Jenny Woodman Co-authors: Hodson D, Gradner R, Cuthbert C, Wooley A, Allister J, RafiI, de Lusignan S, Gilbert R UCL Institute of Child Health

1. 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

2. Institute of Child Health
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:

3. Institute of Child Health
• 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

5. Institute of Child Health
• 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
Rateper1000childyears
1995 1997 1999 2001 2003 2005 2007 2009 2011
*First event per child per calendar year included in denominator

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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 care
But
• 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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9. 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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