Responses to concerns about child maltreatment: a qualitative study of GPs in England

BMJ Open. 2013 Dec 3;3(12):e003894. doi: 10.1136/bmjopen-2013-003894.


Objectives: To provide a rich description of current responses to concerns related to child maltreatment among a sample of English general practitioners (GPs).

Design: In-depth, face-to-face interviews (November 2010 to September 2011). Participants selected and discussed families who had prompted 'maltreatment-related concerns'. Thematic analysis of data.

Setting: 4 general practices in England.

Participants: 14 GPs, 2 practice nurses and 2 health visitors from practices with at least 1 'expert' GP (expertise in child safeguarding/protection).

Results: The concerns about neglect and emotional abuse dominated the interviews. GPs described intense and long-term involvement with families with multiple social and medical problems. Narratives were distilled into seven possible actions that GPs took in response to maltreatment-related concerns. These were orientated towards whole families (monitoring and advocating), the parents (coaching) and children (opportune healthcare), and included referral to or working with other services and recording concerns. Facilitators of the seven actions were: trusting relationships between GPs and parents, good working relationships with health visitors and framing the problem/response as 'medical'. Narratives indicated significant time and energy spent building facilitating relationships with parents with the aim of improving the child's well-being.

Conclusions: These GPs used core general practice skills for on-going management of families who prompted concerns about neglect and emotional abuse. Policy and research focus should be broadened to include strategies for direct intervention and on-going involvement by GPs, such as using their core skills during consultations and practice systems for monitoring families and encouraging presentation to general practice. Exemplars of current practice, such as those identified in our study, should be evaluated for feasibility and acceptability in representative general practice settings as well as tested for efficacy, safety and cost. The seven actions could form the basis for the 'lead professional' role in general practice as proposed in the 2013 version of 'Working Together 'guidance.

Keywords: Primary Care; Public Health; Qualitative Research.