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What is the challenge your project is going to address and how does it connect to your chosen theme?

The challenge of GP attendance at child protection case conferences is an issue of concern nationally. GPs must contribute to the safeguarding of children as a requirement of the GMC. A recent review carried out by the General Practitioners Committee of the British Medical Association noted that the contribution by GP’s to safeguarding meetings of children deemed to be at risk falls short of the mandatory requirement. In N.I.  recommendations regarding improving GP engagement in child protection processes were made by the Safeguarding Board of NI following practice based concerns about child welfare. Social workers and GPs have told us that traditional working arrangements inhibit information sharing and relationship building .Families tell us they are confused and frightened when their GP engages with social services. Adopting an ‘All teach, all learn’ approach we will build improvement capabilities across boundaries, establishing trusting relationships and improving child safety.

What does your project aim to achieve?

Our aim is to increase GP participation in child protection processes and case conferences initially in one Trust area, and then spreading across NI (and beyond). Using a QI approach, a prototype has been developed with one GP practice , which has focused on building relationships and trust across boundaries, reviewing and streamlining processes for sharing complex information, provision of local safeguarding  and QI training and reviewing arrangements for child protection meetings which enable enhanced  GP attendance.Using this approach has increased GP attendance at conferences in one practice  from 2 to 14.

Improvements will contribute to ensuring the safety and enhancing wellbeing of children at risk. This will be measured through

  • GP attendances at case conferences
  • Increased information provided by GP practice to child protection processes
  • GP data base accuracy following child protection decisions
  • Improved communication between SW and GP practice
  • Improved GP & SW knowledge of QI

How will the project be delivered?

This improvement initiative was endorsed for  prototype testing by HSCQI – the NI  approach to improvement. A project management structure was established in July 2018 ; this will continue to have a coordination role , reporting to HSCQI and Directors of SW. The project leads are experienced quality improvement practitioners working within social work and primary care –  all participants are Q members. The prototype developed in one GP practice will now be tested in two further practices as agreed by the respective GPs . This will commence with GP trainees and service user undertaking an initial scoping exercise to co design the approach.  Local social work  teams will  be engaged with GP practices  to develop a shared approach to  improvement and  build relationships across boundaries. QI and safeguarding training will be provided to create opportunites to test new ideas collectively.Risks are minimised due to high level support; to be reviewed monthly by the  project management team.

What and how is your project going to share learning throughout?

The challenge of GP engagement in child protection is a national issue. Through iterative testing,this approach will explore the factors that improve GP participation in child protection and influence change in the way in which GPs are engaged by local Trusts. The approach will use appreciative enquiry to understand the change making process and will make progress visible through GP Federations, communications and events,shared learning opportunities and though regular reporting at HSCQI events/website and the Q Community. During the development of this idea,we have connected with other Q members who are  keen to influence and extend the spread of the  initiative – we will work with them to build a community across social work and primary care in NI – making visible our measurements and progress as we work within  individual  practices and social work teams. We will engage SW  and  GP trainees to work together developing a shared story to present in universities and teach others.

How you can contribute

  • We are keen to hear of any initiatives across the UK who have made improvements in this area of practice.
  • Any ideas/existing approaches to sharing and learning together across Trusts and primary care.

Plan timeline

20 Sep 2019 Project steering group
4 Nov 2019 formal updates to stakeholders on progress of work
20 Nov 2019 Agree release of 2 PT Improvment Advisors
21 Nov 2019 Meet with Gp practice 2 and 3 - confirm timescales
1 Dec 2019 scoping excercise with 2 GP practice and social work teams
3 Feb 2020 Agree basline data - provide QI and safeguarding training
13 Feb 2020 Implement testing/PDSA for improvement
9 Mar 2020 Monthly cordination meeting reviewing tests of change
1 Sep 2020 Review progress and move to addtional GP practices

Comments

  1. This is such an important piece of work. Well done on what you have achieved so far. There are a number of common themes that influence GPs ability to attend conferences. When I started in practice more than 20 years ago, it was possible to juggle surgery times or miss "taking a house call" to attend a conference. I also felt welcome and a valued contributor and the family involved appreciated it. However the workload is so great now that this is rarely feasible. I believe all GPs would want to have a better working relationship with social work teams and contribute in a meaningful way to case conferences. The work that has been done in the prototype will go a longway to encouraging GPs to believe that it can work better. There is huge benefit to social work staff who are under intense pressure and crucially improvement in patient care should follow.

    1. Thank you for your feedback and encouragement Louise - it would be great if you could join us in this work going forward,as we know you have been making great progress in primary care!

  2. Recognising the concerns outlined I fully support all your efforts to engage with local GP practices, build your prototype and plan to spread to 2 other practices in your locality.

    I've rarely had opportunity to participate in case conferences, unless I have had significantly personally involvement.   I do my best to support colleagues across HSC when information gathering for conferences usually via telephone professional conversation.  I am concerned I don't have the protected time to commit more and support. In three years I have never met personally any of colleagues in my locality involved in such conferences and feel we miss the face to face interacting with colleagues across HSC for this and many other professional scenarios as well.

    Apart from workload pressures GPs are under, what have you identified as the main barriers to GP involvement and engagement with child protection cases?

    What has been done differently with success in the first practice that has impacted positively for all?  I am wondering whatever has been successful for SET in this prototype could it be scale and spread allowing me in a different area of Northern Ireland to consider how may be effective in my own practice, with positive relationship building with our Trust colleagues in our area and ongoing work of breaking down silos.

    Also a wider thought but does it always have to be a GP in practice that are first point of contact for child protection.   Could a senior member of the practice team (e.g practice manager or assistant manager) be called upon for help/support in absence of GP involvement for child protection issues?  Speaking from observation and appreciating experience of my practice manager's gifting, her knowledge of families in the area could not be matched by a clinician and she would contribute a lot to case conferences and communicate back to the GP team if called to represent the practice team.  It is for this reason that our practice manager along with one of my partners share role in Child Protection leadership for the practice.  It could be rewarding to develop this further and recognise the other members of the primary care team that can assist.

    I wish you success and supporting you all as always.

    1. Hi Philip, thanks for your feedback. We would be really keen to share this work across NI, including with you in Portadown. You raise really important issues which we have been learning about in the early stages of the work. One of the biggest barriers we have observed and continue to learn about , is the absence of relationships between  GPs and local social work teams - we have found that by building connections and establishing relationships, then practitotners are more likly to engage with each other both in informal and formal processes. We have also learned about the importance of the practice manager role and how they can as you suggest, liase and plan engagements on behalf of the GP - they definitely are a key reource and we should contiue to explore how we can support them in leading and developing QI in primary care -we hope this project will assist in the learning process. it would be great to come to Portadown soon and share our work with you. Barbara

  3. Guest

    Mandy Gormley 1 year, 9 months ago

    This innovative approach would be valuable for all Trusts in NI and wider who deal with similar difficulties.  Good luck.

    1. Thanks Mandy - hope fully we will be able to spread up to the West!

  4. Excellent initiative to increase GP participation in case conferences for vulnerable children would be great to spread this to other GP’s within NI.

  5. A great example of working in partnership with primary care.  Would be good to see the early work in this are built upon.  I hope the bid is successful

    1. Thanks Gill, would be great to get addittional support to help build the momentum and then we could get upo= to the Northern Trust and work with you again which would be great!!

  6. Such an important project - best of luck to you.

  7. This is an important interdisciplinary initiative, focusing on inclusive decision making for children at risk. Would be brilliant to see the prototype replicated across the region, with GPs being engaged in the safeguarding process.

    1. Thanks Ruth - would be lovelty to see it spread across NI, as part of HSCQI!

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