Safeguarding Children Multi Site Audit

The safeguarding children multisite audit was a joint initiative in 2012 between the RCGP Clinical Innovation and Research Centre's (CIRC) Dr Janice Allister and Dr Imran Rafi, the Institute of Child Health (Professor Ruth Gilbert and Jenny Woodman) and Surrey University (Professor Simon de Lusignan).

It was a three year audit with funding provided by HQIP. The aim of the audit was an analysis and improvement of how GPs record information around children safeguarding issues.

Audit

The team recruited a group of 11 GPs who were safeguarding leads in their respective practices. They met and described examples of families, children and young people they had concerns about, but did not necessarily meet the threshold for intervention from social care.

The patients registered in the 11 practices included 38,506 children and young people aged 0-18 in England. The team analysed over 350 codes that GPs were using to record this type of concern and, using consensus methods with the 11 lead GPs, developed a short list of the most helpful. The 11 GPs went back to clinical meetings at their practices, suggesting this list of codes for a safeguarding template (data entry form).

The main idea behind the new approach was that, as a minimum, a single code should be used to flag the whole spectrum of child safeguarding concerns - ‘child is cause for concern’ (13If) - with other codes and free text to be used at the GP’s discretion.

Following the initial data collection phase it was found that marked under-recording regarding child maltreatment was occurring and a three stage approach to coding was recommended.

The key messages from the audit are:

  1. This three stage approach for recording maltreatment concerns was generated from a systematic analysis of current practice and builds on evidence that use of data entry forms and/or standardised coding in primary care settings can improve recording.
  2. Improved recording allows the GP to rapidly identify any previous maltreatment concerns during a consultation.
  3. At a practice level, searches for children with maltreatment concerns can be used to ensure rate review in team meetings or early intervention (e.g. targeted health visiting and parent training).
  4. We recommend that GPs flag whenever maltreatment is considered using the code ‘child is cause for concern’ (Read version 2 term: 13If Read 3: XaMzr) and a data entry form (template) for key elements of the case.

Having insights into the work of GPs with children and families in the 11 practices through the audit was humbling and encouraging  because it showed the depth of involvement with families and the knowledge of family context by GPs. Relationships, continuity and compassion were key.

A description of the audit and summary of findings can be found in an article published in the RCGP Clinical News, July 2015. You can read it here.

Further information regarding the recommended READ codes and guidance are found below.

Tools

Useful links

Woodman J, Allister J, Rafi I, de Lusignan S, Belsey J, Petersen I, Gilbert R; RCGP Multisite Safeguarding Audit. A simple approach to improve recording of concerns about child maltreatment in primary care records: developing a quality improvement intervention. Br J Gen Pract. 2012 Jul;62(600):e478-86. doi: 10.3399/bjgp12X652346. (accessed 20 April 2015)

Woodman J, Woolley A, Gilbert R, Rafi I, Allister J, de Lusignan S, et al. The GP's role in responding to child maltreatment: time for a rethink? London: NSPCC, 2014.

Guthrie B, Saultz JW, Freeman GK, Haggerty JL. Continuity of care matters. BMJ. 2008;337:a867. doi: 10.1136/bmj.a867.

BMJ June 2012: What is the role of GPs in safeguarding children?

BJGP July 2012: A simple approach to improve recording of concerns about child maltreatment in primary care records: developing a quality improvement intervention (Abstract only, members can log in to view full text)

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