Devon PCT - Information Sharing for GPs in Child Protection - June 2009

Local Children’s Social Services and Police Child Abuse Investigation Units are always grateful to receive appropriate, relevant and proportionate information from GPs about children at risk and their carers in the course of a child protection investigation. But it appears that some colleagues have been reluctant to share information even if it has been in the interest of the child to do so. It would be worth spending a few minutes reflecting on the current statutory guidance in this area of practice.

In England and Wales, the Children Acts of 1989 and 2004 give GPs a statutory duty to share information if there are concerns about a child’s safety or welfare (section 47 and section 27, duty to co-operate, Children Act 1989). Working Together to Safeguard Children, HM Government 2006, states (para 2.77): “Because of their knowledge of children and families, GPs, together with practice staff and primary healthcare team (PHCT) members, have an important role in all stages of child protection processes. This includes appropriate information sharing (subject to normal confidentiality requirements) with children’s social care when enquiries are being made about a child, contributing to assessments, and involvement in a child protection plan to protect a child from harm. GPs, practice staff and other PHCT practitioners should make available to child protection conferences relevant information about a child family, whether or not they – or a member of the PHCT – are able to attend”.

The General Medical Council (GMC) 2007 0-18 years: Guidance for all doctors, paragraphs 56 and 57, states:
“Your first concern must be the safety of children and young people. You must inform an appropriate person or authority promptly of any reasonable concern that children or young people are at risk of abuse or neglect, when that is in a child’s best interests or necessary to protect other children or young people. You must be able to justify a decision not to share such a concern, (cholme bold) having taken advice from a named or designated doctor for child protection or an experienced colleague, or a defence or professional body. You should record your concerns, discussions and reasons for not sharing information in these circumstances.You should participate fully in child protection procedures, attend meetings whenever practical and co-operate with requests for information about child abuse and neglect. This includes Serious Case Reviews set up to identify why a child has been seriously harmed, to learn lessons from mistakes and to improve systems and services for children and their families. When the overall purpose of a review is to protect other children or young people from a risk of serious harm, you should share relevant information, even when a child or young person or their parents do not consent, or if it is not possible to ask for consent. You must be prepared to justify your decision not to share information in such cases” (cholme bold).

Please note also that since the GMC published this guidance, there is now a statutory duty on Local Safeguarding Children Boards to investigate all child deaths up to the 18th birthday, to identify causes and possible preventable factors. The Peninsula Child Death Overview Panel office in Plymouth may request the completion of a “Form B” from you, seeking information, from your records, about the previous state of health of the child. Whilst many deaths will be due to natural causes, it is always helpful if you can give proportionate and relevant information on the parents as well, e.g. for a neonatal death, did the mother engage with antenatal care by 12 weeks gestation, were there any problems during the pregnancy, and for deaths at any age, were there significant family problems with physical or mental health, substance misuse or domestic abuse.

Where there has been good practice, we would wish to acclaim this. The aim is to identify lessons to be learnt.

The Data Protection Act 1998 allows us to share confidential information without consent if one of the following three conditions apply:
(i) if there is a statutory obligation
(ii) if a court orders it
(iii) if the child’s or public interest overrides that of the individual.

A Check-list for Sharing Information
When asked for information about a child or family, practice staff should consider:
Identity – check identity of the enquirer to see if they have a bona-fide reason to request information. Call the switchboard or ask for a faxed request on headed notepaper.
Purpose – ask about the exact purpose of the inquiry. What are the concerns?
Consent – is it a situation where a child needs to be protected? If it is, you should not delay while consent to share information is sought. If it is not, then you would normally wait for the informed consent of the child/ young person (as appropriate), or the person with parental responsibility/ carer. See General Medical Council [2007] 0-18 years: Guidance for all doctors
Need-to-know basis – give information only to those who need to know.
Proportionality – give just enough information for the purpose of the enquiry, and no more. This may mean relevant information about parents/carers.
Keep a record – make sure that you record the details of the information sharing, including the identity of the person you are sharing information with, the reason for sharing and whether consent has been obtained and if not why not.

Disclosing Third Party information to organisations
When you hold information about a child or young person, you will often hold information about their family as well. This can create difficulties when you want to share information about the child with other organisations for the purpose of safeguarding their welfare, but are not sure whether you can share information about their parents, siblings and other family members too.

You can disclose information about third parties providing that you have a legitimate and lawful purpose.  However, any disclosures you make must be adequate for the purpose of the disclosure, relevant to the disclosure and not excessive for the purpose of the disclosure. Remember that any concerns within the family about previous child abuse, substance or alcohol misuse, domestic abuse or mental illness in a parent or carer may be highly relevant.

“Blocks” to Information Sharing
Finally, it appears that the “block” to any sharing of information may not always lie with GP colleagues themselves but sometimes with practice staff such as receptionists or practice managers. I would be grateful if you could ensure that all your staff are aware of the statutory guidance in this area.

Advice Available
If you have any concerns about information sharing and you would like to discuss with a medical colleague, please do not hesitate to ring or email one of the Named Doctors for Child Protection in Devon PCT:

• For North Devon: Dr Stephen Richardson, North Devon Hospital, tel: 01271 341521,  email: stephen.richardson@ndevon.swest.nhs.uk
• For Exeter and East Devon: Dr Ron Smith, Royal Devon and Exeter Hospital, tel: 01392 406143,  email: ron.smith@rdeft.nhs.uk
• For Mid Devon: Dr Richard Tomlinson, tel: 01392 207752, email: richard.tomlinson@rdeft.nhs.uk
• For South Devon: Named Doctor post vacant, please ring duty paediatrician South Devon Healthcare NHS Trust, tel: 01803 614567
• Devon, Torbay and Plymouth Local Medical Committee: Dr Kate Gurney, Surgery 01404 814447, email kgurney@nhs.net

Finally, Recommendations from Research
Examples of good GP practice emerging from GP interviews, Delphi Panel and Focus Groups in managing child protection concerns, conflicts and tensions (Tompsett, Ashworth et al):

• Talking to parents and to children about concerns and involving them in decisions  to share information even where this may prove difficult; showing the ability (and making the opportunity) to listen to patients
• Making clear or forewarning parents early of the limits to confidentiality
• Taking time to make an assessment, reassure, consider a response
• Arranging for follow up
• Allocating separate GPs to parent and child / children if there was felt to be a conflict of interest
• Sharing worries with other colleagues, and engaging in significant event analysis
• Developing a consultative, reflective space prior to referral, utilizing the skills of named and designated professionals, paediatricians, and training and case discussion in the practice
• Carefully recording decisions and justifications
• Ensuring that assessments (of the child or the parent) and records of common data were maintained for all relevant members of the family
• Keeping the long term view and allowing the family / relationship time to adjust and recover from difficult decisions.

Source Documents

• General Medical Council 2007 0-18 years: Guidance for all doctors
• Working Together to Safeguard Children, HM Government, 2006
• Information Sharing: Guidance for Practitioners and Managers, DCSF, London, 2008
• Data Protection Act, 1998, HM Government
• Sharing Information about Children, Young People & their Families, a Practitioner’s Guide, Devon PCT, 2008
• Safeguarding Children and Young People in General Practice: A Toolkit, London. RCGP and NSPCC, 2007
• The Child, the Family and the GP: tensions and conflicts of interest in safeguarding children, Tompsett H, Ashworth M, Atkins C,  Bell L, Gallagher A, Morgan M, and Wainwright P. Kingston University / St George’s University of London, 2009.

Dr Charles Holme
Consultant Paediatrician
Designated Doctor Child Protection
Devon PCT
County Hall
Exeter EX2 4QQ 
June 2009

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