We’re continuing our five-minute delegation series with a set of quick audits of patients who have more significant safeguarding needs. Most of the audits can be carried out by any member of your team, though you might need to delegate the follow-up actions more selectively.

Safeguarding is an essential and overarching theme within general practice, and, without doubt, will come up when you’re inspected by CQC. Audits are a brilliant way to check your historical data and data quality. The added benefit of well-conducted reviews is the ability to look holistically at the processes and identify any systemic failures. If you don’t currently pick up some of the issues identified, then you have a basis for changing your process going forward. With the advent of patient online records access, the continual improvement of data quality is ever more critical.

While safeguarding concerns and vulnerability vary, depending on the nature of the concern and the patient themselves, your processes should be robust, rigorous and not subject to variation.

Before you delegate your audit, you should be clear about what you want to achieve. You might also need to stipulate how you want the information noted. Without precise guidance, you might find that information comes back to you lacking clarity, and then you’re faced with sorting through it yourself to extract the useful parts. The other issue you might want to consider is what you’re going to do with the information once you have it. Any audit should start with a clear view of what you’re going to do with the data. In some cases, you’ll be able to ask the auditor to make any necessary adjustments as they go along. As always, make sure you ask them to save any anomalies until the end. If you don’t do this, you might find that five-minute delegations take much longer!

Before you start, discuss the implications and actions with your safeguarding lead; they might want to have some input. You should also review the findings with your safeguarding lead. It would be a good idea to document and minute this formally, as this part of the process is crucial to your CQC ratings, and ‘closing the loop’ by re-auditing and reviewing in 6 or 12 months should show improvements where necessary.

You can find other posts in our five-minute PM series here.

What: Safeguarding and vulnerability audit and activity

Who: Any suitably qualified team member

Resources: To report on:

• Patients aged over 18 with a safeguarding alert relating to them as the ‘subject’ of a safeguarding concern.
• Vulnerable patients: As well as the standard list of categories you include, you might want to add those who have learning difficulties, those who’ve had previous safeguarding alerts, and those who have brain injuries. You might want to consider those who’ve had involvement from CAMHS or Adult Mental Health services, along with those who are or have been ‘looked after children’.
• Patients who are currently or have previously been ‘looked after children’.
• Children on a Child Protection Plan.
• Children with a Child in Need or Child Protection Plan identified.

Benefits: Improved care of vulnerable patients.

How long (estimated): Varies with patient list size and caseload, but should be in the region of two minutes per reported patient for the simple audits, to ten minutes per audited patient where the actions needed are more significant.

Related KLOEs/Quality Statements:

S1.1: How are safety and safeguarding systems, processes and practices developed, implemented and communicated to staff?

S1.2: How do systems, processes and practices protect people from abuse, neglect, harassment and breaches of their dignity and respect? How are these monitored and improved?

S1.5: Do staff receive effective training in safety systems, processes and practices?

S1.7: Do staff identify adults and children at risk of, or suffering, significant harm? How do they work in partnership with other agencies to ensure they are helped, supported and protected?

Remember, with CQC Manager, you can easily switch to Quality Statements once your area move to this method of inspection. Mapped against KLOEs, it’s a simple switch. Practices in the South East are currently being inspected against Quality Statements.

What to do:

• Patients with a safeguarding alert who are over 18: Check notes to establish what the safeguarding concern was and whether it’s still relevant. If the safeguarding alert was added under the age of 18 and the circumstances surrounding the safeguarding alert no longer apply, arrange for the removal of the safeguarding alert. Where the details or concern around the safeguarding alert still apply, you should check to make sure that any relevant adult safeguarding actions have been completed – for example, is the adult safeguarding team aware of the patient?
• Vulnerable patients: Make a list of the relevant read codes and add this to your report. Once complete, add an alert to the patient’s notes for appointment booking, the opening of records or in the alerts tab so that other staff dealing with the patient are aware that they are vulnerable.
• Patients who are or have been ‘looked after children’: These patients might have missed routine immunisations through their childhood. Check the appropriate immunisation schedules and invite patients for catch-up sessions where applicable.
• Children on a Child Protection Plan: Ensure that there are appropriate warnings on the record. Check that sensitive detail is marked appropriately, especially when considering online sharing, and that the social worker is named/identified. Ensure actions have been completed and that the safeguarding lead and usual GP have reviewed the plan.
• Children with Child in Need or Child Protection Plan identified: Check that any multi-agency case conferences, initial and review meetings are being appropriately recorded and actioned.
• Bonus tip – you can set up checks with Checks Manager to remind you to carry out these tasks regularly!

Helpful hint: Not all patients in a group who are identified by read code may be vulnerable, and not all vulnerable patients will be picked up by a read-code-led report. It’s always worth asking your patient-facing staff and clinical staff if there are any patients who they consider to be vulnerable.