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UK

It’s not enough to train general practitioners in child protection. What happens next?

Following a colleague’s retirement I have now become the safeguarding lead for children at my GP practice. This means that I review cases, update our practice policies on safeguarding children and act as a liaison between staff, families, school nurses, paediatricians and social services. Like many other GPs, I come across cases of emotional or physical neglect through poverty, or parents having mental health or substance abuse problems.

Sometimes it is the police, Accident & Emergency or health visitors who alert me to concerns they have about a child’s welfare. But worryingly, for every child on the child protection register there are another eight who are not known to agencies, according to the National Society for the Prevention of Cruelty to Children (NSPCC). And this can only get worse as cuts to local authority children’s services continue.

Since 2013, the Care Quality Commission asks that all GPs do at least two hours’ safeguarding training a year. Mine has focused on real cases of neglect and abuse. We discuss these cases, with failings highlighted often at multiple points where a child may have come into contact with health professionals. It has helped us to make informed and early referrals to child protection.

The decision to make a safeguarding referral is not one taken lightly. But once done, often help is either very hard to access or just not available. It’s usually not the social worker’s fault: the reality is that the child protection system is simply unable to keep up with demand.

For example, when I refer Daisy (not her real name), who is three years old, to the child protection team for neglect, her mother is struggling with alcohol use and Daisy is malnourished and physically and emotionally left to fend for herself. Her nursery attendance is poor. After some delay, the social worker decides that Daisy should not have a child protection plan but is a child in need instead (an allocation that comes with little resources or practical support for Daisy or her mother). The system’s focus is on severe cases (such as those of physical or sexual abuse) rather than prevention through early help for less severe cases.

Children’s social services have lost £2bn in savage funding cuts, despite the growth in safeguarding referrals, up 15% between 2013 and 2016 for adults and children. Vacancy rates for social workers are high and long-term sickness common, meaning caseloads often have to be reallocated. Children’s social services cuts have also slashed the early help and intervention that young people and families used to receive, such as through Sure Start or similar schemes.

Social workers do a very difficult job in a system under huge strain. Yet, from a doctor’s perspective, it often feels as if the threshold for accepting safeguarding referrals is governed more by the level of demand or staffing on the day than the severity of the case. This is particularly true for issues of neglect or where there are parental mental health or substance misuse problems, when I have been asked to access help for the parent, rather than focus on the child as well.

My experience is echoed across the country. Many GPs says they find it hard to access timely support from social services and lengthy delays, unclear pathways or ineffective responses to safeguarding concerns are common complaints. Where is the effective response for them when thresholds for taking action remain ambiguous or sky high, or funding cuts mean that early help is lacking?

As GPs become more proficient in spotting the signs of neglect and abuse, we are likely to make more safeguarding referrals. But without more funding for children’s services, we will be only adding to the pressure on social workers.

It seems ill-conceived that the government has pushed for widespread safeguarding training, but not planned at all for its aftermath.

Zara Aziz

7 November 2017 

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