Rowena Christmas, GP Principal
Aneurin Bevan University Health Board
This Bevan Exemplar project developed a multidisciplinary peer support group for Primary Care clinicians to share best practice in safeguarding.
The evidence of the lifelong damaging effect of adverse childhood experiences and the emotional and economic impact of domestic abuse is clear and compelling. Our aging population means older patients are increasingly vulnerable.
Primary care has a key role to play in protecting the vulnerable in society, using local knowledge and influence. Clinicians are in a unique position to recognise victims of domestic abuse, children at risk or the vulnerable elderly. Recognising concerns means we can signpost to help and support, potentially changing lives while protecting our overburdened social care system.
Our Patient Participation Group coordinates collections of outgrown children’s toys, clothes and books to give to families in need; these parcels address practical need, but also ensure that at their most vulnerable people feel cared about. We see intergenerational benefit from this co-production – communities feel useful, while learning about hardship experienced locally.
There is marked variation in the quality of safeguarding practice; it’s critically important to do it well but this is challenging. The possibility of leaving a vulnerable person at risk of harm must be balanced against intervening unnecessarily and placing stress on an already struggling family. Doctors can find themselves isolated, addressing highly sensitive issues. Such cases increase the risk of developing stress and burnout.
There is currently no specific training for GP Safeguarding Leads to support them to perform their role in ensuring that all practice staff are fulfilling their safeguarding responsibilities. Health Inspectorate Wales (HIW) repeatedly highlights the need for more training in safeguarding and increased peer support:
In 2016 – 2017, they made recommendations to 44% of practices inspected to strengthen their approach to safeguarding.
HIW recommend that General Practice would benefit from increased peer support in safeguarding.
To raise the standard of safeguarding management to that of those practising at the highest level.
To develop a multidisciplinary group of safeguarding leads from neighbouring practices, forming a peer group of experts; addressing the need for more training and peer support.
To prevent harm through early intervention and promoting well-being in patient populations.
The peer group have held seven meetings to date, covering 12 practices and collecting extensive and positive feedback.
The group has been running for 18 months and attendance is consistently high from all practices.
The group meets quarterly to hear a presentation, share best practice and most importantly discuss complex cases in a challenging but mutually supportive safe space. The group lead is available for informal advice and support between meetings.
The group cover all safeguarding issues, including vulnerable children, the homeless, asylum seekers, victims of domestic violence and the frail elderly. The group members later share their learning within their own practices.
Case discussion provides a variety of opinions and our evidence shows that discussions support doctors making difficult decisions and improve outcomes. We can demonstrate our awareness of safeguarding issues in routine consultations has increased.
The project is underpinned by the principles of Prudent Healthcare and the aims of 'Healthier Wales' by facilitating local innovation through clusters and shifting resources into the community. Discussions make us more likely to refer only when necessary, care for those with the greatest health needs first, and reduce inappropriate variation in safeguarding practice.
Swansea University have secured ethical approval to collaborate with the team on a research project to assess the impact of the group.
Having demonstrated the effectiveness and value of the pilot, the team are now scaling groups out across Wales. To facilitate this, three ‘Ted Talk’ style presentations have been recorded describing the pilot, Domestic Violence & Capacity Issues in the Elderly. These are available as a resource for doctors to access either individually or during Safeguarding Supervision Groups.
The discussion of challenging cases is most valued. These challenging cases include:
Historic sexual abuse.
Vulnerable elderly & capacity issues.
Possible sexual abuse.
Concern about home schooling.
Gender dysphoria & safeguarding.
Personality disorder & impact on parenting.
Power of Attorney.
Genital examination of a young child.
"Divorce & parental responsibility". "Safeguarding is everyone's business, but in primary care we have a unique opportunity to recognise issues and alert relevant organisations. We should never assume someone else is going to sort a problem out." Rowena Christmas
Part of cohort Bevan Exemplar Projects 2018-19