Treating children and young people safely in general practice

Medical Protection’s Education team have undertaken around 1400 Clinical Risk Self Assessment (CRSA) visits to practices in the UK and Ireland. They have helped practice staff to identify potential risks to patients and find safe solutions.

The following advice – which is relevant to children and young people – has been gathered from these CRSAs and aims to help you learn from the experience of others, so that you can take steps to ensure that your practice is as child friendly as possible. This advice is by no means exhaustive, but you may wish to use it as the basis for discussion within a staff training session.

1. Child protection

• Ensure that you have an up-to-date and regularly reviewed child protection policy and a nominated clinical child protection lead.
• Review when your staff last had child protection training, the level of training each staff member needs and whether refresher training is required.¹
• Ensure there are clear posters in consultation rooms and the reception area, with easy-to-find details of who should be contacted if there are child protection concerns.
• Familiarise yourself with the RCGP/NSPCC Safeguarding Children Toolkit for General Practice.²
• Ensure that all new staff have the appropriate pre-employment disclosure checks, where indicated.

2. Appointments

• Allow young persons under 16 to see a clinician without the presence of an adult if requested. The General Medical Council (GMC) advises that you should avoid giving the impression that young people cannot access services without a parent.³
• Consider displaying a poster to let young people know that they may request to be seen alone. Unwillingly attending with an adult could potentially prevent a young person from asking for help.
• Consider offering teenage-friendly times for consultations, for example over school lunch breaks. Young people are more likely to access help if it is convenient to them.
• Practice privacy notices, detailing how patients’ personal data is used, should be provided in a format that can be understood by children and young people.⁴
• Children under 16 can consent to medical treatment if they understand what is being proposed. Clinicians must assess whether the child has the maturity and intelligence to fully understand the nature of the treatment, the options, the risks involved and the benefits. A child who has such understanding is considered Gillick competent.

3. Confidentiality

• Young people who have the capacity to understand the implications of their health and treatment have the same rights to confidentiality as any other patient.
• Ensure that you have systems in place to protect their confidentiality. For example, a 14 year old may not want his parents to know that he had an appointment at the practice for his acne; a 15 year old may not want her mother to pick up her prescription for her contraceptive pill.
• Develop clear protocols for test results and prescription requests to ensure that results or prescriptions are not given to parents without the consent of the young person.
• Follow GMC guidance if faced with a parental request for access to their child’s medical records.⁵
• Consider excluding children under 16 from your text messaging service, as there is a risk that their parent’s mobile number could be linked to their record.

4. Health and safety

• Ensure that sharps bins are not located on the floor or within easy reach of children. These large bright yellow boxes may attract the attention of small children, who may perceive that they are part of the practice’s toy collection.
• Consider a dedicated children’s waiting area – with toys – as this may encourage children to be more relaxed and potentially easier to examine once they are in the clinician’s room.
• Organise a regular cleaning rota for any toys that the practice provides for young patients. It is accepted that soft toys are more likely to be a risk of infection than hard toys, therefore consider only providing hard toys in waiting areas.⁶
• Conduct a regular safety check of toys and discard any that are broken.

1. BMA. Helping you meet your training obligations (2018). Available at: https://www.bma.org.uk/advice/employment/gp-practices/gps-and-staff/practice-staff-training-resource
2. RCGP/NSPCC. Safeguarding Children and Young People: The RCGP/NSPCC Safeguarding Children Toolkit for General Practice (2014). Available at http://www.rcgp.org.uk/clinical-and-research/resources/toolkits/the-rcgp-nspcc-safeguarding-children-toolkit-for-general-practice.aspx
3. GMC. ‘Communication’, 0–18 years: guidance for all doctors (updated 2018). https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/0-18-years/communication
4. ICO. Right to be informed. https://ico.org.uk/for-organisations/guide-to-the-general-data-protection-regulation-gdpr/individual-rights/right-to-be-informed/
5. GMC. ‘Accessing medical records by children/young people/parents’, 0–18 years: guidance for all doctors (updated 2018). https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/0-18-years/accessing-medical-records-by-children-young-people-parents
6. Merriman E et al. Toys are a Potential Source of Cross-infection in General Practitioners' Waiting Rooms. British Journal of General Practice 2002;52(475): 138–40.