The GP medical training website for everyone, not just Bradford.
Est. 2002

CHAT- trainee        CHAT-AKT        CHAT-RCA        CHAT-trainer        CHAT-TPD

Bradford VTS Online Resources:

Clinical Knowledge

Safeguarding Adults

SOURCES OF HELP FOR VICTIMS

  • The Hideout – children/young people experiencing domestic abuse
  • Mind – this link has lots of useful resources for patients.
  • Respect – run a phone line for perpetrators of Domestic Violence and Abuse and for men experiencing domestic violence and abuse.
  • Counselling Directory – info page on domestic violence and help finding a local therapist

If you have files you would like me to host on here and share with others, OR if you would like to help develop these pages further, then please email me.  
rameshmehay@googlemail.co.uk

Controlling vs Coercion

  • These two things underpin all domestic abuse and the grooming and exploitation of individuals
  • Controlling – isolate and regulate – makes a person subordinate or dependent – deprives them of the mean for independence
  • Coercive – act to hurt and intimidate, a continuing act or pattern of assault, threats, humiliation and intimidation – or other abus that is used to harm, punish or frighten their victim
    •  

The Care Act 2014 - 6 things

  1. Accountability – we have a safeguarding statutory duty and responsibility
  2. Proportionality – proportional response to the risk  (eg severe crime à police ASAP)
  3. Empowerment – empowering the adult to make decisions
  4. Protection – protecting the person
  5. Prevention – to prevent it happening again
  6. Partnership – working together to resolve the problem

Capacity - The Mental Capacity Act 2005

Don’t automatically assume a person lacks capacity just because they have something like Learning Disabilities or a Stroke – no matter how big that disability looks like at first glance.  Don’t be pulled in by your first impressions.   They may well have capacity – in fact assume they have capacity rather than starting with the impression that they don’t.  Look at Stephen Hawking when he was alive. Even if he didn’t have that fancy computer software, he still would have capacity, but many of us would have mostly talked to to his carers rather than him (if we didn’t know him).

  • Capacity is always decision-specific
  • Capacity can and does fluctuate (for example, in dementia)
  • Can the person execute the specific decision made?

Remember:

Try and talk to the patient when they are most likely to have capacity.  For example, for a patient with dementia –  a home visit rather than the unfamiliar surroundings of a surgery, daylight hours rather than night, and minimise the number of people present in the discussion (perhaps have one familiar face).

For capacity – patients have to satisfy 3 things

  1. RETAIN information
  2. WEIGH UP the decision for themselves (i.e. the pros and cons)
  3. COMMUNICATE their decision

Remember….

  • Patients are allowed to make (what seems to us) – unwise decisions.
  • Remember the principle of The Least Restrictive Pathway.   For instance, if a patient  refuses hospital admission for their severe LRTI (despite  totally understanding the need and the pros and cons), that does not mean you are absolved of all responsibility.   In this case, the least restrictive pathway would be to give home antibiotics.

FAQ: Who needs to make the assessment for capacity?
It is the decision maker – i.e. the person who wants a capacity related decision making.

Consent

Try and use this model to determine where a patient is in terms of their consent.   

AN IMPORTANT POINT ON LASTING POWER OF ATTORNEYS

  • A LPA should be made when the patient has capacity to make an LPA.   It cannot be done retrospectively (i.e. when the patient is too far gone!).
  • Even if a patient has an LPA in place, that does NOT stop them from making decisions while they still have capacity.  

IF YOU’RE THINKING OF MAKING A DECISION FOR THE PATIENT… consider these things: 

What to do when you have a concern

INITIAL RESPONSE

  • Immediate develop safety plan with the adult
  • Call 999 (if immediate response required)
  • Call Urgent Social Care/Emergency Duty Social Work Team (in Bradford: 01274 431010)
  • Do not disturb any potential evidence of a crime
  • Check your local safeguarding protocol - have you done everything?
  • Document in medical record
  • Discuss with GP Safeguarding Lead (in house and CCG leads)

REPORTING A CONCERN

  • Make safeguarding personal - what does your patient want to do?
  • Assess their mental capacity
  • Assess their ability to consent - any factors harming that?
  • Do they meet the criteria for an Adult at Risk?
  • Is this part of organisational abuse/neglect? Is there a 3rd party duty to protect?
  • Report the concern. (In Bradford 01274 431 077 office hours. 01274 435 400/431 010 out of hours.
  • Document in medical records.

REMEMBER...

  • Negotiate on going safeguarding planning with the adult & consider referral with consent, to Adult Social Care for an assessment of care and support needs if not Adult At Risk.
  • Ensure children involved are safe and/or referred to Children's Social Care
  • Communicate with relevant agencies & organise follow up with the adult
  • You are not required to investigate the abuse/neglect BUT if your concerns are not acted upon - seek further support and advice e.g. from CCG safeguarding lead.
  • Follow your Freedom to Speak Out policy
  • Never confront an alleged abuser or put yourself in danger.

Domestic Abuse

If a patient says they have been abused…

  • Do not use word “alleges”   as in “patient alleges Mr XXX assaulted him”. 
  • Why not use the word alleges?   Because it seems to suggest/imply an element of not believing them – even though that is not our intention. 
  • Instead use the word “says”.  “Patient says Mr XXX assaulted him”.  Can you see the difference?  And of course, don’t write “Mr XXX assaulted the patient” – because that implies Mr XXX did when in fact you were not there.
Information Sharing in Cases of Domestic Violence and Abuse
In summary, an individual’s information may be shared if it is believed that it is necessary to prevent or reduce the risk of serious harm to themselves or others.   
  • It cannot be “ethically” justified if we hold information that we know could prevent serious harm to others and yet knowingly decide not to share it.
  • A ground rule for Caldicott Guardians – all information shared about both victims and perpetrators must be in the context of the normal requirements of information sharing without consent, in this case on the basis of prevention and detection of crime or serious harm.
  • In terms of proportionality, the more serious the harm the greater the imperative to prevent it and the greater the justification for sharing information without consent. It is difficult but important to try and quantify or measure the risk of potential harm. One way of doing this (in cases of domestic abuse) is to use the CAADA checklist . This process asks the individual victim 24 key questions, the responses are recorded. This process formalises the risk assessment process and provides key evidence in terms of justification when it comes to information sharing with other agencies.

Use the DASH toolkit to help you assess risk in Domestic Abuse, Stalking and Honour-based Violence.   This assessment of risk should help you determine what to do next.  Remember, seek help from other doctors/health professionals around you, your local safeguarding team and the medical defence union to which you belong.

RECORDING DOMESTIC ABUSE IN THE MEDICAL RECORDS – RCGP (2021):

  • “If you do code a consultation or communication as History of Domestic Abuse, as we recommend, this should be a major active problem until the abuse is resolved or the patient is presenting it as a past problem.
  • “Be mindful that DA does not necessarily stop when a relationship ends.”
  • “Also be mindful that the nature of DA can change over time so may always be relevant. The impact of DA can be significant on a victim’s long-term physical and mental health.”
  • “Use the online visibility function to hide this consultation from patient online access”

PREVENT & Radicalisation

PREVENT is the governments counter-terrorism strategy to prevent people from being radicalised.  It’s often the vulnerable that become radicalised.   The vulnerable like the homeless, those with learning disabilities, people struggling financially, children and so on.   It is important to safeguard these vulnerable people from such activities.  PREVENT  is all about safeguarding.

The diagram on the bottom right shows how violent or extremists people manage to move vulnerable people from a non-criminal space to a criminal one.   We can be the ones that help strengthen the wall the attempts to break the blue arrow.    But remember – only report the concern to the police – never take it upon yourself to investigate or challenge the aggressors – consider your safety and that of your family.  

Modern Slavery

Modern slavery is global – 40+ million people are slaves.  And it’s not just foreign nationals – British people are affected too.  In fact, more modern slavery victims IN THE UK are BRITISH!    More British slaves at our doorstep than in any other country!    The perpetrators pick on the vulnerable and promise them things like a better life, money, belonging to a caring community and so on.  They then take their documents off them so they can’t leave.  And then come along the threats of what will happen to their families if they do.  Do you see how the cycle works?

VULNERABLE GROUPS

  • Mental Health
  • Those with alcohol and drug related issues.
  • Homeless
  • People with Disabilities
  • Children (1 in 4 victims are children!)

Source: UN, National Referral Mechanism Stats, Hope for Justice

Which countries do the modern slaves in the UK originally come from?

Albania, Vietnam, UK (yes, you read correctly!), China & India
Keep an eye out!

SPOTTING THE SIGNS

  • Non-specific trauma, old injuries that have been untreated
  • Sexual trauma, STIs, pregnant/low late booking
  • Neglect, poor nutrition, poor dental hygiene
  • Stomach problems, back pain problems, TATT
  • Depression, anxiety, self-harm, withdrawn, submissive, looks distressed
  • Always accompanied, moves frequently/agitated, language barriers, isolated
  • No documentation, Not registered with GP, inconsistent info, always coming in for “emergencies”/on-call doc.
  • Socially – often goes missing,  lights on at their premises late, dropped off in the large group, lots of mattresses in the house when you do a home visit, people living in outbuilding/trailers

WHAT SHOULD YOU DO?

THE NATIONAL REFERRAL MECHANISM

If you believe your patient to be a victim of modern slavery then explain the National Referral Mechanism and  gain consent.   For more details click here.

HOPE FOR JUSTICE

  • Office hours only (9am-5:30pm Mon-Fri): 0300 008 8000
  • Outside of office hours:
    Contact Crimestoppers on 0800 555 111.
  • help@hopeforjustice.org

DON’T FORGET, YOU CAN ALSO CONTACT YOUR LOCAL POLICE DEPARTMENT

101/Modern Slavery Helpline is 08000 121 700

Please leave a comment if you have a tip, spot an error, spot something missing or have a suggestion for a web resource. And of course, if you have developed a resource of your own, please email it to me to share with others.

'Make GP Training Better Together'

Scroll to Top