Protecting children and young people - the responsibilities of all doctors

COMMENTS ON
General Medical Council
Protecting children and young people: the responsibilities of all doctors

The Royal College of Physicians of Edinburgh is pleased to respond to the GMC on its consultation on Protecting children and young people: the responsibilities of all doctors. The document is a welcome and admirable attempt to address a difficult area of clinical practice. The consultation gives time to address areas that could be improved upon, facilitating greater clarity and assistance for doctors and other interested parties.

It is felt that the document needs to be more explicit at whom it is aimed. Clearly, much of the guidance is appropriate to general practitioners, hospital paediatric practice, emergency medicine and intensive care. However, many doctors have entirely adult based practices and much of the advice would not be relevant for them. Thus, confusion might be generated since the guidance deals with responsibilities of all doctors but often details expectations which are really the preserve of a specialist with a higher level of expertise than a generalist. Some of the statements are more related to the specialist in child protection matters. A suggestion would be for a development of a simplified version for doctors for whom most of the document would never apply.

It would be worthwhile mentioning parental learning difficulties as a factor in abuse, or more commonly neglect. Thus, changing para 6a to “a parent with drug or alcohol misuse, mental health problems or learning disability”. Similarly, in section 6d, it is felt that there are cases where a child’s abuse of animals has been a presenting concern arising from neglect by parents, thus 6d could be made to read “abuse or neglect of animals by parent or child”

Comments on the questions asked in the questionnaire for doctors and other professionals:

But it would be unrealistic to expect all doctors to:

Doctors should know how to find out how seek advice when needed.

1. Do you think that the duties set out in the table below should apply to all doctors or only those who routinely work with children and young people?

   In answer to the specific scenarios, it is felt that all doctors should:

   1. Consider the needs and safety of children and young people.
   2. Be able to identify risk factors that might be linked to abuse or neglect, for example, domestic abuse or parents with mental health problems.
   3. Recognise where families need additional support, provide such support where it is part of their role, or refer the family to other health or local authority children’s services.
   1. Have a working knowledge of local procedures for protecting children and young people in their area.
   2. Know who the named or designated doctor for child protection, or lead clinician, is in their area and know how to contact them.
2. Boundaries between parental freedom and child protection concerns
    

   This is again only relevant to some but not all doctors. This would be an area in which it would be important to consult with other agencies.

3. Communication with parents
   This seems to be the right approach.
4. Communication with children and young people
   The guidance should make clear the differences between the child’s abilities under law regarding assent, consent and capacity.

   Paragraph 18 states that children's views must be considered. This might be better as should, since irrational and delusional comments will not be valid.

   There is a discrepancy in para 56 which seeks written consent from the child, but oral consent will suffice from the parent.

5. Confidentiality and information sharing
   Do you think that breaking down the decision making process in this way is helpful?

   The breakdown of decision making process is helpful. There is a concern about “discussing problems with colleagues without identifying the child” as in (c) reflecting para 36. The reasons for this approach are not explained and seem counter-intuitive. An explanation of the reasons for this approach would be helpful for non-specialists in para 36.

6. Record Keeping
   How important are the following factors in maintaining good record keeping where child protection concerns arise?

   All are important, but the linkage of the records of a child and their family and others might be difficult. Paragraph 27 suggests that, when information is disclosed about a member of the child’s family, this should documented in the family member’s records. This is felt to be misleading and it may be impracticable to record information such as this in the notes of family members, some of which maybe hearsay. This may include their general practitioner’s records or hospital notes or both. It may also be that the person concerned does not have legitimate access to the notes.

7. Acting as an expert or professional witness
   The section ‘Doctors giving evidence in court’ (paragraphs 70 – 91) is largely generic advice. Most doctors' exposure to giving evidence in court will not arise from child protection matters. Perhaps only the relevant passages to child protection matters should be included in the current publication.