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 8 of 11 · Ethics, Law & Safeguarding
Adult safeguarding and the Care Act
One three-part test, ten categories, six principles — and a duty that binds the local authority, not you.
The section 42 three-part test
A local authority must make enquiries where it has reasonable cause to suspect that an adult in its area:
- has needs for care and support (whether or not the authority is meeting any of them);
- is experiencing, or is at risk of, abuse or neglect; and
- as a result of those needs, is unable to protect themselves against the abuse or neglect or the risk of it.
Scope: the Care Act 2014 applies to England. Wales uses the Social Services and Well-being (Wales) Act 2014 (s126, plus the Adult Protection and Support Order); Scotland the Adult Support and Protection (Scotland) Act 2007, with its own three-point test and its assessment, removal and banning orders; Northern Ireland has no adult safeguarding statute yet.
The s42 duty binds the local authority. You do not “make a s42 referral” — you raise a safeguarding concern. A concern needs limbs (a) and (b); it is the local authority that applies limb (c) and decides whether a s42 enquiry is triggered. Where limb (c) is not met, the authority may still run a non-statutory “other” enquiry.
Two things s42 does not depend on: whether the person has capacity, and whether the authority is already meeting their needs. An adult with full capacity who is being financially abused and cannot protect themselves because of their care needs is squarely within it.
The ten categories of abuse and neglect
From the Care and Support Statutory Guidance. The list is not exhaustive, but it is the list that gets examined.
| Category | Typical presentation in general practice | |
|---|---|---|
| 1 | Physical abuse | Unexplained injuries, inconsistent history, injuries at different stages of healing |
| 2 | Domestic violence or abuse | Frequent attendance, vague symptoms, partner attends and answers for them |
| 3 | Sexual abuse | Recurrent genitourinary symptoms, new sexual dysfunction, disclosure |
| 4 | Psychological or emotional abuse | Fearfulness, deference, withdrawal in a carer’s presence |
| 5 | Financial or material abuse | Unpaid bills despite means, sudden changes to a will, a relative controlling the money |
| 6 | Modern slavery | Controlled by another, no documents, no address, someone else speaks for them |
| 7 | Discriminatory abuse | Harassment or poorer treatment on the basis of a protected characteristic |
| 8 | Organisational abuse | Patterns across a care home — rigid routines, multiple residents affected |
| 9 | Neglect and acts of omission | Pressure ulcers, dehydration, missed medication, ignored care needs |
| 10 | Self-neglect | Hoarding, refusal of essential care, insanitary conditions |
The six principles
Empowerment · Prevention · Protection · Proportionality · Partnership · Accountability. A useful order to remember them in is the order of the decision: whose decision is it (empowerment), can we act before harm (prevention), who most needs support (protection), is our response the least intrusive that works (proportionality), who else must be involved (partnership), and can we justify what we did (accountability).
Making Safeguarding Personal
The adult defines the outcome they want. Safeguarding is done with them, not to them.
“Making Safeguarding Personal” does not mean walking away when someone declines. You continue to work on risk mitigation, and there are circumstances in which you act anyway.
A 68-year-old woman with COPD and reduced mobility discloses that her son, who lives with her, shouts at her, has taken control of her bank card and sometimes withholds her inhalers. She has capacity. She begs you not to tell anyone, saying it will make things worse.
What is the right response?
Her wishes carry great weight, but they are not the end of the analysis. Withholding prescribed medication from a person with COPD is potentially life-threatening, and financial control plus intimidation are recognised markers of escalating risk.
Overriding a capacitous adult without discussion is a last resort, not a first step, and covert referral can increase her danger. You should tell her what you are doing and why unless doing so would increase risk.
Work through it in order. Establish the detail. Explain what a safeguarding referral would and would not do — much of what people fear is not what happens. Offer a safety plan and information about services she can use herself.
You may act without her agreement where: others are at risk (children or another vulnerable adult in the household), a serious crime may be prevented or prosecuted, there is evidence of coercion or undue influence vitiating her decision, or there is a concern about a care provider or a pattern of organisational abuse.
Withholding medication and controlling finances may amount to controlling or coercive behaviour, a criminal offence — which raises the case above simple respect for her refusal. Document your reasoning either way.
Honesty about the limits of confidentiality is right. But announcing a referral as a fait accompli, without exploring her fears or safety-planning, tends to end the disclosure and the relationship — and she may not come back.
There is no comfortable answer here. Pick the one you would write in the notes.
Self-neglect
Self-neglect became a category in 2014, but it does not automatically trigger s42 — it is judged case by case. The useful clinical distinction is between decisional capacity (can she describe and weigh the risks of the hoarded flat?) and executive capacity (can she actually act on that understanding?). Someone may pass a bedside conversation and still be unable to implement any decision at all.
Modern slavery and the NRM
| Question | Answer |
|---|---|
| Can a GP refer into the National Referral Mechanism? | No. Referral is by designated first responder organisations only — police, the NCA, Home Office immigration bodies, local authorities and specified NGOs. NHS bodies and GPs are not first responders. |
| Do adults have to consent? | Yes. An adult must consent to an NRM referral. If they decline, an anonymous Duty to Notify can still be submitted — but only by a body subject to the s52 Modern Slavery Act duty (police, local authority, NCA), not by the practice. |
| Do children? | No. A child must be referred without being asked to consent. |
| What should a GP do? | Raise a safeguarding concern with the local authority, contact the Modern Slavery Helpline (08000 121 700), and involve police if there is immediate danger. |
Safeguarding Adults Reviews
A Safeguarding Adults Board must arrange a review where there is reasonable cause for concern about how agencies worked together, and either the adult has died and the Board knows or suspects the death resulted from abuse or neglect, or the adult is alive and is known or suspected to have experienced serious abuse or neglect. Other cases may be reviewed at the Board’s discretion.
Self-testWhat is the difference between a Safeguarding Adults Review and a Serious Case Review?
Terminology, mostly — and the exam likes precision. In adult safeguarding, the Care Act 2014 s44 created Safeguarding Adults Reviews (SARs), replacing what were called Serious Case Reviews. In children’s safeguarding, Serious Case Reviews were replaced by local child safeguarding practice reviews and national reviews under the Children and Social Work Act 2017.
So “Serious Case Review” is the term for neither system now, and appears as a distractor in both.
Self-testA care home manager asks you not to make a safeguarding referral about a resident’s pressure ulcer because “we are already investigating internally”. What do you do?
Make the referral. An internal investigation is not a substitute for the statutory process, and a provider investigating itself is precisely the situation the safeguarding system exists to catch. A grade 3 or 4 pressure ulcer that has developed in care is a recognised trigger.
Also think wider: is this one resident, or a pattern? Organisational abuse is one of the ten categories, and multiple residents affected turns a single concern into a provider-level one that the local authority and CQC need to know about.
The Care and Support Statutory Guidance was last updated in July 2025, but Chapter 14 (safeguarding) has not substantively changed since 2023 — the amendments were to charging and capital rules. Adult safeguarding is one of the more stable parts of this syllabus. The change that does affect it is the deprivation of liberty judgment in Chapter 3.
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.
Everything the AKT asks about safeguarding
Core Revision covers adult and child safeguarding across the question bank, the Core Compass and timed mocks. Start free.
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