Safeguarding Collaborative Arrangements
The NHS Act obliges NHS bodies to provide advice to statutory bodies in relation to social services, education and public health functions. Thus NHS England and CCGs, as NHS bodies, have to enable the Local Authority to carry out is safeguarding duties. This is known as the “collaborative arrangement”. GP practices are not NHS bodies, but are contracted to perform services under the GMS, PMS, or APMS contract. Any non-contractual work should thus be reimbursed separately.
Historically GPs and practices have been able to claim a fee for attending safeguarding conferences or providing reports to safeguarding conferences. This is supported by the GMS regulations which state-
“The contractor may demand or accept a fee or other remuneration—
(a)from any statutory body for services rendered for the purposes of that body’s statutory functions”
As the county council’s Lincolnshire Safeguarding Children Board (LSCB) is a body carrying out a statutory function, we should be able to “demand or accept a fee”.
The current debate
Over recent months the CCGs, LSCB, and county council have argued that these fees should not be paid. They argue that newer regulations and guidance states that safeguarding is implicit in our role as GPs. We agree that safeguarding is implicit, though still believe that the regulations, which we agree on an annual basis, and the NHS Act, have not changed, and that a fee can be sought.
Lincolnshire is not the only county which does not pay fees for safeguarding related services, but there are a number of counties who do pay. Locally, both Cambridgeshire and East Yorkshire fund these services. The time and effort involved in producing an in-depth report must be worth funding in the best interest of the parties involved.
We have not been able to agree with the safeguarding team a way forward. They have sought legal advice, and we are also seeking legal advice from the BMA legal team.
The current LMC position
Until we have definitive legal advice we would encourage practices to-
- Engage with safeguarding processes in order to prevent avoidable harm to your patient
- Provide a report to the safeguarding team, a template can be found at the bottom of this document
- Before attending safeguarding conferences confirm that a fee will be charged to reimburse locum costs
- Charge a suitable fee for providing more lengthy written reports to safeguarding conferences
The LMC is not able to recommend a precise fee as this is prohibited by competition law, however basing a fee on the costs to your practice of engaging a locum for the time taken would be considered reasonable.
Below are some useful passages from safeguarding guidance which may help you if you wish to claim a fee from the safeguarding team.
The RCGP Safeguarding Toolkit (2014) states-
“GPs are usually invited to Child Protection Case Conferences and are expected to produce a report for the Conference. GMC Child protection Guidance 2012 advises that GPs should be involved with this procedure. GPs often find case conference attendance difficult because they are called at short notice and finding cover for busy surgeries becomes problematical.
“If attendance is impossible, it is still essential that a comprehensive report be produced and discussed by telephone with the family’s social worker and the Conference Chair prior to the conference. It is good practice for this report to also be shared and discussed with the family as well as the child/ren if mature enough, unless to do so would increase risk and/or harm to the child/ren.”
The RCGP Toolkit (2014) also states-
“Some GPs request payment for supplying child protection information or attending case conferences – see GMC Child protection Guidance 2012 for advice and consult local guidance but be aware that failure to provide information or to contribute to the child protection process in a timely manner may be construed as professional misconduct.”
The GMC Child Protection Guidance 2012 states-
- If you are asked to take part in child protection procedures, you must cooperate fully. This should include going to child protection conferences, strategy meetings and case reviews to provide information and give your opinion. You may be able to make a contribution, even if you have no specific concerns (for example, general practitioners are sometimes able to share unique insights into a child’s or young person’s family).
- If meetings are called at short notice or at inconvenient times, you should still try to go. If this is not possible, you must try to provide relevant information about the child or young person and their family to the meeting, either through a telephone or video conference, in a written report or by discussing the information with another professional (for example, the health visitor), so they can give an oral report at the meeting.
BMA guidance can be found at-