UCL-Institute of Child Health

Jenny Woodman j.woodman@ucl.ac.uk

14th April 2015

Co-authors: Hodson D, Gardner R, Cuthbert C, Woolley A, Allister J, Rafi I, de Lusignan S, Gilbert R

Rethinking the GP’s Role in Responding to Child Neglect

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What is the evidence-base about GP responses to maltreatment-related concerns in the UK?

How far does policy and practice guidance support these responses?

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Objectives:

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• Increasing interest in universal services

• GPs are theoretically in a good position

• Unclear what direct GP responses to families

might look like

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Background:

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Methods: research

• Systematic searches from 2000-Oct 2013

• Targeted updates in summer 2014

• Included: research about GPs and vulnerable

or maltreated children in UK settings

• Four relevant studies

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• Recording concerns1,2

–GPs coded vulnerability: 1% of all children

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Findings: research

1. Woodman J, Allister J, Rafi I, de Lusignan S, Belsey J, Petersen I, et al. Simple approaches to improve recording of concerns about child maltreatment in primary care records: developing a quality improvement intervention. Br J Gen Pract 2012;62(600):e478-e86(9).

2. Woodman J, Freemantle N, Allister J, de Lusignan S, Gilbert R, Petersen I. Variation in recorded child maltreatment concerns in UK primary care records: a cohort study using The Health Improvement Network (THIN) database. PLOS ONE 2012;7(11):1-9.

3. Woodman J, Gilbert R, Allister J, Glaser D, Brandon M. Responses to concerns about child maltreatment: a qualitative study of GPs in England. BMJ Open 2013;3(12):e003894. doi: 10.1136/bmjopen-2013-94.

4. Tompsett H, Ashworth M, Atkins C, Bell L, Gallagher A, Morgan M, et al. The child, the family and the GP: tensions and conflicts of interest for GPs in safeguarding children May 2006-October 2008. Final report February 2010. London: Kingston University, 2010.

• GPs’ role and responses3,4

– GPs were case-holding low-level neglect– Monitor, coach, advocate, opportune healthcare, record, refer, joint wor

2.0

4.0

6.0

8.0

10.0

Rate

per

1000 c

hild

years

1995 1997 1999 2001 2003 2005 2007 2009 2011

*Firs t event per child per calendar year included in denom inator

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• For children across the spectrum of need and severity • Before, at the same time and after referral to children’s social careBut• Are direct responses effective and safe?

The model of care

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• Searched Oct 2013

• Included: current policy or practice which mentioned GPs

• UK, but focused on England

• 109 policy documents reviewed & 10 practice guidance

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Methods & findings: policy review

• Heavily recognition, assessment, inter-agency working, organisational structures and audit.

• Some expectation of monitoring & on-going support by GPs

• Persistent sub-text of ‘identify and refer’

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Implications

• What’s collaborative about direct responses?– Parent-GP working– Between professionals

• They need to be acknowledged as safeguarding– Give GPs permission – Get research funded– Make sure collaborative working with parents is safe and that

collaborative working with other professionals happens.

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UCL-Institute of Child Health

For more information……….

Full report: http://www.nspcc.org.uk/Inform/research/findings/gps-role-report_wdf103317.pdf

Editorial, with opportunity to comment

Woodman J, Rafi I, de Lusignan S. Child maltreatment: time to rethink the role of general practice. Br J Gen Pract 2014;64(626):444-5

Lay summary

http://societycentral.ac.uk/2014/07/29/child-safeguarding-can-family-doctor/

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• Notes from teleconf

Alice

Jenny

Ebd

Gcp

Bring hand-outs n=24• Add stuff about collaborative working – with

parents, with other professionals. Can do in last slide

• Add new nspcc logo

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