdiagnosis in safeguarding/child protection and the effective management of diagnostic uncertainty and risk.
• Have an understanding of Fabricated or Induced Illness (FII).
• Have an understanding of emerging evidence on child sexual exploitation and FGM.
• Have an awareness that vulnerable young people may become victims of radicalisation.
• Know when to liaise with expert colleagues about the assessment and management of children and young people where there are concerns about maltreatment.
• Understand the needs and legal position of young people, particularly 16-18 year oldsliv, and the transition between children’s and adult legal frameworks and service provision.
• Understand the principles of consent and confidentiality in relation to young people under the age of 18 including the concepts of Gillick Competency and Fraser Guidelines.
• Know how to share information appropriately, taking into consideration confidentiality and data-protection issues.
• Understand the impact of a family’s cultural and religious background when assessing risk to a child or young person, and managing concerns.
• Know about models of effective clinical supervision and peer support.
• Understand processes for identifying whether a child or young person is known to professionals in Children’s Social Care and other agencies.
• Aware of resources and services that may be available within Health and other agencies, including the voluntary sector, to support families.
• Know what to do when there is an insufficient response from organisations or agencies.
• Know the long-term effects of maltreatment and how these can be detected and prevented.
• Know the range and efficacy of interventions for child maltreatment.
• Understand procedures for proactively following up children and young people who miss outpatient appointments or parents under the care of adult mental health services who miss outpatient appointments.
• Have an understanding of the management of the death of a child or young person in the safeguarding context (including where appropriate structures and processes such as rapid response teams and Child Death Overview panels).
• Understand and contribute to processes for auditing the effectiveness and quality of services for safeguarding/child protection, including audits against national guidelines.

Skills

• Able to contribute to, and make considered judgements about how to act to safeguard/protect a child or young person.
• Able to work with children, young people and families where there are child protection concerns as part of the multi-disciplinary team and with other disciplines, such as adult mental health, when assessing a child or young person.
• Able to present safeguarding/child protection concerns verbally and in writing for professional and legal purposes as required (and as appropriate to role, including case conferences, court proceedings, core groups, strategy meetings, family group conferences, and for children, young people and families).
• Able to contribute to, and make considered judgements about how to act to safeguard/protect a child or young person.
• Able to work with children, young people and families where there are child protection concerns as part of the multi-disciplinary team and with other disciplines, such as adult mental health, when assessing a child or young person.
• Able to communicate effectively with children and young people, ensuring that they have the opportunity to participate in decisions affecting them as appropriate to their age and ability.
• Able to give effective feedback to colleagues.
• Able to identify (as appropriate to specialty) associated medical conditions, mental health problems and other co-morbidities in, children or young people which may increase the risk of maltreatment, and able to take appropriate action.
• Able to assess as appropriate to the role the impact of parental, carer and family issues on children, and young people, including mental health, learning difficulties, substance misuse, and domestic abuse.
• Able to challenge other professionals when required and provide supporting evidence.
• Able to provide clinical support and supervision to junior colleagues and peers
• Able to contribute to inter-agency assessments and to undertake an assessment of risk when required
• Able to identify and outline the management of children and young people in need
• Able to act proactively to reduce the risk of child/young person maltreatment occurring
• Able to contribute to and make considered decisions on whether concerns can be addressed by providing or signposting to sources of information or advice.
• Able to participate and chair multi-disciplinary meetings as required.
• Able to apply lessons from serious case reviews/case management reviews/significant case reviews.
• Able to contribute to risk assessments.
• Able to write chronologies and reviews that summarise and interpret information about individual children and young people from a range of sources.
• Able to contribute to a management plan for FII.
• Able to contribute to/formulate and communicate effective management plans for children and young people who have been maltreated.
• Able to complete the audit cycle and/or research related to safeguarding/child protection as part of appropriate clinical governance and quality assurance processes.
• Able to obtain support and help in situations where there are problems requiring further expertise and experience.

Attitudes and values

• Understands the importance and benefits of working in an environment that supports professionals.
• Understands the potential personal impact of safeguarding/child protection work on professionals.
• Recognises when additional support is needed in managing presentations of suspected child maltreatment, including support with all legal and court activities (such as writing statements, preparing for attending court) and the need to debrief in relation to a case or other experience.
• Recognises the impact of a family’s cultural and religious background when assessing risk to a child or young person, and managing concerns.
• Recognises ethical considerations in assessing and managing children and young people.
• Understand the possible lifelong impact of abuse on adult survivors.
• Competence should be reviewed annually as part of staff appraisal in conjunction with individual learning and development plan.

Are there a specific number of hours I need to ‘log’?

No, in the Intercollegiate document indicative times are given. The main thing is that you achieve the competencies and are kept up to date.

For guidance only the Intercollegiate document suggests the following: 

For those individuals moving into a permanent senior level post such as substantive career grade, consultant, GP or team leader who have as yet not attained the relevant knowledge, skills and competence required at level 3 it is expected that within a year of appointment additional education will be completed equivalent to a minimum of 8 hours cxx of education and learningcxxi related to safeguarding/child protection, and those requiring specialist-level competences should complete a minimum of 16 hours cxxii cxxiii.

• Over a three-year period, professionals should receive refresher training equivalent to a minimum of 6 hours (for those at Level 3 core this equates to a minimum of 2 hours per annum) and a minimum of 12-16 hours (for those at Level 3 requiring specialist knowledge and skill) cxxiv
• Training 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. This should be appropriate to the speciality and roles of the participants. At level 3 this could also for example include attendance at a HealthWRAP/prevent cxxv workshop where appropriate. Organisations should consider encompassing safeguarding / child protection learning within regular multi-professional and/or multi-agency staff meetings, vulnerable child and family meetings, clinical updating, clinical audit, reviews of critical incidents and significant unexpected events, and peer discussions.

cxx Two Programmed Activities (PA)s/sessions

cxxi 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

cxxii For those professional groups who may have previously been placed at Level 2, transitional arrangements should be put in place to enable attainment of core Level 3 education and training over an 18-month period

cxxiii Those undertaking level 3 training do not need to repeat level 1 or level 2 training as it is anticipated that an update will be encompassed in level 3 training

cxxiv Training can be tailored by organisations to be delivered annually or once every 3 years and encompass a blended learning approach

 

Somerset CCG Safeguarding Children - Safeguarding Training and Somerset CCG Safeguarding Policy 

Somerset CCG - Full Safeguarding Professionals Contact List October 2020

Safeguarding Children and Young People the RCGP Toolkit for General Practice

Safeguarding children and young people:roles and competences for health care staff Intercollegiate Document

Rapid Training Guide for GPs returning for Covid - free online resources (you will need to register) which meet the refreshers requirements can be found at e-lfh learning for Healthcare

Somerset GP Education Trust (SGPET) - Introduction to Safeguarding ChildrenTraining 

What CQC is looking for in relation to Safeguarding

Online training available through Blue Stream academy via the LMCs buying group

 

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