Safeguarding young people and children

Find out about safeguarding young patients when it comes to proxy access.

Redacting safeguarding information

It can be difficult for you to detect that a child is at risk. Parents or carers may misuse proxy access to harm a child. They may want to check for any record of evidence that you've made of safeguarding risks.

It's important to follow up and document any suspicions you have of safeguarding risks. Proxy access must not stop you from entering information about safeguarding concerns in the child's record. You could put the child at risk if you do not record this.

All safeguarding information entered in the record needs to be hidden from online view for the proxy and child. This is called redaction.

If you're not confident that you can hide potentially harmful information, it may be best to decline or withdraw proxy access to the child's records.

Limiting adult access to a child's medical information

If the child named in the application is aged 10 or 15, we let the applicant know that their access to the child's services may stop when they turn 11 or 16. You may still want to discuss this with them.

When the patient is turning 11

Once a patient reaches age 11, review any previous access granted to the parent or guardian. You must then assess whether the child is Gillick competent. You should involve the child's parents in this process, when it's in the child's best interests to do so.

This assessment may happen when they are next seen or when there is a change to the patient's record. You should not stop access before assessing capacity. Only do this if you have reason to believe that continued access could be harmful.

If the child is Gillick competent, you must get their consent for continuing access.

If the child is not Gillick competent, you do not need to make changes to access.

When the patient is aged between 11 and 15

If the child does not have capacity yet, think about the challenges that may happen if they become competent to make their own healthcare decisions in the future.

The child may decide to change or withdraw access once they are competent. You need to assess child competency regularly after they turn 11. The Royal College of General Practitioners (RCGP) suggests doing this annually or when the patient or proxy requests this.

It can be good practice for you to review if this access is appropriate and meeting the patient's needs, when you have contact with them.

A child with capacity may want to:

stop an adult's access to their online services, if the adult still has this access after the child turns 11
give their parent or guardian access to some or all of their online services
request access to their own online services, which is only available if the child is aged 13 or over
switch off all online access, including the access that others have, until they want it in the future

When the patient is turning 16

If an adult with parental responsibility still has access to a young person's online services at this age, proxy access should be reviewed or revoked.

When a young person turns 16, they are assumed to have capacity, unless you have a reason to think otherwise. For example, if they have a long-term medical condition or learning disability that means they cannot consent to proxy access.

If the young person has been given access to their GP online services before they turn 16 and no one else has access to their services, you do not need to make any changes unless they want you to.

If they have an account for GP online services, they will automatically have prospective record access when they turn this age.

Reviewing changes to parental responsibility

More than 2 people can have parental responsibility for a child, depending on the situation the child is in. This may change throughout their childhood. Changes to who has parental responsibility for a child should be part of ongoing reviews of access.

For example, a child may be taken into care under a care or voluntary order. When this happens, the child's parents will share parental responsibility with the local authority, but the local authority will have final say on the child's care.

When a child can be more vulnerable to abuse

Any child can be at risk of abuse, but a child can be more vulnerable to this if:

they're living in poverty, poor housing and deprivation
they have a disability
their parent or carer has substance misuse problems, mental health problems or a history of domestic abuse

A child can be vulnerable to continuous abuse if:

the parent or carer does not engage with services
one or more previous episode of child abuse or neglect has already happened
the parent or carer has a mental health or substance misuse problem that really impacts their parenting tasks
the parent or carer has chronic parental stress
the parent or carer was abused or neglected as a child

To help stop abuse from happening, the RCGP recommends promoting family well-being and strong relationships between parents and children.

Remember that most parents in families with these factors do not abuse their children, while some parents in families that show none of these factors do.

The RCGP Safeguarding toolkit part 2A: Identification of abuse and neglect has more information on how to identify abuse.

Suspecting abuse

If you're concerned that a child may be at risk of abuse, there are steps you can take shown in the RCGP Safeguarding toolkit part 3B: Responding to concerns about child abuse.

Last edited: 11 December 2024 9:19 am