Persuading GPs to become properly involved in child protection strategies can leave social workers feeling frustrated. Yet GPs have a key role in identifying signs of abuse or neglect. What can frontline staff do to improve matters, asks Julie Griffiths
More needs to be done to ensure GPs are proactive in doing all they can to keep children safe. So said Lord Laming’s progress report The Protection of Children in England last year.
But how can this change when social workers report a widespread failure by GPs to engage in child safeguarding strategies and attend case conferences?
The first step has to be improving GPs’ understanding of child protection, says Joanna Nicolas, a consultant, trainer and social worker. Doctors are focused on patient confidentiality, sometimes to the exclusion of everything else, says Nicolas. “When a GP gets a phone call from a social worker, it’s often difficult to get information,” she says. “They don’t understand what their child protection responsibilities are.”
Nicolas believes that GPs will not take an interest in child protection until there is a legal requirement for them to do so. One suggestion is adding it to the GP contract.
But Dr Richard Vautrey, deputy chairman of the British Medical Association’s GPs committee, says this is missing the point. “I don’t think having it in the contract would make much difference. It’s not about making it an obligation; it’s about understanding what information is needed and how it’s asked for,” he says.
Just as social workers feel GPs lack understanding about their work, GPs shunt the same criticism back at them. Dr Vautrey says it is unrealistic to send huge reports to general practice with the expectation that the GP has time to pick out relevant information. There is also the problem of giving short notice of case conferences, allowing no time to arrange cover for surgery.
Research on the topic published last year by Hilary Tompsett, head of social care at Kingston University, found the fundamental problem is a mismatch of expectations.
Her report, The Child, The Family and the GP, found that GPs saw their role as referring patients where there were concerns while social workers expected fuller engagement in child protection processes.
Tompsett says there is also often a lack of confidence in child protection services among GPs, which may explain a reluctance to become more involved.
“They felt the response from social services was not always as they would wish. Sometimes it was to go in with all guns blazing, or to do nothing,” she adds.
But there are some positive examples of good inter-professional working. At a national level, Tompsett points to the Royal College of General Practitioners initiative to raise GPs’ awareness of child safeguarding. The college has produced a joint toolkit with the NSPCC entitled Safeguarding Children and Young People which is used in GP training. According to RCGP chairman Steve Field all new GPs now routinely receive training in this area to recognise possible presentations.
There are also ways of improving the situation locally. In Bolton, it was noted that GP attendance at conferences was poor. This led to an initiative to understand barriers to GPs attending and ways of removing them. Now, instead of sending full reports to doctors, a template has been created so that GPs receive the key bits of information
Social workers can also make a difference. Stockport GP Dr Janice Allister says that working together becomes easier the better the GP knows the worker. This reduces any fears about social workers’ intervention making a situation worse and damaging the doctor-patient relationship. “Going to case conferences often means re-arranging something and GPs will probably be more open to it if the relationship is there,” she says.
Top tips for gaining GPs’ co-operation
Be specific in requests to GPs
Dr Richard Vautrey, of the British Medical Association’s GP committee, says doctors want to engage in child safeguarding, but the system stands in the way: “Social workers need to be more focused in their requests and be realistic about what a GP can deliver. There’s no point in cascading vast volumes of reports to us that are not specifically directed at general practice”.
Make it easy for GPs to get involved by summarising what is required
Wessex Local Medical Committee has written a policy template for practices which sets out the responsibilities of different members of the team.
The template suggests appointing a practice lead on child protection who would act as a single point of contact for social workers and external agencies, making relationships and the system more straightforward and efficient.
Wessex LMC director Sheila Williams says there are so many reports on child safeguarding that the template policy took her three months to write. It is impractical to expect busy practices to do this for themselves, she says. “One policy alone was 500 pages. There’s too much for them to wade through.”
If LMCs, councils and PCTs work together it becomes easier for everyone involved. In addition, some practices are now organising their own practice training days on child safeguarding. Southampton Council has asked the LMC to put on local training aimed at practice managers and GPs.
Avoid Mondays when arranging case conferences
Carmarthenshire GP Chris John says it helps to give plenty of notice before a meeting so doctors can arrange cover for their regular clinics. It is also useful to think about the day, time and location.
“Social workers have a lot of pressure on them and it’s not easy to arrange meetings that have lots of people going to them but certainly, having a case conference on a Monday morning is difficult for us,” he says.
Dr John was involved in drawing up joint guidelines last January with the LMC, health board and children’s services on the attendance of GPs at case conferences.
Holding a meeting in primary care premises works well in his area, although he acknowledges that not all practices will have the room.
Make sure you are contacting the right GP
Dr Janice Allister, secretary of the Primary Care Child Safeguarding Forum at Stockport PCT, says there are likely to be several GPs in a practice who know the family. Social workers need to be more targeted in approaching the right one.
“Social workers need to find out who to speak to and when would be the best time to reach them,” she says.
Explaining to a GP why their involvement is needed can also be useful, she adds. If it is to find out the context of the wider family, then say so and tell the GP why this is important. “If they know the conference will benefit their patient they are more likely to go,” she says.
This article is published in the 11 February 2010 edition of Community Care under the headline “Healthy relations?”
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