Milton Keynes Clinical Commissioning Group (CCG) identified a need to provide guidance to healthcare professionals encountering children who they believe may be in need or at risk of harm.
By working in partnership with the CCG’s Designated Nurse for Safeguarding Children, Arden & GEM Commissioning Support Unit’s Clinical IT Service developed a specialist template to support GPs in their safeguarding responsibilities.
The template is now is use in 30 Primary Care sites across Milton Keynes and is promoting a culture of safeguarding, increasing GP confidence, helping to identify to children at risk of harm and ensuring the right action is taken to keep children safe.
Understanding the challenge
As an organisation offering activities or services to children and young people, GP practices have a legal and moral duty to safeguard the children and young people they work with.
"To support GP practices in their safeguarding duties, I wanted to provide a tool for professionals in line with national and local guidance, to assist in identifying children, young people and families who may be in need or at risk of harm. The solution needed to ensure children get the right response from the right service at the time they need it.
From working closely alongside GPs, it became apparent that the best option would be an aid within the patient records system. We were able to achieve this through a close working relationship with the team at Arden & GEM."
Andrea Piggott, Designated Nurse for Safeguarding, Milton Keynes CCG
Developing a solution
Our Clinical IT Service worked in partnership with the Designated Nurse for Safeguarding at Milton Keynes CCG to produce an information and referral template for GPs and safeguarding leads within the local health economy.
The template was designed to support GPs to:
- Identify safeguarding concerns
- Identify vulnerable children and families who require additional support
- Recognise and describe the indicators of child abuse and neglect
- Understand what actions to take if they have concerns about a child
- Share information with colleagues and other agencies
- Readily identify children subject to a child protection plan and Looked After Children.
- Appreciate their own role and responsibilities, and those of others, in safeguarding and promoting the welfare of children.
In developing the template, the team engaged with a wide group of stakeholders including Milton Keynes Safeguarding Children’s Board, the Local Medical Committee and the Protected Learning Panel (attended by over 200 GPs).
Relevant guidance was also reflected including:
- recent CQC inspections
- learning from serious case reviews
- Safeguarding Level 3 training
- RCGP’s Safeguarding Children toolkit.
The tool has been implemented within the SystmOne patient record system and uses the Milton Keynes Effective Support windscreen, and the different levels of need contained within, as the entry page for all indicators and tabs. Each sub page sets out the features that a GP should be looking for when they have concerns about a child or young person with appropriate next steps and actions.
Where a clinician has a safeguarding concern, they are able to add a case to the multi-disciplinary meeting agenda at the simple click of a button. Where a referral is needed, template letters, forms and information leaflets are also available within the system, with fields autopopulated to save time.
The initial version of the template has been continually improved to incorporate ongoing feedback from stakeholders. It now includes one click access to body maps, to allow accurate recording of injuries and concerns, and the Child Sexual Exploitation screening tool. Specific tabs have also been added for Looked After Children and Female Genital Mutilation.
Further development is already scheduled, including the ability to have a specific icon display against a child’s record where safeguarding concerns have been identified. This would be visible to pratice reception and administration staff (while keeping specific details confidential) ensuring identified children can be given priority appointments.
Outcomes
Since April 2017, the safeguarding template has been in use in 27 practices, two branch sites and the Primary Care Children’s Team within Milton Keynes. The template rollout has been supported by significant stakeholder engagement, training documentation and a series of visits to practices to demonstrate use.
The tool is already providing significant benefits in terms of addressing the challenges of identifying children at risk of harm and ensuring the right action is taken to keep children safe.
- The information and guidance provided to GPs across Milton Keynes is now consistent, in line with best practice and presented in a simple to follow format.
- The risk of relevant information not being passed from GP to GP when a family moves practice has been reduced.
- Practices have been enabled to undertake a data cleansing exercise, ensuring children and young people are coded correctly on the system.
- GPs have increased confidence in their safeguarding role as they understand and are prompted to follow the correct course of action for their concerns.
The overall effect has been to promote and enable a culture of safeguarding.
"We have tested the safeguarding template in our practice, and my colleagues and I recommend it extremely highly. It is an excellent resource for clinicians particularly those who do not have day-to-day involvement with safeguarding issues with regard to children. It has all of the information needed and relevant referral forms, which are pre-populated wherever possible, together with advice and very useful links. We are fortunate to have this resource available to improve safeguarding services."
Nigel Fagan, Milton Keynes GP and Local Medical Committee Chair
Next steps
In order to ensure joined up multi-disciplinary working, there are plans to roll the template out to social care, police and education.
The template also has the potential to be replicated across other health economies, with customisation to reflect different level of need models.
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