- Involve patients in decisions about their care.
- You can disclose information to protect the patient or others from harm.
- Work in partnership with local safeguarding organisations.
Separate laws relating to safeguarding apply in different parts of the UK. All emphasise the need for healthcare providers to raise concerns about adults at risk of harm and for effective cooperation and information-sharing between local agencies:
Also relevant are the Mental Capacity Act 2005 and the Adults with Incapacity (Scotland) Act 2000, which protect the rights of vulnerable adult patients to make decisions about their own care and treatment. The Mental Capacity Act 2005 made ill-treatment and wilful neglect of adults without capacity a criminal offence.
Types of abuse
Safeguarding means protecting an adult's right to live in safety, free from abuse and neglect, and is an ethical and legal duty for all doctors. GPs in particular are often in a good position to notice changes in an adult that may indicate they are being abused or neglected.
Consider risk factors that might make a patient vulnerable, such as:
- Personal circumstances – mental or physical disability, substance abuse, frailty.
- Environment – living conditions, family circumstances, available help and support.
Be vigilant for signs of possible harm or abuse, including:
- Physical abuse – such as pushing, restraint, slapping and unexplained injuries.
- Domestic violence – such as emotional and physical abuse, 'honour' based violence.
- Sexual abuse – rape, sexual harassment, exploitation.
- Psychological abuse – humiliation, verbal abuse, coercion.
- Financial abuse – such as coercion in relation to a patient's will.
- Modern slavery – trafficking and forced labour.
- Neglect – ignoring medical, physical or emotional care needs.
- Discrimination on grounds of race, gender, age, disability, sexual preference, religion.
- Organisational abuse – neglect/poor practice within a care setting or care provided in the home.
Good safeguarding practice
The Department of Health's best practice guidance for healthcare practitioners establishes six principles that should underpin adult safeguarding policies and procedures.
- Empowerment – patients are supported and encouraged to make their own decisions.
- Protection – support and representation for those in greatest need.
- Prevention – prevention of harm or abuse is a primary goal.
- Proportionality – the least intrusive and restrictive response appropriate to the risk presented.
- Partnership – working collaboratively with local communities and services to prevent, identify and respond to harm and abuse.
- Accountability – accountability and transparency in delivering safeguarding.
To ensure you are able to meet their safeguarding obligations, your organisation should have effective arrangements in place, including:
- Regular mandatory staff training in safeguarding. Everyone in the practice team should be aware of their personal responsibility to report concerns and know the reporting process.
- A named lead for adult safeguarding who can organise training, advise staff and oversee the reporting of concerns.
- Safe recruitment practices and arrangements for dealing with allegations against people who work with vulnerable adults.
- A suite of safeguarding policies, including a chaperoning policy.
- Procedures of information-sharing and working with other agencies to protect adults at risk.
Raising safeguarding concerns
If you have reasons to believe an adult patient is being abused or is at risk, take the following steps:
- If your concerns arise during a consultation, establish the facts and the extent of the abuse as far as you can. For example, is there an emerging pattern of abuse? What is the impact on the patient? Are others at risk? If you raise the issue with your patient, make sure they have the support they need and that the suspected abuser is not present.
- If the patient has capacity, you should usually seek their consent before taking action. A vulnerable patient may have difficulty in understanding or expressing their wishes, but the GMC expects you to involve the patient in decisions about their care and protection.
- If a patient with capacity refuses consent for you to raise concerns, you should usually respect this, unless disclosure is required by law or can be justified in the public interest. The GMC's confidentiality guidance states: 'When victims of violence refuse police assistance, disclosure may still be justified if others remain at risk.' Where practicable, you should tell the patient if you intend to disclose information, unless this would undermine the purpose.
- If the patient lacks capacity and you believe they are being neglected or physically, sexually or emotionally abused, you must inform an appropriate responsible person or statutory agency, in line with local arrangements.
- In most cases, concerns should be raised with the local Safeguarding Adults Board (or equivalent). However, if you believe a criminal offence may have been committed, this should be reported promptly to the police to ensure forensic evidence is not lost or contaminated. Seek advice from your local safeguarding lead, health board or the MDU if you are unsure whether or how to raise concerns.
- If the authorities request information about a vulnerable adult patient, you can share relevant information with the patient's consent, in line with local information-sharing protocols.
- Where information is shared against the patient's wishes (for example, to protect others at risk) the rationale for decision-making should be recorded. If you decide to disclose information, the GMC says you should 'inform the patient first, if it is safe and practicable to do so, even if you intend to disclose the information without consent'. The NHS Confidentiality Code of Practice says: 'Wherever possible the issue of disclosure should be discussed with the individual concerned and consent sought. Where this is not forthcoming, the individual should be told of any decision to disclose against his/her wishes.'
Allegations against healthcare staff
If you believe vulnerable adult patients are at risk within a healthcare setting, either from neglect or poor professional practice, you have a duty to raise your concerns.
- The GMC says you have a duty to act if you believe 'patient safety or care is being compromised by the practice of colleagues...' This duty overrides any personal or professional loyalties.
- If you are concerned about a colleague, follow your organisation's procedures for raising concerns about staff members. NHS England has produced a policy for managing allegations against NHS staff, including GPs. This says allegations should be reported to your line manager, the safeguarding senior officer and the safeguarding lead so an immediate risk assessment can be made and actions agreed (this may include informing the police and social services).
- If the concerns relate to another care provider, such as a care home, you should usually inform a senior manager in the first instance. However, if they are implicated, you may need to inform the Care Quality Commission or equivalent regulator. Seek advice from your local safeguarding lead if you are unsure.
- Keep a written record of your concerns and the steps you have taken to resolve them.
- Expect to be updated. If you believe nothing has been done to address the issue, you may need to inform the regulator, for example the Care Quality Commission. Seek advice from the MDU first.
- Employers are obliged to obtain Disclosure and Barring Service (DBS) (or Disclosure Scotland) checks if staff work with vulnerable groups. Your duties as an employer also include providing information to the DBS about employees who may pose a risk, or who have harmed children or vulnerable adults.
This guidance was correct at publication 25/03/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.