Level 2 safeguarding training and standards

Induction

All new staff members should, within their induction period:

• have a practice/organisational safeguarding induction AND
• complete relevant safeguarding Level 2 e-learning modules

New to role

Any current staff member moving into a Level 2 role should, within 1 month of starting:

• complete relevant safeguarding Level 2 e-learning modules
• have a safeguarding induction with an appropriate senior leader e.g. practice manager/practice safeguarding lead depending on nature of role. This induction should include:
  • discussion about the safeguarding structure, policies and procedures within the practice/organisation
  • identification of any areas of professional development related to safeguarding

Annually: Local Level 2 safeguarding update

Level 2 safeguarding updates should be aligned to the RCGP safeguarding standards for general practice and could include:

• topics across the breadth of the five key areas of the safeguarding standards
• child and adult safeguarding, including topics which apply to both e.g. transitional safeguarding, domestic abuse
• practical applications to general practice such as the use of case-based learning
• relevant learning from any local or national safeguarding reviews
• multi-agency and multi-disciplinary safeguarding learning
• relevant safeguarding updates
• role-specific training and updates

Updates could be face-to-face or virtual. It could include watching a recorded update.

1. Professional safeguarding responsibilities

Knowledge

• Understand your statutory, legal and professional safeguarding responsibilities as set out in relevant legislation and national safeguarding guidance in the UK nation you work in
• Understand and follow professional safeguarding responsibilities as set out in terms of employment
• Awareness of the impact of safeguarding issues on own wellbeing and how to access support as necessary
• Awareness of how and when to raise any concerns about behaviour or actions of colleagues or anyone in a position of trust that have caused harm, or may cause harm to patients or others
• Awareness of practice/organisational policies on managing allegations against staff and whistle blowing policies
• Awareness of local safeguarding professional contact details and referral processes

Capabilities

• Be able to carry out your statutory, legal and professional safeguarding responsibilities as set out in relevant legislation and national safeguarding guidance in the UK nation you work in
• Be able to carry out professional safeguarding responsibilities as set out in terms of employment
• Ensure that professional competence in safeguarding is maintained and keep up to date with changes in safeguarding
• Be able to recognise how own beliefs, experience and attitudes might influence professional involvement in safeguarding work
• Be able to recognise how own actions impact on others
• Be able to promptly act on any concern about behaviour or actions of colleagues or anyone in a position of trust that have caused harm, or may cause harm to patients or others, including how to report and escalate concerns outside your organisation should this be necessary

2. Identification of abuse and neglect

Knowledge

• Knowledge of indicators and signs of all types of child and adult abuse and neglect and how these might present in primary care
• Knowledge of domestic abuse, including coercive control
• Awareness of Adverse Childhood Experiences (ACEs) and their lifelong impact
• Awareness of the impact on child wellbeing of parental issues e.g. parental behaviour, mental and physical health and substance misuse
• Awareness of the increased needs and vulnerabilities of children on child protection plans, Looked After Children, children with disabilities, unaccompanied asylum seeking children, care leavers, young carers and missing children and that these needs may continue into adulthood
• Understand the principles of consent and confidentiality in relation to young people under the age of 18 including the concepts of Gillick Competency and Fraser Guidelines
• Understand the principles of mental capacity legislation for those aged 16 years and over
• Understand the rights of the child as defined in national and international law
• Awareness of the importance of adults’ rights in the safeguarding context and the essential knowledge of relevant legislation e.g. human rights acts and mental capacity legislation
• Awareness of what constitutes an adult at risk
• Awareness that adults who have experienced abuse in childhood may have specific vulnerabilities and risks in adulthood resulting from adverse childhood experiences (ACEs)
• Awareness of the effects of carer behaviour and family factors on adults at risk of abuse, harm or neglect
• Awareness of the significance of health deficits on health and wellbeing through the life course, e.g. homelessness, loneliness and poverty
• Awareness of which children and adults may be at greater risk of abuse and neglect
• Understand that identifying abuse can involve building up a picture over time
• Understand the potential lifelong impact of abuse
• Understand that victims and survivors of abuse may face multiple barriers to healthcare and have awareness of how these barriers can be broken down
• Understand actions that may need to take place within the practice to manage high risk persons such as those highlighted to the practice from MAPPA (Multi-agency Public Protection Arrangements) or PPANI (Public Protection Arrangements Northern Ireland) if there are agreed local processes in place with general practice for this to occur
• Awareness of the Prevent programme (for practitioners in England, Wales and Scotland)
• Awareness of lessons to be learnt, relevant to role, from significant safeguarding events within own practice/patient population, local and national safeguarding reviews
• Awareness that general practice provides services for everyone which will include those who perpetrate abuse
• Understand that those who perpetrate abuse may have significant health needs
• Awareness of the Independent Inquiry into Child Sexual Abuse (IICSA)
• Awareness that children, and adults with care and support needs, who are not being brought to appointments can be an indicator of abuse and/or neglect
• Mental capacity:
  • Awareness of mental capacity legislation as relevant to the country of practice, including deprivation of liberty legislation and relevant roles such as advocates, powers of attorney and how this relates to job role
  • Awareness of roles and responsibilities in relation to mental capacity legislation
  • Knowledge and awareness of indicators that should prompt assessment of mental capacity
  • Knowledge and understanding of the factors that can impact on, and cause, fluctuating mental capacity
  • Recognise when a more detailed assessment of capacity for a more complex decision is required and when to seek advice
  • Recognise when there may be concerns about someone lacking capacity and know who to contact in the organisation for advice and support
  • Recognise when capacity needs to be assessed
  • Recognise restrictions and what actions to take to explore how they can be reduced
  • Awareness of best interest decision-making
  • Awareness of roles such as advocates, powers of attorney, Independent Mental Capacity Advocates and how this relates to job role
  • Understand the importance of seeking consent, and how to proceed if a person might lack capacity to give or refuse their consent to any proposed intervention
  • Understand the importance of establishing, acting or making a decision in person’s best interests as reflected in legislation and key statutory and non-statutory guidance
  • Awareness of when and where to record application of the Mental Capacity Act
  • Understand advance decisions and advance care planning relevant to role

Capabilities

• Be able to support adults at risk who do not feel able to participate in service support, for example those experiencing coercive control and those who face multiple barriers to services
• Be able to identify (as relevant to role) children, adults, families who may be struggling to access healthcare or struggling with other issues, and:
  • Be able to provide support as needed to remove barriers to healthcare such as facilitating choice of mode of consultation
  • Be able to signpost to relevant services e.g. social prescribers
  • Be able to highlight concerns to the relevant clinician
• Be able to pass on any safeguarding concerns, even seemingly minor concerns, about a patient/person to the relevant clinician, following practice/organisational procedure
• Be able to identify, and take action as per practice policies, when children and adults with care and support needs are not being brought to appointments
• Be able to facilitate the use of formal interpreters and communication aids for patients as needed
• Be able to approach job role and interactions with patients with an understanding of the impact of trauma exposure
• Be able to record/code (as relevant to role) information contained in documents coming into the practice regarding safeguarding, risk to self or others, experience of trauma
• Be able to learn lessons relevant to role from significant safeguarding events within own practice/patient population, local and national safeguarding reviews
• Be able to implement learning (as relevant to role) from the Independent Inquiry into Child Sexual Abuse (IICSA)
• Be able to implement and oversee (as relevant to role) system changes that are needed in light of any learning from significant safeguarding events or reviews
• Be able to identify (as relevant to role) safeguarding indicators related to medication and prescribing e.g. inappropriate medication requests for adults with care and support needs, medication not being requested or picked up for a prolonged period of time
• Mental capacity:
  • Be able to support patients to make day to day decisions within the framework set by the MCA
  • Be able to direct people (individuals and their family and friends) to sources of advice and information re MCA/DoLS
  • Be able to clearly document application of mental capacity legislation

Organisational or institutional abuse / neglect

Knowledge

• Awareness of potential signs of abuse and neglect, including early warning signs, in an organisation/institution (e.g., care/nursing homes, homes for adults with learning disabilities)
• Understand the importance of escalating concerns, however minor, about an individual or organisation to the safeguarding lead within the practice/organisation

Capabilities

• Be able to identify early warning signs as well as potential signs of abuse and neglect in an organisation/institution that could indicate organisational abuse/neglect and raise these concerns with the safeguarding lead within the practice/organisation

3. Responding to abuse and neglect

Knowledge

• Recognise obligations to act when there is a safeguarding concern, including when acting is against the expressed wishes of the person/family/carers
• Awareness of local referral processes for child and adult safeguarding including early help services
• Knowledge of local support services e.g. domestic abuse services
• Knowledge of whom to speak to within the practice/organisation if unsure how to manage any concerns about abuse or neglect e.g. Practice Safeguarding Lead, Practice Manager
• Knowledge of how to escalate concerns about abuse if reported concerns have been dismissed or minimised
• Knowledge of how to promptly manage and report any concerning behaviour or allegations of abuse by a person in a position of trust, including colleagues

Capabilities

• Willingness to listen to children, young people, adults at risk, families and carers and to act on issues and concerns
• Be able to seek appropriate advice and report any safeguarding concerns in line with practice/organisation policy and be confident that they have been understood
• Be able to signpost patients to local support services e.g. domestic abuse services
• Be able to confidently signpost patients to emergency services in the event of a life-threatening situation e.g. a patient discloses on the phone that they are terrified their partner is going to hurt them
• Be able to manage (as relevant to role) complaints which include any safeguarding features and liaise with the practice safeguarding lead or external safeguarding professionals as necessary
• In leadership/managerial positions, be able to support staff who have safeguarding concerns and provide guidance on managing these as per practice/organisation policy
• In leadership/managerial positions, be able to support staff who are victims of abuse themselves e.g. victim of domestic abuse

4. Documenting safeguarding concerns and information

Knowledge

• Awareness of the importance of safely and accurately documenting safeguarding concerns and documentation in the patient record, including other patients’ records as applicable
• Awareness of the safeguarding challenges and risks related to patient online access (if applicable) and how to mitigate these as much as is possible in a general practice setting
• Understand when and what information needs to be redacted in situations such as medical reports and Subject Access Requests, according to data protection legislation

Capabilities

• Be able to safely manage safeguarding information coming into the practice
• Be able to safely and promptly manage requests from other health professionals or external agencies, for information in a safeguarding context
• Be able to mark information not for online access (if applicable)
• Be able to document safeguarding concerns safely and accurately in the patient record
• Be able to, and be able to advise others on, redact information as necessary e.g. for medical reports, Subject Access Requests
• Be able to use standardised and appropriate read codes to be able to conduct searches on vulnerable/at risk registers effectively
• Be able to use standardised and appropriate read codes when filing safeguarding information
• Be able to recognise the safeguarding challenges of patient online access (if applicable) including coercion to access records and have strategies to avoid giving access while seeking help if coercion is suspected, and to support others to do the same

5. Information sharing and multiagency working

Knowledge

• Awareness that multi-agency working and information sharing are essential for effective safeguarding
• Understand that general practice holds relevant and important information which is significant for the multi-agency safeguarding response to concerns about abuse and neglect
• Understand that timely, relevant, proportionate and necessary information sharing is fundamental to safeguarding
• Awareness that UK legislation is not a barrier to information sharing – rather it provides a framework to share confidential information safely and appropriately
• Awareness of confidentiality and it's limits
• Awareness of the differences regarding consent in the common law and data protection legislation and how both need to be considered separately, but equally, when sharing information for the purposes of safeguarding
• Understand that legislation and guidance about confidentiality does not prohibit healthcare staff listening to family/friends/carers concerns about patients, especially when there are welfare and safeguarding concerns
• Awareness of terminologies used in multiagency settings such as safeguarding conferences, strategy meetings, MARAC, MARAM, MAPPA, statutory reviews in order to be able to prioritise information sharing

Capabilities

• Be able to manage requests for confidential patient information from other agencies such as social care and the police as per practice/organisation policy, protocol and local information sharing agreements
• Be able to manage safeguarding information/documents coming in and out of the practice, including coding and marking not for online access (as relevant to role)
• Be able to work closely with practice/organisational safeguarding lead