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Referrals & Procedures

Checked: 23-02-2023 by 3 Vicky Ryan Next Review: 23-02-2024

The following guidelines where last updated by the Children's safeguarding team in April 2024.

Safeguarding Children Referrals

If you have a concern about a child/family, please refer them to the Local Authority in which they live.

The decision on whether to refer children and young people for early intervention or for safeguarding intervention depends on whether a threshold has been crossed. This involves assessing the impact of the family situation on the child.

The local authorities have issued their own specific Threshold Guidance, which can be helpful in making this decision. 

BRISTOL Keeping Bristol Safe Partnership

ReferralsDetailed guidance |Threshold guidance

If you are concerned about an immediate risk of harm to a child or young person, you can call 0117 9036444 or 999.

SOUTH GLOUCESTERSHIRE Children’s Partnership:  

ReferralsDetailed guidance | Threshold guidance

If you are concerned about an immediate risk of harm to a child or young person, you can call 01454 866000 or 999. 

NORTH SOMERSET Children’s Safeguarding Partnership:

Referrals| Detailed guidance| Threshold guidance

If you are concerned about an immediate risk of harm to a child or young person, you can call 01275 888808 or 999.

 

*** Urgent OUT of HOURS referrals BNSSG wide ***

(5pm-9am weekdays and weekends): EMERGENCY DUTY TEAM: 01454 615165 

 

Connecting Care 

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: Connecting Care - login page

Injuries to Non-Mobile Babies

There is BNSSG wide, multi-agency guidance for injuries in non-mobile babies. There is also an Addendum for Early years settings and Child Minders.

This policy was produced following a Serious Case Review (SCR) into the death of a baby in South Gloucestershire and should be used when any injury is identified in a baby who cannot move independently.

Please remember it is not the responsible of the primary care practitioner to determine causality. 

A BNSSG wide Keeping Babies Safe leaflet explaining the process should be downloaded and printed and given to the parents/carers.  This leaflet is also available in EASY READ format.

Congenital Dermal Melanocytosis - previously known as blue spot marks advice sheet.

Concerning injuries in mobile children - Policy

There is a BNSSG wide pathway for injuries in mobile children.

This policy was produced following a Single Agency Review into the case of a mobile toddler who’d presented to primary care with ear bruising, later admitted with extensive injuries and subsequently taken into care. This policy should be used when an injury is identified in a child who is able to mobilise independently.

Please remember it is not the role of the primary care practitioner to determine causality. 

Was not brought to appointment - Policy

Children rely on adults to attend their health appointments. When a child fails to attend an appointment, the ‘did not attend’ (DNA) terminology is potentially both incorrect and punitive.

Across BNSSG the phrase ‘was not brought’ (WNB) is being promoted and missed appointments should be coded as such. A WNB event should trigger a review of the child’s health and care needs, with an appropriate response required from clinicians.

The BNSSG WNB policy is available to assist primary care clinicians in managing these events safely.

Child Sexual Exploitation (CSE) and other specific concerns

Child Sexual Exploitation is a form of sexual abuse. Children in exploitative situations may receive gifts, money or drugs for performing sexual activity or may be tricked into believing they are in a consensual loving relationship. They may be groomed online, at school or during out of school activities. Exploitation may be by individual abusers who may be part of a peer group or by much older individuals. Exploitation may be by organised groups of abusers.

Following recent high profile cases, the Spotting the Signs Proforma tool has been produced to help clinicians identify young people at risk of CSE.

Each local authority has their own specific guidance around CSE: Bristol / North SomersetSouth Gloucestershire.

Referrals are via the above pathways.

Actions following a referral

All local authorities follow the procedures required under the Children Act 1989, which are set out in the document Working Together to Safeguard Children 2023

Referrals are triaged by a Single Point of Access service and passed to the appropriate team. The individual procedures are often referred to by social care colleagues using the different sections of legislation e.g. the initial assessment following a referral is often labelled a “Section 17 assessment”

When it is thought that the child may be suffering from or is at risk of suffering from significant harm, a Strategy Discussion (under Section 47 of the Children Act) takes place to decide whether further assessment needs to be undertaken. Strategy Discussions are coordinated by the Children’s Social Care manager and should involve police, education and health professionals.

If appropriate, the Social Care team carrying out the Strategy Discussion will arrange a child protection medical with the duty Community Paediatrician.

The outcome of this discussion should be communicated to all relevant professionals.

When a child protection Case Conference is held to discuss and assess concerns about a child, GPs are asked to complete a report for the Chair of the Case Conference. GMC guidance highlights the requirement for GPs to complete these reports. GPs should be invited to attend case conferences but in practice, it is unusual for them to attend. This makes it particularly important that conference reports are submitted. Local arrangements are in place for payment for these reports. Please see individual Safeguarding Partnership websites for guidance and forms

Following a Case Conference, all involved professionals should receive a report with a relevant action plan highlighted. This should include a decision as to whether the child is made subject to a Child Protection Plan. The report should also include the date of the next follow-up conference, so that follow-up reports can be submitted in a timely fashion. Case conference reports are sent by secure email or paper mail.

Practice safeguarding policies

Safeguarding Children Policy

Each practice should have a Safeguarding Children Protocol. The RCGP toolkit is generally considered the best available guide for GPs. It is a comprehensive document which can be made available on practice intranet and contains guidance on how to set up a practice specific protocol and how to undertake a practice based self-assessment. Practices can use this toolkit to produce a concise practice specific safeguarding protocol, as required by the CQC.

Link / Lead GPs

It is a requirement that every practice in BNSSG has a Children’s Safeguarding Link GP.

In many surgeries, one GP is taking dual roles in adults and children’s safeguarding. The role of the lead GP is to ensure that members of the practice team have relevant training and resources, to disseminate newsletters and information and to ensure that the practices have an up-to-date safeguarding protocol. Link GPs attend meetings organised by the ICS safeguarding team at which current topics and issues in safeguarding are discussed.

Please email to let us know when there is a change in your Link GP so we can update our records. bnssg.safeguardingadmin@nhs.net

BNSSG ICB Children's Safeguarding Team

The BNSSG safeguarding team provide support and training for primary care colleagues. They arrange regular meetings with link GPs, provide training updates, host Q+A drop-in sessions and participate in a variety of policy groups and committees.

They are happy to give advice on safeguarding matters to clinicians. Please remember that they cannot offer urgent advice but are happy to talk through complex issues. Any advice given is provided to assist you in your decision making and you may still wish to liaise with your indemnifying organisation or seek further advice from, for example, your data protection officer.

Head of Safeguarding: Faye Kamara

Designated Nurse for Safeguarding Children: Toyah Carty-Moore

Designated Professional for Safeguarding Adults: Alex Morgan

Named GP for Safeguarding: Dr Marie McVeigh

Named GP for Safeguarding: Dr Ben Burrows  (until July 2024)  

Designated Doctor for Safeguarding Children (Bristol & South Glos): Dr Emma Bradley

Designated Doctor for Safeguarding Children (North Somerset): Dr Richard Williams

Deputy Designated Professionals for All Age Safeguarding:

Designated Nurses: Lucy Austin, Louise Field, Harjit McLean

Named Professionals for Primary Care (All Age):

Kirsten Bowes, Louise Ledgerwood-Care

Safeguarding Administrator: Daniella Daniels

MCA and DoLS Lead: Johnson Koikkara

Community DoLS Assessors: Sarah Dunn, Selena Stennett

All team members should be contacted via the Single Point of Contact safeguarding email address: bnssg.safeguardingadmin@nhs.net  

 

Our focus this coming year is on:

  • Delivering Level 3 safeguarding training twice per year (children and adults separately).
  • Running Link GP meetings twice per year
  • Offering informal Q&A drop-in sessions for peer-to-peer case discussions and queries

We will also aim to develop further safeguarding learning resources (e.g. webinars / podcasts) to help primary care staff stay up to date & achieve their mandatory CPD requirements annually.

For further information about safeguarding training please see our ICB webpage: Safeguarding information - NHS BNSSG ICB

Safeguarding Dates 

Link GP meetings: 1:00 - 2:30pm on various dates across BNSSG (1.5hrs CPD)

Level 3 Safeguarding training on MS Teams: 9:30 - 12:30am (3hrs CPD)

These courses are for primary care staff and will have a primary care focus. For core level 3 training, with a multi-disciplinary focus, please attend various topic-specific courses available to all NHS staff via your local authority / adult safeguarding boards. 

Children’s level 3 safeguarding – 18th September 2024

Adults level 3 safeguarding – 27th November 2024

For dates in 2025, please await Safeguarding team communications

Q+A drop-in sessions: 1:00 - 2:00pm (1hr CPD)

These sessions are aimed at safeguarding link GPs (and practice staff involved in complex safeguarding cases) to participate in some interactive and peer-led case-based discussions. Please bring your current cases for consideration, advice and support.

Allegations against people who work with children

Allegations of abuse of children by adults who work with children are becoming increasingly common especially following recent high-profile cases. This includes teachers, foster carers, youth and community workers and other professionals and volunteers. It may also include NHS staff including practice staff. Concerns may be identified by parents attending with children or during consultations with adult patients who work with children themselves.

The framework for managing cases applies where it is alleged that a person has;

  • Behaved in a way that has harmed a child or may have harmed a child
  • Possibly committed a criminal offence against or related to a child; or
  • Behaved towards a child or children in a way that indicates that they may pose a risk of harm to children

Allegations are investigated by the Local Authority Designated Officer (LADO) in Bristol and South Glos or Designated Officer for Allegations (DOfA) in North Somerset.

The role of the LADO/DOfA is to provide advice and guidance and be involved in the management and oversight of all allegations cases regarding people who work or volunteer with children. Practices are expected to support the LADO in leading any investigations into practice staff.

Cases can be discussed with the LADO/DOfA and referrals made using the appropriate referral forms and pathways on the links below:

Bristol | S. Glos | North Somerset

Rapid Reviews & Child Safeguarding Practice Reviews (CSPRs)

When a child dies or is seriously harmed as a result of abuse or neglect, reviews may be conducted to identify ways that professionals and organisations can improve the way they work together to safeguard children and prevent similar incidents from occurring.

Agencies involved will be contacted to submit documentation within 15 days of notification to the National Child Safeguarding Practice Review (CSPR) Panel for a Rapid Review. The BNSSG ICB team will contact GPs when we are notified (emailing the Link GP for Safeguarding Children and the Practice).

The aim of a Rapid Review is to enable Safeguarding Partners to:

  • Gather the facts about the case, as far as they can be readily established at the time
  • Discuss whether there is any immediate action needed to ensure children’s safety and share any learning appropriately
  • Consider the potential for identifying improvements to safeguard and promote the welfare of children
  • Shared Learning identified with agencies so that actions can be implemented where needed
  • Decide what steps they should take next

Outcomes may include either a Local or a National Child Safeguarding Practice Review (CSPR). If the case does not proceed to a CSPR, then the Rapid Reviews are used to distil any learning, which will be fed back to practitioners and for wider training.

We assume that the BNSSG ICB team will undertake Rapid Reviews on behalf of Primary Care. However, if practices would like to and have capacity to do so, we need to be informed within 24 hours of our email.

We request GP records from practices, however, if we are unable to do this rapidly, our team will use Connecting Care to draw up a chronology of events for each person involved, in order to meet the deadline.

Reviews are not conducted to hold individuals, organisations or agencies to account. Their aim is to prevent or reduce the risk of recurrence of similar incidents at both local and national levels, and to identify improvements to be made to safeguard and promote the welfare of children.

Following the Rapid Review, we will be in touch with practices to share relevant learning points and provide feedback. We will then follow this up with a subsequent request for evidence and assurance that the learning has been implemented.

The official document used to guide processes for safeguarding children is called: Working Together to Safeguard Children 2023: statutory guidance

Here is the BNSSG learning brief on Rapid Reviews and CSPRs.

The NSPCC also has useful information on the Child Safeguarding Processes.

Published CSPRs can be found on the relevant local Safeguarding Partnership websites:

 Bristol  |  North Somerset  |  South Gloucestershire

 

Resources

Centre of Expertise on Child Sexual Abuse -   eLearning, training and events 



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.