New approach to recording suspected child abuse in patient records

A simpler, more standard way for GPs to record suspected cases of child abuse is outlined in a paper published in this month’s issue of the British Journal of General Practice. The method was developed based on a survey of 11 GP surgeries, led by the UCL Institute of Child Health (ICH) together with the Royal College of General Practitioners (RCGP) and the University of Surrey.

The study, funded by the Healthcare Quality Improvement Partnership, looked at how GPs currently record their concerns in patients’ electronic records, and the potential problems they face. GPs were interviewed over the phone and in workshops and their views were used to help develop a simplified approach to coding. This approach is currently being piloted in the 11 practices.

All health professionals have a statutory responsibility to protect children from abuse and neglect. GPs are well placed to identify, monitor, and respond to maltreatment. However, they may be reluctant to clearly state their concerns in records for fear of: causing further problems for the child or the family; of damaging their ability to work with and support the family; or of coming up against legal barriers.

The study found that GPs recorded maltreatment-related codes during 2009-2010, across the 11 surgeries for every eight children per thousand children registered for a year. Rates were higher in children under five, but did not differ significantly between the sexes. Rates varied from 2.8 per 1,000 children per year to 31 per 1,000 children per year in practices in areas of greatest deprivation.

Professor Ruth Gilbert, UCL ICH, says: “Children under five see their GP on average five times a year. As GPs often see several family members, they can spot signs such as parental depression or addiction that put children at risk. However, GPs are often ambivalent about ‘labelling’ the child or family, and may use indirect or euphemistic terms. We don’t have a full picture of how often GPs in England actually report suspected cases to child protection services, but this is likely to be a minority of the estimated four per cent of children in the UK experiencing abuse or neglect each year.”

Dr Imran Rafi from the Clinical Innovation and Research Centre at the RCGP, says: “A wide variety of codes and terms are used in electronic records, which supports the argument for standardisation. We recommend the use of a single code ‘child is cause for concern’ as a simple way to flag concerns whenever child maltreatment is ‘considered’, as stated in the NICE guidance. We have developed a systematic approach to reporting concerns with guidance that is simple, feasible, and easy to remember.”

The paper recommends further controlled trials to evaluate whether improved recording of maltreatment concerns leads to better outcomes for children and their families.

The study was carried out by University College London, Royal College of General Practitioners, and University of Surrey.