Decide not to act on Jacquie's comments that she is finding caring for her son difficult as all single parents struggle from time to time and her addiction doesn't automatically mean she can't cope without social services' involvement?
Working with doctors Working for patients
Jacquie and Dr Clifford
Introduction
Jacquie is under the care of Dr Clifford, a general practitioner with a special interest in substance misuse. Jacquie is a single parent - her son Olly is five years old. Although children's social services were involved when Jacquie first sought treatment, there are currently no safeguarding concerns.
Jacquie is in treatment for heroin addiction and has been stable on methadone for some time. She has come to see Dr Clifford for review: this is their fourth appointment.
Jacquie
Nobody tells you how hard it's going to be looking after a little boy - he's always rushing around and I just feel like I don't have the energy sometimes... And then there's just this constant pressure, getting him up and dressed and getting him to school on time, remembering to pick him up, day in day out.
Dr Clifford
But you are getting him to school every day aren't you? As you know I'm in touch with his teacher and she's confirmed that he hasn't missed any days recently. So tell me more about how you handle the pressure?
Jacquie
Well my mum is helping out a lot, which means that social services aren't interfering, and that's obviously a good thing. But mum isn't always free any more and if I have to manage by myself for more than a day or two...the smallest things can be so hard. Just making it to this appointment was a nightmare.
Dr Clifford
I realise it's hard for you right now, and the fact that it's so difficult highlights just how important it is for you to stay in treatment. You're making very good progress and things will start to feel easier after a time.
Jacquie
I know, and I will stick with the treatment. It's just...sometimes it's hard enough looking after myself without having Olly to look after as well.
See what the doctor did
Dr Clifford decided to speak about Jacquie's case to the named practitioner for child protection. They agreed that, though Jacquie was finding caring for Olly difficult, he did not appear to be at risk of serious harm. They agreed that it was important that Jacquie continued to engage with her treatment and that Dr Clifford should monitor the situation and, if things deteriorated, should reconsider what action to take.
References
Doctors play a crucial role in protecting children from abuse and neglect. You may be told or notice things that teachers and social workers, for example, may not. You may have access to confidential information that causes you to have concern for the safety or well-being of children.
(0-18 years: guidance for all doctors, paragraph 56)
Children, young people and parents may not want you to disclose information about them if they think they will be denied help, blamed or made to feel ashamed. They might have had bad experiences or fear contact with the police or social services. You should help them understand the importance and benefits of sharing information. But you must not delay sharing relevant information with an appropriate person or authority if delay would increase the risk to the child or young person or to other children or young people.
(0-18 years: guidance for all doctors, paragraph 59)
Confidentiality is important and information sharing should be proportionate to the risk of harm. You may share some limited information, with consent if possible, to decide if there is a risk that would justify further disclosures. A risk might only become apparent when a number of people with niggling concerns share them. If in any doubt about whether to share information, you should seek advice from an experienced colleague, a named or designated doctor for child protection, or a Caldicott Guardian. You can also seek advice from a professional body, defence organisation or the GMC. You will be able to justify raising a concern, even if it turns out to be groundless, if you have done so honestly, promptly, on the basis of reasonable belief, and through the appropriate channels.
(0-18 years: guidance for all doctors, paragraph 60)
Risks to children's or young people's safety and welfare often become apparent only when a number of people share what seem to be minor concerns. This may include people from different agencies. If a child's or young person's condition or behaviour leads you to consider abuse or neglect as one possible explanation,* but you do not think that they are at risk of significant harm, you should discuss your concerns with your named or designated professional or lead clinician or, if they are not available, an experienced colleague. If possible, you should do this without revealing the identity of the child or young person.
(Protecting children and young people, paragraph 43)