Policy responses and statements
- Name of organisation:
- General Medical Council
- Name of policy document:
- Protecting children and young people - the
responsibilities of all doctors
- Deadline for response:
- 14 October 2011
Background: The General Medical Council is consulting on new draft
guidance Protecting children and young people: the responsibilities
of all doctors.
The draft guidance has been developed by a working group chaired
by the Rt. Hon. Lord Justice Thorpe. The group has been brought together
by the GMC to develop clear principles for all doctors, including those
who do not routinely treat children.
The draft guidance gives advice to doctors on:
a.their duty to identify children and young people at risk of abuse
and neglect, even when only treating adults
b. the boundary between parental freedoms and child protection concerns
c. good communication with children, parents and families when there
are child protection concerns
d. respecting confidentiality and when to share information
e. good record keeping practice
f. seeking consent to examination or investigation
g. understanding how other professionals involved in child protection
work consider and act on child protection concerns
h. training and skills development
i. giving evidence in court as a witness of fact and as an expert
witness.
The consultation will interest organisations, doctors, young people,
parents and carers with an interest in, or experience of the issues
addressed in the guidance. It will also interest other professionals
that have a role in child protection work, for example nurses, social
workers, lawyers and the police.
To supplement the draft guidance, the GMC has produced the 'Factsheet:
paediatricians and our fitness to practise procedures' explaining how
the GMC's fitness to practise procedures work, and how paediatricians
are represented within them. The paper aims to make this information
more widely available to the profession and the public and the GMC
is not therefore seeking views on it.
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:
- 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:
- Consider the needs and safety of children and young people.
- Be able to identify risk factors that might be linked to abuse or neglect,
for example, domestic abuse or parents with mental health problems.
- 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.
But it would be unrealistic to expect all doctors to:
- Have a working knowledge
of local procedures for protecting children and young people in their area.
- Know who the named or designated doctor for child protection, or lead clinician,
is in their area and know how to contact them.
Doctors should know how to find out how seek advice when needed.
- 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.
- Communication with
parents
This seems to be the right
approach.
- 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.
- 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.
- 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.
- 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.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[14 October 2011]
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