Core Revision
Revision aid, not clinical advice. This page is educational material written for exam preparation. It is not a substitute for the current guideline or for clinical judgement, and must not be relied on for the care of any individual. Always check up-to-date national guidance and verify independently before acting on anything here.
Chapter 7 of 11 · Ethics, Law & Safeguarding
Child safeguarding: consider versus suspect
Two words from NICE decide what you do next. Most safeguarding questions in the AKT are really testing whether you know which one you are in.
The four categories
Statutory guidance recognises four categories of abuse. Note which ones require persistence in their definition — a single act can be physical or sexual abuse; emotional abuse and neglect are defined by pattern.
| Category | Definition (Working Together) |
|---|---|
| Physical | Hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating or otherwise causing physical harm. Includes fabricated or induced illness. |
| Emotional | The persistent emotional maltreatment of a child such as to cause severe and adverse effects on their emotional development. |
| Sexual | Forcing or enticing a child to take part in sexual activities, not necessarily involving violence, whether or not the child is aware of what is happening. Includes non-contact and peer-on-peer abuse. |
| Neglect | The persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in serious impairment of health or development. |
Consider or suspect? The NICE NG76 distinction
Suspect means a serious level of concern — short of proof. Action: discuss with your named or designated safeguarding professional and refer to children’s social care.
Consider means abuse or neglect is one possible explanation among several. Action: do not refer yet. Look for other alerting features, gather information from other agencies (health visitor, school, other practices), speak to the child, and arrange review. If concern rises, it becomes “suspect”. If it falls away, consider an early help assessment instead.
The examiners are testing your threshold, not your suspicion. “Refer immediately” is the wrong answer to a “consider” stem, and “monitor and review” is the wrong answer to a “suspect” stem. Learn a handful of features that push you from one to the other.
Features that move you to “suspect”
- Any injury in a child who is not independently mobile — bruising in a non-cruising infant is the single most-cited red flag
- An explanation that is absent, inconsistent, or does not fit the injury or the child’s developmental stage
- Delayed presentation without adequate reason
- Injuries in protected sites — ears, neck, buttocks, inner thighs, torso
- Sexualised behaviour inappropriate for the child’s age
- Disclosure by the child
- Parental behaviour that is hostile, rejecting or scapegoating
- Repeatedly not brought to appointments — the phrase matters; children do not fail to attend
A 5-month-old is brought in with a 2 cm bruise over the left cheek. Mum says he rolled off the sofa yesterday onto a carpeted floor. He is not yet rolling independently on examination, and is otherwise well and thriving.
Where does this sit?
Bruising in a child who is not independently mobile, with a history that does not fit their developmental stage, is a classic “suspect” presentation. Waiting and reviewing is not safe here.
Two features put this firmly in “suspect”: bruising in a non-mobile infant, and a mechanism the child is developmentally incapable of. Discuss with your safeguarding lead or the ICB named GP, and refer to children’s social care today, confirming in writing.
He also needs same-day paediatric assessment. Do not seek parental consent to refer where doing so may place the child at increased risk or prejudice enquiries — and never where a parent is the suspected perpetrator. Tell them you are referring unless that would increase risk.
The account is not plausible for a child who cannot roll. That mismatch is the finding.
The health visitor should be involved, but as part of the referral, not instead of it. A week is far too long for a suspected inflicted injury in an infant.
Pick an option to see the answer.
The legal framework
| Provision | What it does | Consent? |
|---|---|---|
| Children Act 1989 s17 | “Child in need” — local authority duty to provide services to safeguard and promote welfare. | Voluntary. Needs parental agreement. |
| Children Act 1989 s47 | Where the LA has reasonable cause to suspect a child is suffering, or is likely to suffer, significant harm, it must make enquiries. | No consent needed. |
| Children Act 1989 s31 | The court threshold for a care or supervision order. | n/a — a court test, not a referral test. |
| Children Act 2004 s11 | Duty on NHS bodies, LAs and police to discharge their functions having regard to safeguarding. | n/a |
s31 is the court threshold. If a stem asks what threshold your referral has to meet, the answer is s47 — reasonable cause to suspect significant harm — not s31.
What happens after you refer
- The local authority decides its response and tells the referrer within 1 working day
- Assessment completed within a maximum of 45 working days
- A strategy discussion decides whether to start a s47 enquiry
- Initial child protection conference within 15 working days of that strategy discussion
- Core group first meets within 10 working days of the conference
- First review conference at 3 months, then at least every 6 months
Child protection plan categories are the four categories of abuse. There is no “grave concern” category — that was abolished decades ago and still appears as a distractor.
Sharing information
The seven golden rules of information sharing are worth knowing as a set, but one carries the exam weight: you do not need consent where a child is at risk of harm.
Never seek parental consent where a parent is the suspected perpetrator, in suspected fabricated or induced illness, in suspected child sexual abuse, or in FGM. And record your reasoning whether or not you share — a decision not to share is a decision that must be justified.
Who is who in general practice
- All GPs need Level 3 safeguarding children competence
- The named GP for safeguarding is a Level 4 role employed by the ICB, providing advice to all practices — not a practice post
- Designated doctors and nurses are Level 5, strategic ICB roles
- Your practice will also have its own safeguarding lead, which is a separate, local arrangement
Working Together to Safeguard Children 2026 was published on 18 March 2026, replacing the 2023 edition. Key changes: “Family Help” merges targeted early help with s17 support; multi-agency responsibilities extend to looked-after children; there is an explicit duty to analyse data for disproportionality; harm categories are expanded to name infant and pre-birth harm, honour- and faith-based abuse, group-based exploitation and online harm linked to offline risk; and the rapid review must now be submitted within 15 working days of the serious incident notification — the 15-day period itself is not new, but the anchor and the submission requirement are. The three statutory safeguarding partners are unchanged: the local authority, the ICB and the police. Schools are relevant agencies, not partners.
Scope: Working Together is statutory guidance for England. Wales works to the Social Services and Well-being (Wales) Act 2014 and the Wales Safeguarding Procedures — and note that Wales, unlike England, places a genuine statutory duty to report a child at risk on relevant partners. Scotland uses the National Guidance for Child Protection and the Children’s Hearings System; Northern Ireland uses Co-operating to Safeguard Children.
Mandatory reporting of child sexual abuse is enacted but not yet in force. The Crime and Policing Act 2026 (Royal Assent 29 April 2026) creates a duty on those in regulated activity with children in England — healthcare professionals included — to report where a child or perpetrator tells them, or where they witness abuse. Recognising indicators alone will not trigger it. Failure to report will not be a criminal offence (the sanction is DBS and regulator referral), but preventing someone from reporting will be. No commencement date has been announced. Until it commences, ordinary safeguarding duties apply — and even afterwards, they will sit alongside it, not be replaced by it.
Four scenarios. Only one currently carries a statutory mandatory reporting duty on you personally.
Which one?
This will fall under the Crime and Policing Act 2026 duty once it commences — but that has not happened. Today it is an urgent safeguarding referral under ordinary duties, which you must make.
FGM Act 2003 s5B: a girl under 18 has told you FGM was carried out on her. This is the one statutory mandatory reporting duty that binds you personally, and it has been in force since 2015. Report to police on 101 by the close of the next working day, and make a safeguarding referral for her and any sisters.
Suspicion of neglect is a safeguarding referral, made on professional judgement. There is no statutory mandatory reporting duty for neglect.
s5B applies only where the victim is under 18 at the time you find out. An adult disclosing childhood FGM is not a mandatory report — but you should risk-assess any girls in the family, record on the FGM Enhanced Dataset, and explain that FGM is a criminal offence in the UK.
Pick an option to see the answer.
Self-testA mother repeatedly brings her 7-year-old with symptoms nobody else observes. He has had four hospital admissions, three specialist referrals and 40 school absences this year. All investigations are normal. What is this, and what do you do?
This is the pattern of perplexing presentations, which may represent fabricated or induced illness. Alerting features here: reported symptoms not independently observed, multiple opinions and investigations, over-medicalisation, and school non-attendance out of proportion to any illness.
What to do: do not confront the parent. Discuss with your safeguarding lead and with paediatrics — the RCPCH framework expects a paediatric-led health plan for perplexing presentations, and a safeguarding referral where there is significant harm. Gather a chronology across all agencies. Record observed versus reported findings separately from now on.
Self-testPrivate fostering: what is it, and what are the timescales?
A child under 16 (under 18 if disabled) cared for for 28 days or more by someone who is not a parent, does not have parental responsibility, and is not a close relative (grandparent, sibling, uncle, aunt or step-parent). Cousins and family friends are private fostering; grandparents are not.
The local authority must be notified at least 6 weeks before a planned arrangement, or within 48 hours if it has already started. The LA must visit within 7 working days. GPs commonly encounter it when a child is registered by an adult whose relationship is unclear — ask.
Written and checked by NHS GPs. Last reviewed 24 August 2026. UK law and guidance change — always follow current local policy and your defence organisation’s advice in a real case.
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