This article relates to the CQC key question: Is your practice safe?
Safeguarding children is defined in Working Together to Safeguard Children as:
- protecting children from maltreatment
- preventing impairment of children’s health or development
- ensuring that children grow up in circumstances consistent with the provision of safe and effective care and
- taking action to enable all children to have the best outcomes.
Working Together to Safeguard Children is statutory guidance 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.
All NHS staff must have the competences to recognise child maltreatment and to take effective action as appropriate to their role. They must also clearly understand their responsibilities, and should be supported by their employing organisation to fulfil their duties. Independent contractors, such as 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 and this requires committed safeguarding leadership
On our inspections, our inspectors will want GPs and all other practice staff to demonstrate their competence in safeguarding children and young people at risk:
- demonstrating their understanding of how to identify a child in need of safeguarding
- demonstrating their understanding of their responsibilities in the event of a child or young person’s safeguarding concern, in line with safeguarding policies and procedures. This will be set out in a Safeguarding Children and Young people policy.
- being aware of the internal arrangements for recording a child, or young person, safeguarding concern
- being aware of the external process for reporting the concern and that this is in line with local multi-agency policy and procedures.
Each practice should have a designated lead for safeguarding children and young people. These people have a key role in promoting good professional practice within their organisation, providing advice and expertise for fellow professionals, and ensuring safeguarding training is undertaken.
Child safeguarding in a good practice
In a ‘good’ practice:
- There will be evidence that safeguarding vulnerable children and young people is given sufficient priority within the practice.
- Staff take a proactive approach to safeguarding and focus on early identification. Steps are taken to protect people where there are known risks, with appropriate responses to any signs or allegations of abuse and effective work with other organisations to implement protection plans.
- There are active and appropriate engagement in local safeguarding procedures and effective work with other relevant organisations.
There is clear guidance for training in child safeguarding or child protection from the Royal Colleges about the appropriate competencies and levels of training for different members of staff. These are clearly defined and, for GPs, need to be demonstrated for purposes of annual appraisal and revalidation.
The Intercollegiate Guideline (ICG) "Safeguarding Children and Young People: roles and competences for health care staff" (2014), sets out the competences all health staff must have, and the minimum training requirements necessary, to recognise child maltreatment and take effective action as appropriate to their role.
This framework identifies five levels of competence, and gives examples of groups that fall within each of these:
- Level 1: All staff including non-clinical managers and staff working in healthcare settings. This includes GP practice reception staff.
- Level 2: Minimum level required for non-clinical and clinical staff who have some degree of contact with children and young people and/or parents/carers. This includes practice nurses and healthcare assistants
- Level 3: Clinical staff working with children, young people and/or their parents/carers and who could potentially contribute to assessing, planning, intervening and evaluating the needs of a child or young person and parenting capacity where there are safeguarding/child protection concerns. This includes GPs.
- Level 4: Named professionals
- Level 5: Designated professionals
Practices may also find it useful to refer to Safeguarding children and young people: the RCGP/NSPCC Safeguarding children toolkit for general practice (2014).
This RCGP toolkit takes account of new policies, legislation and emerging evidence as well as the constraints of the 10 minute consultation and the pressures of 21st century general practice. It is not a textbook of child safeguarding but a practical workbook for busy GPs and their teams, designed to help practice staff recognise when a child may be at risk of abuse, to know what to do if there are concerns and to ensure that as a practice the team works with other disciplines and agencies to achieve the best possible outcomes for children by safeguarding and promoting their welfare.
RCGP Chair Dr Maureen Baker said: 'This guidance highlights the changing landscape of general practice - and how GPs are on the frontline of increasingly complex health and societal challenges.
'Children and young people today are facing unprecedented pressures from all angles at a younger and younger age and a consultation with a GP may be the only time that they can be alone with a trusted adult.
'GP teams have a number of roles to play in providing understanding, compassion and support. The unique relationship between GP and patient places us in an ideal position to identify potential risks to the physical and mental health of our young people, along with the legal and safeguarding protocols and support networks that are available to them.
'The toolkit brings together the information and procedures necessary to make informed, appropriate and confident decisions about the health and safeguarding of younger patients in general practice.
'We are pleased to be working with the NSPCC in this area and hope that you will share this guidance as widely as possible to support GPs and other health professionals working with children and young people so that they receive the best care and advice possible.'
This mythbuster aims to provide practices and our inspection teams with information to ensure a framework for safeguarding children and young people is integrated into existing practice systems and processes for delivering primary care. The emphasis should be education and training as a means to acquiring necessary skills and competences rather than 'training' as an end in itself.
- Working Together to Safeguard Children
- Safeguarding Children and Young People: roles and competences for health care staff (2014),
- Safeguarding children and young people: the RCGP/NSPCC Safeguarding children toolkit for general practice (2014)
Professor Nigel Sparrow is senior national GP advisor and responsible officer at the CQC
More CQC resources
- View the full CQC Essentials series on Medeconomics
- CQC's recommended reading to help practices meet regulations and prepare for an inspection