1. Safeguarding Children Level 3 Training for General Practitioners
Jonathan Leach Director Primary Care/Named GP
Catherine Whitehouse Consultant Nurse
Adrian Todd Detective Inspector
West Mercia Constabulary

2. Looking at the National Picture How big is the problem?
In ,700 children 0-18 years subject to child protection investigation (s47 Children Act 1989)
50% of that number 44,300 children were made subject of Child Protection Plans
Numbers of children suffering or likely to suffer significant harm has increased by 30% over the last two years following the circumstances surrounding the death of Peter Connelly which emerged early in 2009.
Maltreatment figures are much higher from reported children’s experiences (Childline and NSPCC online surveys)
2.5% under 11 years and 6% years had experienced maltreatment from a caregiver in the previous year.

3. Headline Messages
Emotional abuse and neglect – damaging and corrosive impact on children’s long-term life chances. Often comes to light through ‘crisis’ incident or injury
Impact of maltreatment on babies in utero and in first two years particularly damaging
Co-existing parental problems
Witnessing domestic abuse- damaging form of emotional abuse, harms babies as young as 9 months
Pregnancy – high risk period for domestic abuse
Adolescent neglect – difficult to identify, often goes unnoticed

4. Emerging Patterns in Worcestershire
120,000 children and young people 0-18 years
400 currently subject to Child Protection Plans (CPP)
600 Looked After Children
Highest category - 47% of children subject to CPP for neglect.
Often associated with ‘toxic mix’ parental mental health difficulties,
domestic abuse and chaotic drug or alcohol misuse
General Practitioners see on average 2 new safeguarding cases per year

5. Processes and Systems
New Threshold Guidance for Practitioners launched in September 2011 outlining process and detailing sharing of information
All referrals routed through one Access Centre Children’s Social Care
Three Social Workers available to undertake professional conversation with referrer and explain decision making.
Police Officer will also be based in the Access Centre to enable linking of domestic abuse information
Designated and Named Professional’s available through NHS Worcestershire and Worcestershire Health and Care Trust for advice and support in relation to safeguarding concerns.
Purpose of the Professional Conversation
Exploring and Understanding the Concern
Identifying the way forward
Advice/Signposting /Referral 5

6. Information Sharing and Understanding Thresholds

7. Views of General Practitioners The Child, The family and The GP: Tensions and Conflicts of Interest in Safeguarding Children (April 2009)
See role as referring patients or families on where concerns were raised
Supporting parents seen as best way to support children – where serious harm or likelihood of harm evident, the child’s interests must come first
GPs are clear ‘what to do’ if situation is clear cut CP issue
More complicated issues often seek advice from Paediatrician or Health Visitor first
Lack of confidence in responses from Children’s Social Care.
Lack of confidence expressed through not being able to speak directly to a social worker
Over or under response to concerns
Lack of feedback when referrals were made
Potential impact on families of intervention cited as reason for hesitancy in referral and dilemmas in confidentiality 7

8. Guidance on Information Sharing
General Medical Council – Confidentiality and Information Sharing
‘See the adult behind the child’ and ‘see the child behind the adult’ or “think family, not individual”
Safeguarding Children and Young People –A Toolkit for General Practice (2010)

9. Good Practice
Talking to Parents and to young people about concerns and involving them in decisions to share information
Taking time to assess, reassure and consider a response
Arranging for follow up
Allocating separate GPs to parent and child if conflict of interest

10. Good Practice
Sharing worries with other colleagues and engaging in significant event analysis
Utilising the skills of Designated and Named professional’s, Paediatricians
Training and case discussion within the practice
Carefully recording decisions
Use “pop ups” on computers

11. Inter-Agency Working The Role of the Police

12. Learning From Serious Case Reviews and Multi-Agency Case File Audits

13. All babies count: NSPCC November 2011
Almost half of all SCR involve a child under one
Large proportion relate to first three months of life
Practitioner’s underestimate the fragility of the baby
Under one more likely to suffer neglect and abuse than a child of any other age.

14. Analysis of Serious Case Reviews in Worcestershire 2007-2011
Profile
5 out of 8 children under one year
1 of 8 cases was aged 16 years
Cause of Death
2 cases Head Injury
1 case Physical Abuse
1 case Suffocation, Burns and Head Injury
1 case Hypothermia/Drowning
2 cases unascertained

15. Previous Contact with Agencies
None of the children were subject to CPP at the time of injury/death
But
In 2 cases CPP previously in place
In 2 cases CPP had been in place for their siblings
In 2 cases older sibling had been a Looked After Child or placed for adoption

16. Parental History
Parents often had history of abuse and neglect in childhood
Frequent history of being subject to CPP or being Looked After by LA
Frequent moves of address
Criminal behaviour

17. Emerging Themes Parental Mental Health Difficulties Substance Misuse
Resistant Families (Fathers)
Homelessness
Domestic Abuse

18. Pointers for Practice Vulnerability of very young children
Important role of universal services e.g Health and Police
Importance of effective information sharing between agencies
Need for agencies to have processes for escalating concerns
Importance of accessing advice from Safeguarding Leads