Contextual Safeguarding

Since the new RCGP Safeguarding Standards arrived a couple of years ago, I’ve been trying to explore those topics it includes that might be less familiar to GPs and their teams when I lead safeguarding training sessions.  The comprehensive, all-age approach it outlines includes some concepts that might seem quite new; although I’d argue that sometimes the “new” covers work we have done for many years, without perhaps naming it.

One such topic is contextual safeguarding.  This is a term that’s only been in use since 2015, when excellent work at Durham University led to a framework that addresses the significant harm that can come to children, young people and vulnerable adults from outside of their home.  This might be their school, their peer group, their neighbourhood; increasingly in today’s world, it means online spaces.  My own comparisons of the analogue childhood I had with the massively interconnected, digital world my teenage daughters occupy as second nature never fails to astonish me.   It is a good thing that an understanding of this idea is now highlighted as a learning need by the College; in itself, that’s a recognition that the Government guidance we are expected to follow includes it.

We should all know our most vulnerable patients are at risk of exploitation; be that sexual exploitation, criminal exploitation, radicalisation, modern slavery, and others besides.  The pernicious influences that bring these things to their lives may well come from outside of their family and home.  We need to recognise that relationships children and vulnerable adults form outside of their home, in person or online, can be characterised by violence and abuse. They can lead to isolation, coercion, threat, and sometimes serious harm and even death.

Such dreadful stories may feel distant from our consulting rooms; but in fact, we are key professionals in safeguarding work, and we will sometimes encounter victims because of the trauma they will suffer.  It is why we must “think safeguarding” when we see patients vulnerable to abuse, and why the idea that safeguarding work is a “golden thread” that runs through every consultation is so important.  When we see the teenager with behavioural problems at school, we will always consider their home life: we must also actively consider their peer relationships, and their online world.  The vulnerable adult who is self-neglecting; is their money being used by someone exploiting them?

These cases are much more common than we find it comfortable to think.  Just this year, my own safeguarding work has encompassed a radicalisation case in a child, a mentally unwell adult being “cuckooed” by a criminal gang using his flat, a mental health crisis triggered by online exploitation by a peer.  These cases present to us and need our help.

But importantly, whilst the concept is a newer one, the work it describes is not.  In fact, this speaks to why I firmly believe GPs and their teams are some of the most valuable members of the wider safeguarding team.  We should be proud of being generalists, but we also have a key specialism: our patients themselves.  Our work is stitched tightly into our local community; we already hold key information about those wider contexts that our patients have and using that knowledge in a spirit of empathetic enquiry and respectful challenge has been done by GPs bringing safety to so many, for so long.

We have launched a new and updated all-age safeguarding course at NB Medical, designed to include many topics from the new RCGP standards, and including this one. It has been built around new clinical case examples, covering presentations from children and vulnerable adults, which we hope reflect the real cases you see in your own surgery. We hope that the online presentation and accompanying written material will form a key part of your ongoing Level 3 safeguarding learning, and we are keen to hear your feedback.  Safeguarding work represents some of the most challenging, difficult work we do.  It is also one of the most vital, and we hope our module supports you in carrying it out.