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This area contains links to PDF file documents.
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Resource Library

Domestic Violence (May 2014)
A presentation which includes a case discussion and links to a video to purchase (for £1.49). Presentation duration: 45 minutes.

Mental Capacity Act (MCA) 2005 CCG Presentation
A comprehensive presentation about the MCA 2005.

Safeguarding Adults level 1
Basic Level 1 training for safeguarding adults at risk of abuse & neglect in Cumbria.

Safeguarding level 1 for Administrative Staff
Basic Level 1 training taken from ELFH, which is suitable for administrative teams, etc. Presentation duration: 30 - 40 minutes.

A Case of Possible NIA (child with a skull fracture)
A brief case study, including learning points.

Serious Case Reviews (SCR) and Child J
A description of SCR in general, and a case discussion regarding Child J (teenage suicide).

Adult Case Scenarios
Includes four adult cases for discussion.

A Child Protection Update
A presentation by Dr Deb Lee on safeguarding for GPs which looks at injuries in children and how to respond to them, following NICE guidelines.

NSPCC: "Needs and wants" - A story of neglect (2 minutes)

Looked After Children (5 minutes)
For discussion - How can we give LAC continuity in a GP?

NSPCC: Ending Female Genital Mutilation (9 minutes)
For discussion - How do we ask about this topic?

Daniel Pelka (13 minutes)
For discussion - What were the assumptions made in this case?
For discussion - How do we create a global picture of a childs life prior to a SCR?

NHS Choices: Domestic Violence (7 minutes)

Comic Relief: Domestic Abuse (4 minutes)
For discussion - How do we follow up on a disclosure of domestic violence?
For discussion - How do you assess the impact of domestic violence on children

Female genital mutilation: the facts 
This film explores the severe long-term health impacts FGM has on women and girls, and considers why it still happens and what communities can do to end the practice for good.

Updates from Cumbria Safeguarding Children Partnership (CSCP) can be found on the website here.

Archive Updates

1. Please could you update details of your current practice managers and safeguarding leads to Anne Cooke? Contact details above.

2. Following on from recent requests, please click below links for details on private fostering.
Foster leaflet for parents
Fostering posters
Private fostering summary

3. The following is a link to a useful leaflet of 5 steps to mental health wellbeing for young people

4. The RCN have developed guidance to help nurse/midwives with patients suffering domestic abuse. It may be useful for your practice staff. 

5. The NSPCC have issued really useful guidance on engaging fathers involved with domestic abuse

6. You may want to review the LSCB Policy “Working with Uncooperative Families – Disguised Compliance” prior to the forum which can be found at

1. Please click the below links for useful pathways for dealing with situations involving parental alcohol /substance misuse, mental health.

2. Below is a collection of safeguarding posters/guides that have been developed& collated by Dr Amy Lee (edited for West Cumbria) and can be used as part of your safeguarding notice boards if you wish.

3. Please see two links below regarding CDOP (Child Death Overview Panel) The CDOP leaflet for parents is now in 2 places on the Website – first link is in the professionals box and second is in the parents box:-

4. Please could you encourage all GPs to use SIRMS to report concerns about acute hospital care, CPFT care and observations about Care Homes. With this information we can enable better practice through the various quality meetings the CCG organise.  If concerns are repeated and persistent then these need to be escalated through practice SG lead, Named Doctor for locality and

5. MCA  DOLS Best Interests. There are increasing reports of inappropriate demands in this area: surgeons wishing GPs to do capacity assessments for surgery (the decision maker has to do the assessment), police asking for GP assessment for a court case for example (an expert opinion was wanted).  While we are finalising MCA documentation the RCGP have a good toolkit but this needs additional questions about whether  MHA assessment is needed and whether a SALT( speech and language specialist) is needed to help with communication issues. .  If a carer with power of attorney is not acting in the best interests of a patient without capacity then this is likely to be a safeguarding referral if it cannot be resolved by the clinicians. The GMC also has a useful capacity toolkit

6. There is now guidance on the LSCB website for Bruising in Babies and Children who are Not Independently Mobile

7. A reminder regarding sexting. Many children and even adults do not realise the illegality of sharing a nude/semi-nude image of even themselves if under age of 18. Also Internetmatters is a useful website/resource for parents and any adults on this subject:

1. There have been some UPDATES to the LSCB Safeguarding Threshold Guidance Manual. Please do find time to have a closer look at it as it does help you make decisions and be more confident about those decisions. It is 41 pages, but a useful reference to dip into for your cases.

2.  ACTION: Practice Nurses – Safeguarding Competency Levels: We would like all practices to explore with their safeguarding leads if standards are being adhered to & monitored through appraisal ;

Agreed Levels – Level 2 for most Practice Nurses. Level 3 for contraceptive and sexual health services. Level 3 for Emergency care for adults and children.

This issue was discussed at our meeting last week with NHS England and has also been raised recently by one of our practices. It was agreed as above that all practices need to be level 2, but working towards level 3 if they have particular roles such as running sexual health clinics, providing contraception or assessing acutely ill children eg: nurse practitioners. Could you check with all your practices that this is being addressed and is being monitored through appraisal?

3. Please see the final Child O Briefing and Learning Document.

4. Also note that we can refer young people who are involved in high risk behaviour eg: alcohol, substance misuse, high risk sexual behaviour to Assertive Alcohol Outreach services (referral form here). This does cover cannabis/cocaine use aged up to 18 years.

5. In response to questions raised for Children Looked After;

i.    ‘Children being placed from other LA and the Cumbria CLA Team not being informed – often we get this information from Health Visitors.
ii.    The other issue identified was that some GPs are registering the child placed for adoption in the name which the child will be known as when adopted. This is probably the easiest thing to do but the LA has always been clear with us that the child is registered on systems in their legal name, which until the point of adoption is their birth name. It is unfortunate that not all adoptions are successful or happen quickly – it is a minimum of 10 weeks from placement but usually much longer than this.  As we are getting the child’s details from the Spine this is causing problems and will also risk as there will be a link between the old and new NHS numbers as the child will have the same name.’

Please see attached letter asking GP practices to now consider children arriving in Cumbria as CLA to attend for review. Also attached is guidance information on dealing with the records of adopted children.

6. A reminder of safeguarding practitioner forums, dates are on the LSCB website

7.  The Egress System has been introduced by Cumbria County Council introduced as an easy to use piece of software (called Egress Switch) that will help us ensure that any information sent by email is secure.  The IRO Service would like to send you secure encrypted emails (including large file transfers) using this method in place of letters and minutes which you would normally receive by post.  The IRO Service has already written to Schools, GP Practices, District Public Protection Units, Cumbria & Lancashire CRC, District School Nurses/Health Visitors, Named Doctors for Safeguarding Children, Unity, District CAMHSs and CMHTs about this and it’s rolling out now.
The Egress Switch system can also be used by agencies to send their response information securely to the IRO Service.
If you have not yet been contacted, and you expect to receive child protection correspondence in the future, you may benefit from registering for an account in advance (using the email which you intend to use).  It’s easy to register for an account.  You can do this and browse online training and support for external users at
Further information can be found on the Council website at

If you would like to discuss how other agencies are making Egress Switch work for them, please contact Samantha Davidson, Business Support Manager for the IRO Service on 07827 881540.

8.  Prescribing is a major cause of errors, hospital admissions, some deaths and is a recurrent theme in SCRs.  GMC are very clear that the prescriber has to take full responsibility particularly with the frail elderly and where mental capacity is an issue

9. Diagnosing PTSD in sexual assault and DV survivors is really important.  The PHQ9 and GAD7 don’t have any PTSD questions so the diagnosis is often missed and mislabelled and mistreated as Anxiety or depression.  The toolkit above is helpful and was provided by the First Steps lead Richard Thwaytes.  The high level practitioners in first steps do EMDR work (Eye Movement Desensitisation and Reprocessing) to deal with the symptoms. This is really effective.

10.    Flagging carers is emerging as a theme in SCRs and DHR and ensuring that the notes cross reference. Particularly vulnerable groups are carers of people with dementia, LD and SMI. All these carers should be offered Carer’s assessments.  Issues such as benefits and in particular Attendance allowance which is not means tested should be raised. There is emerging evidence that the frailty of carers of patients with dementia is considerably worse than expected for their age
cannot be resolved by the clinicians.

11.    We discussed the Pokemon (a child’s game collecting creatures, now as a phone app using augmented reality) guidance – this is the link to the NSPCC guidance.

1. Click here for the briefing on serious case report of Child AC, summarising key learning.

2. We are reviewing the GP & health Visitor Vulnerable Child meetings to see if best practice can be achieved through the county. Click here for a list of 8 questions, which we would be grateful if you could answer and send back to your Named GPs by 31st August 2016.

3. If you missed the dissemination of the safeguarding policy guidance and level 3 guidance that was disseminated by the communications team, you can view the guidance here!

4. A reminder of safeguarding practitioner forums, dates are on the LSCB website

5. Please see information below & for information sent to us by NHS England regarding Seen and Heard which includes a link to preview this initiative from the Children’s Society, you can view it by clicking on the link here.

This is a one hour e-learning course, based on the powerful story of a young boy called Tyler. It is aimed at workers primarily in health settings, supporting them to spot the signs of child sexual abuse and exploitation. It also aims to build on the skills of workers to better understand what children have said they need in order to disclose what is happening to them.

6. Please see correspondence below from Dept of Health.

‘I am writing with news to tell you about a new NHS FGM campaign which was launched recently.

As we near the start of the summer school holidays  when the numbers of girls taken outside of the UK to be cut increases, we are raising awareness of the severe health implications of FGM for those living in UK who are members of communities affected by FGM.  We are using TV advertising to directly reach out to communities with this message.

The film features a roundtable table discussion led by Henry Bonsu, a well-known British African broadcaster, together with a panel of experts all speaking openly and candidly about FGM.  Alongside the film, we have produced some short social media videos which are being distributed via Facebook.

The film will be broadcast on several UK African satellite TV channels from 9 – 31 July.  You can view the video, called ‘FGM: The Facts’ on NHS Choices – or you may have seen it on Vox Africa this morning where it premiered at 11:58 am.

We would be grateful if you could promote this campaign via your own channels, sharing the video and using social media help the campaign reach further; please contact either myself or our communications manager, Caroline Symes if we can support you to be part of this campaign.’

7. Finally, please note the next bulletin will be in September.

Please look at the now available LSCB e-learning access; Click on the option for other workers, then chose ‘Health’, then ‘GP’, or other staff as relevant. Then click ‘Register’. You will need your payroll number. Once registered, you will have access to the e-learning. Click ‘Home’ and then ‘Request Learning.’  

2.Please click the link to see a Power Point summary of PROTECT – a research programme regarding health professionals and ability to deal with suspected trafficked persons. You can access e-learning on trafficking on the Cumbria LSCB website as at point 1 above.    

3. NHS England has shared an update on reducing Mental Health homicides – please see attached.  

4. BASCPAN (British Association for the Study and Prevention of Child Abuse and Neglect) is a registered charity. You can become a member and access further training. National Events £130 for members, £180 for non members.    

5. Also in case you have not already seen the communications letters regarding Child L & Child N please find attached the CCG briefing notes and also the following link to the Cumbria LSCB 5 minute briefing regarding Child L    

6. Attached is an opportunity to attend a learning event regarding Mental Health Issues in Liverpool 13th July  

7. Finally, there is also an attachment for guidance on managing cases of intoxicated parents driving children to medical care centres.

1. Please take note of the Step Up Programme (attached, including Family Information Sheet) which is supported by the Youth Offending Team for families affected by Youth Violence. It has been recently trialled in Barrow and is now being introduced in West Cumbria.  

2. Attached is a summary checklist based on the Self Harm Pathway and developed by Dr Amy Lee for use by GPs.  

3. The following is a link to the most updated version of the ‘Working Together Document’ by the government which is a useful resource, especially in regard to appropriate information sharing.  

4. Also here is a reminder of the link to the Cumbria LSCB site, information for professionals, which has the Single Agency Contact Form, Early Help Forms, multiagency thresholds and the hub phone number.  

5. The following link is to the Cumbria County Council Adult Safeguarding Board Leaflets for ‘Keeping People Safe’ and ‘The 7 steps to Keep People Safe’  

6. Finally, hopefully you will soon receive notice of the recommended Tool for Level 3 safeguarding Training to assist with your appraisals.

1. LSCB  - Child Death Overview Panel Processes It has been noted that practices’ engagement with the LSCB CDOP processes has improved with good attendance and provision of information to contribute to Rapid Response, End of Case discussions and completion of CDOP forms. Your efforts are much appreciated, thank you.   

2. Here is a reminder of the learning noted by the NSPCC for Primary Care from Serious Case Reviews. It is useful for in house training.   

3. Attached are the new MARAC referral and assessment forms.  Guidance from RCGP Gene Feder DV champion is that every GP should be able to ask questions Are your children safe?  Are you safe to go home?When confronted with a disclosure of ongoing domestic violence. They should also know about Victim Support, Let Go and referrals to the police and MARAC.  

4. See attached ‘Support for families’ which is a list of useful charitable support services for families of perpetrators.  

5. Also we would like you to consider doing a small audit regarding the recommended changes to new patient questionnaire after the Baby H case. This is attached and hopefully not too long or complicated to do. It is great for evidence of reflective practice/appraisal for the practice. Please complete by FRIDAY 18th JUNE 2016.  

6. Please note there have been some changes in the hub, the details of which are attached. Please note particularly the revision of the single contact form, presence of an IDVA in the hub and the notes about Early Help Panels.  

7. Finally a request from Louise Mason-Lodge Designated Nurse Safeguarding regarding FGM action;  

‘We are aware that a small number of cases of FGM have been identified in Cumbria over the past months.  

Due to the national profile of FGM and its current status as a NHS England priority, we feel it is important that the Designated Leads are routinely notified of any known or suspected cases of FGM for the foreseeable future. This will allow oversight of the local health system engagement and response to FGM and the opportunity to cross reference with the multiagency process.  

Please could you ensure that when a case of FGM is suspected or identified, the following information is provided to Anne Cooke, Safeguarding Business Manager,  who will keep include as part of our confidential log unless specific issues arise that we would need to follow up: -  

NHS no. of Individual:
Date of Birth / Age:
FGM Type:
Circumstances and Issues:
Action Taken:   

Please also note if there are any issues regarding the process which you need to escalate to the Designated Leads. The above actions are requested in addition to the requirements in the guidance.

Please see the Child Safe Trigger Tool by the RCGP/NSPCC here. It is very useful for identifying vulnerable children. One practice has had the idea of asking their admin team to check the list out on children with letters coming from A&E, DNA letters.

A reminder of the Bridgeway Sexual Assault centre contact details, whose speaker was also unfortunately called to an emergency case last moment on the PLT training afternoon. Advice & Support for Professionals is 01768 800670 0r 800671 9:00am to 5:00pm weekdays & 24/7 helpline is 0808 118 6432. Please also see the flyer here, pathway covers different age groups.

The following is a link to a review on Disabled Children and the particular concerns surrounding them and the Child Protection system.;jsessionid=24CDC433F398BFE491C19A1FA81A22FB.f02t02  

Finally please click here for a document that reveals children’s views and opinions on the delivery of services surrounding sexual abuse. Well worth a read.

The following is a very poignant story from a Child Looked After regarding the difference her GP has made.  

1. A reminder of The Bridegway Centre Contact details
This referral pathway will be available on You will also be able to contact The Bridgeway for advice on what services are available to best support your Service User.

Contact Details- From 15th December 2015:
The Bridgeway 24/7 free helpline for victims 0808 118 6432
To make a referral, please complete the referral form at
This can be sent to Fax: 01768 892527, Email: Once the referral has been sent, please call 01768 800670 / 01768 800671 to confirm receipt.

2. The NSPCC has a useful resource of guidance factsheets regarding safeguarding issues. One interesting leaflet details how the decisions to prosecute are taken in abuse cases.

3. If you hadn’t already seen it here is the link to the recently updated NICE guidelines on Care of the Dying for Adults – emphasising an individual approach and clinically assisted hydration according to the patients wants/needs

4. The following is the news article regarding NHS England’s commitment to improve Mental Health services. Fingers crossed this time it actually happens!

5. This following leaflet is by the Office of the Public Guardian and is a useful training resource for vulnerable adult safeguarding, particularly pages 6 & 7 outlining the forms of adult abuse and spotting them.

6. Finally a reminder of the RCGP online learning course on domestic violence – free to RCGP members.

7. Please could you ensure that the message gets out to colleagues that when you do a medical or other referral for a CLA (Child Looked After), it is important to let the provider know that he/she is ‘Looked After’

Please note a general pathway for Self Harm is now available on the LSCB Website 

Please see is a list of free one day events on FGM, note 16th March is in Rheged Centre, Penrith Cumbria.

Mental Health Briefing Note - Needs of Gang Affiliated Young People link -

Please see the attached advice from the Department for Education on protecting children from radicalisation or from being taken into conflict zones.

‘There has recently been an increase in incidents where children or young people have been taken to Syria and other conflict zones by parents. There has also been an increase of incidents where young people have been radicalised and persuaded to travel to conflict zones themselves. In both sets of circumstances children are being placed in great danger. Incidents such as these highlight the importance of safeguarding children and young people by dissuading them or preventing imminent travel to conflict zones.’

This guideline covers the identification, assessment and treatment of attachment difficulties in children and young people up to age 18 who are adopted from care, in special guardianship, looked after by local authorities in foster homes (including kinship foster care), residential units and other accommodation, or on the edge of care. It aims to address the many emotional and psychological needs of children and young people in these situations, including those resulting from maltreatment.

The NSPCC has published key issues for GPs/Primary Care Teams to learn from case reviews

The Bridgeway Sexual Assault Centre in Penrith has now opened. Please look at the below documents to see the contact details and the referral pathways. 
The Bridgeway - Enhancing Support for Victims of Sexual Assault and Sexual Abuse
The Bridgeway Referral Form
Sexual Assault and Abuse Cases Referral Pathway for Professionals

Please see below the VERY SUPPORTIVE guide from the Department of Psychiatry University of Oxford who published a guide FOR PARENTS on coping with their CHILD’s SELF HARM which is based on their in depth research with patients.
Coping with self-harm - A Guide for Parents and Carers

The next document is a significant learning event regarding a prescribing error which a practice has kindly allowed to be shared so that we can all benefit from the learning points within. 
A Prescribing Error

Young Minds and NHS England have launched a toolkit designed to help health professionals be more supportive of parents having a say in care of their children’s mental health needs

Transforming Emotional and Mental Wellbeing Workshops for children/young people are being organised by Cumbria LSCB. For dates please follow the link;

The following is the email link to the State of the Nation Report for Children Looked After (CLA). It is poignant reading & can be used for in house training. Every Child Matters (2005) identified that children and young people who are looked after are four times more likely to misuse substances. Does your practice know who your CLA patients are?

Please see the Craig Melrose letter – can you please feedback to your Named GPs if these actions have been taken.

On Missing Persons the charity Missing People has launched a new website to support its own helpline. It provides information and support to young people while and after they are missing. Please help share this very supportive website.

The following is a reminder of the links on the Cumbria LSCB website for guidance on CSE (Child Sexual Exploitation) Very good for in house training.  
Safeguarding Policies – The NSPCC has a useful section on guidance for safeguarding policies for all organisations. Worth comparing your own policy with this.   Hate Crime – please see below a further two useful leaflets on Hate Crime.

- Together, we can tackle Homophobic or Transphobic Hate Crime
Together, we can tackle Religious Hate Crime

You can also subscribe to the LSCB website newsletter if you wish

Sexting in schools is an increasing problem. You may find the attached ebooklet useful guidance for staff and families.    

Please find the updated versions of the GP Early Help forms below. Once completed a form should be sent to your Early Help Officer. The Early Help Officer will then check if the family are open to help/Social services and let you know who is identified as the lead for assessment. For those of you in Copeland & Allerdale, Hilary Cowley is updating us at the next safeguarding lead meeting. (.Officers for South Lakes and Barrow are Anne Downe and Carlisle area Steph Smithson)

GP request for consideration of an Early Help Assessment:
Form 1
Form 2
Form 3

Also be aware that an email regarding the LSCB Section 11 audit will be coming out soon, with a deadline of 20th November 2015 for completion.

The link for the audit is as follows - Questions or comments contact or telephone 01228 226898 

Below are a couple of useful Hate Crime leaflets in Cumbria. These two cover disability and race. I will include the ones on religious and homophobic in a later bulletin.
Together, we can tackle Disability Hate Crime
Together, we can tackle Race Hate Crime

Stop Online Abuse  is a really helpful website for women or lesbian/gay/transgender people suffering from abuse and worth signposting any patients who are victims of this. 

Lastly a highlight of a RCGP online course (2 hours)  which is free to RCGP members on violence against women and children;

1. NHS England have said that they would like to work with Practice managers around safety issues. This is important as it impacts on staff safety and morale if it isn’t done effectively. It would be really helpful to have case scenarios from you clinical experience so that they can use these as live examples in discussion. Examples might be patients subject to MAPPA, threatening behaviour around prescriptions for benzos and opiates, telephone abuse, behaviour in waiting rooms. Please could you email your Named GP with any examples you would like to highlight.

2. Please see the attached leaflet regarding FII and the copy of Dr Young’s email below;

‘Fabricated illness (or factitious illness as it is called in adults) seems to be increasingly common. In these cases it is important to note that for a time in the patient/family journey the ‘Duty of Candour’ does NOT apply. This is because for a clinician to reveal the professionals discussions inappropriately could seriously compromise the health and safety of children (and adults.) It is important for the Primary Care clinician to maintain relationships with the family. Enclosed is a paper which looks in detail at some of these issues to help make sense of a complex and demanding topic. Please look at the LSCB website for further information and the FII template which professionals fill in together.’

3. Here is a quick reminder of the working together for children document;

Although it is over a hundred pages, it is something you can dip in and out of for supportive advice regarding a particular situation you may have concerns about. It is very good at explaining the purposes of the legislative sections and the timelines social workers have to respond to, guides on information sharing and please do scroll to end pages where there are numerous links to other useful resources e.g. on domestic violence, GMC guidance etc.

4. Although not specific for doctors the SCIE (Social Care Institute for Excellence) site has some useful resources for learning, especially in regard to adult safeguarding & understanding how colleagues in social care are guided.

5. A reminder on FGM reporting. Make sure all relevant staff are aware of the legal requirements & yes FGM can occur here in Cumbria. The Serious Crime Act states;

‘Section 74 inserts new section 5B into the 2003 Act which creates a new mandatory reporting duty requiring specified regulated professionals in England and Wales to make a report to the police. The duty applies where, in the course of their professional duties, a professional discovers that FGM appears to have been carried out on a girl aged under 18 (at the time of the discovery)’.

The following links will help.

6. The NSPCC Information Office has published a briefing for GP’s regarding learning from the published serious case reviews. Reflecting on this helps towards your level 3 training & is great for some in house training too.