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

Tompsett, Hilary, Ashworth, Mark, Atkins, Christine, Bell, Lorna, Gallagher, Ann, Morgan, Maggie, Neatby, Rozalind and Wainwright, Paul (2010) 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. (Project Report) London, U.K. : Kingston University. 185 p. ISBN 9780955832956


The role of GPs in safeguarding children has long been seen as vital to inter-agency collaboration in child protection processes and to promoting early intervention in families. It has often been characterized as problematic to engage GPs and recognized that potential conflicts of interest may constrain their engagement. The project team was commissioned by DCSF/DH as part of the Safeguarding Children Research Initiative to explore the tensions and conflicts of interest when children, about whom there are welfare concerns, and their parents are both patients, and to suggest ways of resolving these conflicts of interest. The study focus was broadened to explore the complexity of relationships between GPs, parents and children, and other professionals, in response to initial feedback from the piloting of research tools. Key Findings •.Expectations of GPs as set out in Government policy documents are not fully shared by GPs themselves and other stakeholders. GPs interviewed saw their role in most cases as referring patients/families on where concerns were raised, while key stakeholders expected fuller engagement in all stages of child protection processes. • GPs see supporting parents as the best way to support children and families; all study participants agreed that where harm or its likelihood was evident, the child’s interests must come first, but keeping the focus on the child was more difficult. •Although GPs are clear about 'what to do' when the situation is clear cut for child protection referrals to children’s social care services, if it is more complicated they would seek advice and support from a paediatrician or a health visitor first. • GPs’ lack of confidence in responses from child protection services was cited as a reason for this reluctance; not being able to speak directly to social workers in children’s services, over or under response to concerns, lack of feedback from children’s social care services when referrals were made, and potential impact on families of intervention were cited as reasons for hesitance in referral and dilemmas in confidentiality. • An unexpected finding of this study was the lack of reference by most of the GPs (and Key Stakeholders) to the views and wishes of children, suggesting more work is needed to improve communication and children’s involvement in decisions. • The important role of the health visitor in safeguarding children, both for parents and as a key fellow professional for the GP to refer to, was confirmed in this study. Future policy guidance might consider strengthening health visitor safeguarding responsibilities in the light of any location changes away from GP practices for health visitors (e.g. to children’s centres) since this study was completed. • GPs’ in the study had the perception that child protection work is not as valued as other activities which are rewarded under the Quality and Outcomes Framework. It is suggested that policy makers could explore ways of raising the profile of safeguarding work amongst GPs. • GPs in the study reported low attendance at child protection conferences though provision of reports to conferences was higher than expected. Some suggested that conferences may be better informed by other or health professionals who may hold more relevant information.

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