Everyone working with children has a duty to safeguard and promote their welfare and should be able to recognise and act on signs that a child may be at risk of abuse or neglect.
GPs in particular play a vital role in identifying children at risk, and should be familiar with their local child protection procedures and who to contact if they suspect abuse is taking place.
Child abuse is an emotive, sensitive and often very difficult issue for doctors to deal with.

Consider the following principles.

Best interests

In child protection cases, your primary responsibility is to the child; the interests of the child should take precedence over the interests of the parent or carers.

At all times, the best interests of the child should inform your decision-making and safeguarding responsibilities.

Sharing concerns

The GMC guidance states that:

A doctor's duty of confidentiality is the same for children as for adults, but in situations where you consider there may be a risk of abuse, it may be appropriate to disclose limited information proportionate to the risk of harm, with authority if possible.
If the child does not have the capacity to consent, you should seek authority from the parents or a person with parental responsibility, but not if this could jeopardise the child's safety.

Concerns should be raised through the appropriate channels. You can seek advice from us in such cases, but it's also important to share any concerns with your local designated person for child protection, such as a doctor or nurse at your Clinical Commissioning Group (CCG). They can help you reach a decision as to whether a disclosure is necessary and can be justified in preventing harm.

Justification

You'll be able to justify raising a concern that proves to be groundless if you've done so based on a reasonable belief and through the appropriate channels.

The GMC's Protecting children and young people guidance also makes it clear that you must be able to justify a decision not to share a concern that a child or young person may be at risk of abuse or neglect. You should record your concerns, discussions and reasons for not sharing information in these circumstances.

If you're in any doubt about whether to share information, you should seek advice from an experienced colleague or a named and designated doctor for child protection. You can also contact us for advice on dealing with this sensitive issue.

Guidance

If you have concerns about a child who may be at risk of neglect or harm, you must act on your concerns in accordance with local and national guidelines. National guidelines on child protection include:

the GMC's Protecting children and young people
the Department of Education's Working together to safeguard children
NICE guidance: Child maltreatment - recognition and management and updated Child abuse and neglect.
the Royal College of Paediatrics and Child Health (RCPCH): Safeguarding children and young people: roles and competencies.

The RCPCH also have more resources on child protection.

Checklist

Here are a few things to keep in mind around child protection.

Be aware of local procedures and relevant national guidance.
You have a duty to act on any concerns you may have that a child may be at risk.
Each case should be judged on its own merits.
When possible, seek consent for disclosure, although you may disclose information to the police or social services without consent or parental authority if it is needed to safeguard a child. Disclose only the information necessary for the purposes and on a need-to-know basis.
Consider arranging or requesting training in child protection for yourself and your staff if needed. The Royal College of Paediatrics and Child Health recommends that all healthcare professionals should have basic child protection training (level one) and that those in regular contact with children should have standard child protection training (level two or above).

Case example

A 19-year old patient with a three-year old child attended the surgery for a routine appointment but the GP noticed that the mother had unusual bruising on her cheek.

She initially said that this was a result of a fall, but later disclosed that her partner had pushed her during an argument and she had fallen.

She told the GP that her partner had a quick temper and that similar incidents had occurred in the past.

The GP was concerned that this history of domestic violence suggested that the child may be at risk, and wondered whether they should disclose concerns to social services.

The MDU advised that the GP should:

Discuss the concerns with the patient, as they may be able to provide further information.
Discuss the concerns with partners at the practice - this could be particularly helpful if any of them are familiar with the patient and her family.
If, after discussing with the patient and within the practice, there is reasonable concern that the child may be at risk, seek the mother's consent to disclose the information to social services, unless it is considered that this may undermine the purpose of the disclosure or jeopardise the child's safety.
If there are doubts about whether or not a disclosure should be made, discuss the case anonymously with the designated person for child protection.
If satisfied that there may be a risk to the child, disclose only the information necessary to safeguard the child to the relevant authorities.
Make careful notes of how any decision was reached.
If a decision is reached to disclose information to social services, inform the mother about this decision, unless to do so would undermine the purpose of the disclosure or put the child at risk.

Safeguarding children at risk of neglect or abuse

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