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Reporting Concerns
The following guidelines were last updated by the Adult safeguarding team in August 2025
If you have concerns about an adult at risk of harm, please refer to the appropriate local authority in which the adult lives using the links below:
Out of Hours
Emergency duty team - 01454 615165 (All BNSSG)
GPs can access information about families and identify whether Social Care is involved through Connecting Care. If adults have opted out of this service, then please liaise directly with the local authority.
Bristol Adult MASH
The Bristol Adult MASH ( Multi Agency Safeguarding Hub) is a multi agency meeting to discuss complex and high risk adult safeguarding referrals. The aim of the meeting is to determine whether the criteria for Section 42 statutory safeguarding duties under the Care Act 2014 have been met. The meeting will put in place an initial risk management and protection plan for all referrals discussed. You can refer into the Bristol Adult MASH via the Adult safeguarding referral form on the Bristol City Council adult safeguarding website Report suspected abuse: safeguarding adults at risk. It is only for adults who have experienced, or are at risk of, abuse within Bristol.
North Somerset MARM
Multi-Agency Risk Management (MARM) is designed to support people where high levels of risk have been identified and a multi-agency approach would be beneficial. It brings together a multidisciplinary specialist team to identify what needs to be done to reduce the risk. The professionals meet once a month to discuss multiple people. They will then decide if a review meeting is needed to manage the ongoing concerns. MARM does not replace statutory adult safeguarding. It is a framework for managing risk where the concerns do not come from a third party and the person is able to protect themselves, but they remain at risk. The referring agency needs to demonstrate that they have exhausted all strategies to reduce the risk before considering referring to MARM. Multi-Agency Risk Management (MARM) | Adult Safeguarding Board
South Glos - does not have a MARM or adult MASH. Please refer all safeguarding concerns using the usual pathway Concerned about an adult? | SafeguardingSouth Gloucestershire Safeguarding.
Multi-Agency & Practice Policies
Agreed by Safeguarding Adults Boards in BANES, Bristol City, North Somerset, South Gloucestershire, and Somerset.
Practice Safeguarding policies
Each practice should have a Safeguarding Adults Policy. If you require support developing your policy please contact the primary care team: bnssg.safeguardingadmin@nhs.net
Help for health care providers to recognise patterns in missed appointments and/or lack of response to practice communications to identify safeguarding concerns so that appropriate action can be taken.
BNSSG Self Assessment Audit Tool
The BNSSG Safeguarding Self-Assessment Audit Tool is designed to help Primary Care to evaluate and improve their safeguarding practices for vulnerable individuals, including children, young people and adults at risk. It provides a structured way to review policies, procedures and practices, identify areas for improvement, and ensure compliance with regulations.
By completing the self-assessment, Practices can assess the effectiveness of their safeguarding activities, identify training or resource gaps, and show commitment to protecting vulnerable individuals.
The tool covers a range of topics, including:
- Governance and leadership in safeguarding
- Staff training and development
- Risk assessments and reporting mechanisms
- Collaboration with other safeguarding agencies and professionals
- Support systems for patients at risk
You do not have to share the Audit with the ICB Primary Care Safeguarding Team but they are happy to work with you if you need any support.
If your PCN is an employer you may wish to name a safeguarding lead, or delegate this to an individual practice, to oversee the safeguarding induction, training and development needs of any individual employed by the PCN.
Allegations against people who work with adults at risk
Allegations of abuse of adults at risk, by adults who work with them are becoming increasingly common especially following recent high-profile cases. These may include allegations against patients who are carers, and other professionals and volunteers. It may also involve allegations against NHS staff including practice staff. These are investigated by the Local Authority.
Safeguarding Adults Boards within each local authority have their own Persons in a Position of Trust (PiPoT) policy:
Keeping Bristol Safe Partnership
North Somerset Safeguarding Adults Board
South Gloucestershire Safeguarding Adults Board TBC (SEE NOTES)
Please discuss complex cases with the safeguarding team.
RCGP Toolkit and Identification of Risk
Please visit the RCGP Safeguarding Hub for resources focused on safeguarding in general practice
Safeguarding Adults Reviews (SARs)
A Safeguarding Adults Review (SAR) is a multi-agency review process which seeks to determine what agencies could have done differently to have prevented harm or a death from taking place. The purpose of a SAR is to promote effective learning and improvement, not to apportion blame. The chair of the local Safeguarding Adults Board launches a review in cases that meet nationally agreed criteria.
All agencies are requested to provide information detailing their involvement with the adult to which the SAR pertains. A request for a Chronology will be sent directly from the local Safeguarding Adults Board or via the Designated Professional for Safeguarding Adults to the person’s GP practice. The GP practice must complete the Chronology in order for the Named GP for Safeguarding to write an Individual Management Review (IMR).
LINK HERE TO CHRONOLOGY DOCUMENT
Information and summaries of local SARs can be found on the safeguarding board websites:
Bristol: Bristol SAR
NS: North Somerset SAR
South Glos: South Gloucestershire SAR
Following Safeguarding Adult Reviews the ICB safeguarding team will disseminate learning and action plans through regular training events and GP link meetings.
Domestic Homicide Reviews (DHRs)
It is a statutory requirement for local authorities to conduct a Domestic Homicide Review (DHR) where the death of a person aged 16 or over has, or appears to have, resulted from violence, abuse, or neglect by a person to whom they were related or with whom they were, or had been, in an intimate personal relationship, or a member of the same household, or from suicide.
All agencies are requested to provide information detailing their involvement with the adult to which the DHR pertains. A request for a chronology will be sent directly from the local Community Safety Partnership (part of the Safeguarding Adults Board), or via the Designated Professional for Safeguarding Adults, to the person's GP practice. The GP practice must complete the chronology in order for the Named GP for Safeguarding to write an Individual Management Review (IMR).
Following a DHR, the safeguarding team will disseminate the learning identified and consider how this can be used to deliver improvements to practice to safeguard victims and prevent domestic homicide.
Local DHR information can be found at the following links:
Bristol DHR
North Somerset DHR
South Gloucestershire DHR
Section 42 - Statutory Safeguarding Enquiry
The Care Act 2014 (Section 42) requires that each local authority must make enquiries, or cause others to do so, if it believes an adult at risk of harm is experiencing, or is at risk of, abuse or neglect. An enquiry should establish whether any action needs to be taken to prevent or stop abuse or neglect, and if so, by whom.
While many enquiries will need a lot of input from a social care practitioner there will be aspects that should be carried out by other professionals with the necessary skills and knowledge. For example, it may be a health professional who has the closest relationship with the individual and is best placed to explore a particular concern with them in the first instance.
Non-statutory enquiries:
Local authorities are not required by law to carry out enquiries on behalf of adults who do not fit the criteria outlined in Section 42 of the Care Act 2014 but may do so at their discretion. These enquiries would relate to an adult who is believed to be experiencing, or is at risk of, abuse or neglect, and does not have care and support needs (but might have just support needs).
Self-neglect and hoarding
This is a complex issue and covers a wide range of behaviours, such as neglecting to care for one’s personal hygiene, health, or surroundings such as can be seen with hoarding. Further details are available on the local websites below:
Bristol Self-neglect
North Somerset Self-neglect
South Gloucestershire Self-neglect
If your patient is complex and lives in N Somerset or Bristol, please consider input from MARM / adult MASH (see above).
Police welfare checks
Avon & Somerset police will not carry out requests for 'welfare checks' unless:
- There is an identifiable and immediate risk to life or property.
- The vulnerable person or child is suffering, or is at risk of suffering, immediate and significant harm.
- It is reasonably believed that a crime has been committed, is being committed or is about to be committed.
- Attendance of a police officer is necessary to prevent a breach of the peace.
Further information is in the attached letter
Hoarding
Hoarding increases the risk of a fire occurring. The multi-agency approach to sharing information about hoarding strengthens the operational risk assessment when dealing with incidents and fires where hoarding is present.
Avon Fire & Rescue Service - Clutter Image Rating Scale
Please consider fire risk for all vulnerable patients and refer to the Fire service for a Fire safety check: Click here for referral form
Request a home fire safety visit - Avon Fire and Rescue Service
Modern Slavery
Modern slavery means being forced to work illegally against one's will. Some examples of modern slavery include: prostitution, domestic servitude, nail bars, car washes or care homes with little or no pay. A growing form of modern slavery involves recruiting children and adults into crime, “County Lines” drug trafficking or drug production.
Primary care may be the only contact individuals have with the outside world, asking curious questions and seeing the individual alone (using a translator) will maximise the opportunity to safeguard.
Useful resources can be found on the links below:
Unseen is a UK charity with its head office in Bristol. They provide safehouses and support in the community for survivors of trafficking and modern slavery
Helen Bamber Foundation - Quick guide to Modern Slavery and Human Trafficking.
Avon & Somerset Police - share information about vulnerable or exploited people, exploiters or organised crime
Bristol Modern Slavery
North Somerset Modern Slavery
South Gloucestershire Modern Slavery
Independent Mental Capacity Advocate (IMCA)
IMCAs are a safeguard for people who lack capacity to make some important decisions. These are advocates when the patient has been assessed as having no capacity and they have no-one else apart from paid carers to speak on their behalf.
The IMCA role is to support and represent the person in the decision-making process. Essentially, they make sure that the Mental Capacity Act is being followed.
Who should get an IMCA? An Independent Mental Capacity Advocate (IMCA) must be instructed for people in the following circumstances:
- The person is aged 16 or over;
- A decision needs to be made about either a long-term change in accommodation or serious medical treatment;
- The person lacks capacity to make that decision; and
- There is no-one independent of services, such as a family member or friend, who is “appropriate to consult”.
An IMCA may also be provided to people for other decisions concerning:
- Care Reviews; or
- Adult Protection Cases
In adult protection cases an IMCA may be instructed even where family members or others are available to be consulted.
Details of IMCA Services in the BNSSG area
Bristol: POhWER - for ALL types of advocacy (statutory and non-statutory)
Email: pohwer@pohwer.net
Tel: 0300 456 2370
North Somerset: The Advocacy People
Email: info@theadvocacypeople.org.uk
Tel: 0330 440 9000
PO Box 375, Hastings, East Sussex, TN34 9HU
South Gloucestershire: VoiceAbility
Email: helpline@voiceability.org
Tel: 0300 303 1600
VoiceAbility, c/o Sayer Vincent, Invicta House, 108-114 Golden Lane, London, EC1Y 0TL
Information for people living in or being supported in Bristol needing Care Act Advocacy Your Say Advocacy
Email: admin@yoursay-advocacy.com
Tel: 01291 417 933 / 07778 496707
(This needs padding out - needs an explanation of Care Act advocacy, when to apply for it/criteria, agencies across BNSSG - Alex, do you have this information to hand?)
Address: Unit 36 BasePoint, Beaufort Park, Chepstow, NP16 5UH
Multi-Agency Public Protection Arrangements (MAPPA)
MAPPA stands for Multi-Agency Public Protection Arrangements. They are the set of arrangements through which the Police, Probation and Prison Services work together with other agencies to manage the risks posed by those convicted of violent, sexual and terrorism offences who are living in the community, in order to protect the public.
MAPPA are not a statutory body in themselves but are a mechanism through which agencies can better discharge their statutory responsibilities and protect the public in a co-ordinated manner. Agencies at all times retain their full statutory responsibilities and obligations.
The MAPPA website provides professionals and the public with information on how those convicted of violent, sexual and terrorism offences are managed in the community. The public should be reassured that agencies involved in MAPPA are working closely together to ensure that resources are best directed to protect the public and to reduce reoffending.
Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.
