Consultation Guide: Safeguarding Discussions in Children.

INTRODUCTION: Understanding the UK Safeguarding Context as an IMG.

Safeguarding is a core principle in UK medical practice, especially in general practice, where GPs often serve as the first point of contact for vulnerable patients and families. For International Medical Graduates (IMGs), the concept of safeguarding may feel unfamiliar or different from home country practices. In many low- and middle-income countries, safeguarding is either not formalised or managed through community elders, religious figures, or extended family structures. As a result, healthcare professionals may intervene only when harm has occurred, rather than to prevent it. Often healthcare professionals feel limited in what they can do to prevent or protect vulnerable patients.

What is your biggest concern as an International Medical Graduate (IMG) learning about safeguarding in the UK?

• Confidentiality vs. Safeguarding
• Fear of Making a Wrong Call
• Cultural Differences
• Communication Challenges

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You can vote for more than one answer.

In contrast, the UK healthcare model is preventive, legally grounded, and multi-disciplinary, with clinicians expected to act on suspicion or early warning signs, not wait for certainty. Failure to act can have significant implications—clinically, ethically, and legally. It can lead to significant event (harm or death) and expose the healthcare professional to disciplinary referrals and medico-legal litigations. For IMGs, this shift in thinking—from unawareness of UK healthcare system, to familial privacy to child-centred risk management—can feel challenging. There is often a conflict between maintaining patient trust and fulfilling professional obligations.

This guide provides a structured approach to safeguarding discussions in primary care, framed with empathy and practical consultation strategies. It is tailored to support IMGs (newly arrived in the UK) in navigating the emotional, ethical, and communicative complexities of safeguarding in a culturally competent manner.

ESTABLISHING TRUST: Creating a Safe Space Before Raising Concerns

Why this matters: Safeguarding discussions often involve deeply personal and sensitive issues—parenting, family relationships, trauma, or social services involvement. A hasty or poorly framed conversation can lead to breakdown of trust, patient disengagement, or emotional escalation. Establishing a safe, non-judgemental environment lays the groundwork for an open and constructive dialogue.

Educational rationale: Patients are more likely to disclose sensitive issues when they perceive the clinician to be empathic, respectful, and on their side. Rapport-building and early reassurance are thus critical to success.

Phrases for clinical use:

• “Everything you share with me is treated with care. I want to support you and your family in the best way possible.”

• “I know it’s not always easy to talk about family matters in a medical setting, but your child’s well-being is important to me too.”

• “There’s no judgement here—I’ve worked with many families going through challenging times, and I’m here to help.”

  
  

EXPLORING FAMILY CONTEXT: Gathering Information Without Blame

Why this matters: Good safeguarding starts with curious, compassionate, and non-assumptive history-taking. GPs must explore how the child is cared for, what the family structure is like, and whether the environment is physically or emotionally unsafe. For IMGs, this step may feel like overstepping cultural boundaries, especially in cultures where family matters are seen as private.

Educational rationale: Exploring psychosocial dynamics is not only relevant—it’s necessary. Children may not present with physical injuries but with signs of emotional neglect, poor school attendance, behavioural issues, or exposure to harmful environments (e.g., domestic violence, substance misuse).

Phrases to gather information:

• “Can you tell me about a typical day with your child? Who helps with care or routines?”

• “How are things going for you emotionally and practically at home?”

• “Are there any times when things feel too much or you struggle to cope?”

  
  

IDENTIFYING SAFEGUARDING CONCERNS: Recognising Red Flags

Why this matters: UK safeguarding frameworks (e.g. Working Together to Safeguard Children) emphasise the need for early recognition of harm or risk—physical, emotional, sexual, or neglect. GPs are not investigators but first responders in recognising signs that something may not be right, and making a referral to social services who make assessments on safeguarding concerns.

Educational rationale: IMGs may under-report concerns due to fear of over-reacting or lack of exposure to UK thresholds for intervention. Understanding that suspicion alone may warrant action is key. There is no need to “prove” abuse—only to notice and act on signs.

Clinical markers may include:

• Frequent unexplained injuries

• Signs of developmental delay or neglect

• Parent appearing under the influence or hostile

• Missed immunisations or poor school attendance

Consultation phrases:

• “I want to share something I’ve noticed and check how things are going for your child.”

• “From what you’ve said, I’m wondering whether there might be more going on that could be affecting your child’s well-being.”

• “Can I ask—has anything happened recently at home that might be making things harder?”

EXPLAINING YOUR ROLE: Balancing Confidentiality and Legal Duty

Why this matters: This is the most challenging stage for many IMGs. It involves breaking the cultural norm of doctor-patient confidentiality and potentially escalating the case beyond the consultation room. Patients may become distressed or angry. As a GP, your legal responsibility overrides the duty of confidentiality when a child is at risk of harm.

Educational rationale: The Children Act 1989 and 2004 places a statutory duty on healthcare professionals to act to protect children. This duty is not discretionary—it is required, even in the absence of parental consent. However, communicating this clearly, kindly, and with empathy can make a significant difference in how patients respond.

Phrases to clarify your duty:

• “I am sorry that this is distressing to hear, but doctors have a duty to act if we’re worried a child might not be safe. It’s not about blame—it’s about protecting them and ensuring you have the right support.”

• “Sometimes, we have to share concerns even if a parent doesn’t agree—because the child’s safety comes first.”

• “It’s never easy, but I’m here to work with you. Let’s talk about what this means and how we move forward together.”

  
  

MANAGING CONFLICT: Dealing with Resistance and Emotional Reactions

Why this matters: Parents may react defensively, especially if they fear judgement, social services involvement, or loss of custody. These are deeply emotional issues and need to be managed with compassion, not confrontation. IMGs may struggle with this stage due to emotional discomfort, language nuances, or lack of training in conflict resolution.

Educational rationale: Emotional literacy and de-escalation techniques are core GP skills. The consultation can still be therapeutic even when delivering difficult news. Tone, body language, and non-verbal cues all play a role in diffusing tension.

Phrases to manage conflict:

• “I understand this might feel frightening—it’s never easy to hear concerns about our parenting.”

• “The fact that you’re here shows you care—and that’s the most important starting point.”

• “I want to reassure you—my aim is to support, not punish. Safeguarding is about getting help early.”

  
  

FACILITATING VOLUNTARY DISCLOSURE OR COLLABORATION

Why this matters: Involving the family voluntarily in the safeguarding process leads to better outcomes and less resistance. Where possible, encourage the parent to disclose or engage with services themselves. This promotes agency and trust.

Educational rationale:Evidence suggests that when families are active participants rather than passive recipients of safeguarding decisions, they are more likely to comply with interventions and maintain engagement with care.

Phrases to promote involvement:

• “Would you be willing to speak to the school nurse or health visitor with me? That way we can work together.”

• “You have the chance to tell your story first-hand, rather than someone else speaking for you.”

• “Let’s talk about who else might be able to support you and your child.”

  
  

ESCALATING WHEN NECESSARY: Making a Safeguarding Referral

Why this matters: When significant risk is identified, a referral must be made, often to children’s social care, with or without parental consent depending on the urgency. It is essential to explain this process clearly and calmly, so the family understands the purpose and the next steps.

Educational rationale: Trainees must know how to initiate safeguarding referrals in line with local protocols. This includes contacting the safeguarding lead, using appropriate templates, and documenting meticulously.

Phrases to use during escalation:

• “Because I’m concerned, I’ll need to share this with our safeguarding team. They’re trained to assess situations and offer the right help.”

• “You’ll be informed every step of the way. We want to work with you to keep your child safe.”

• “You’re not alone—there’s support available for families in exactly this kind of situation.”

DOCUMENTATION AND GOVERNANCE

Why this matters: Documentation in safeguarding is both a clinical and legal task. Accurate, objective notes protect the patient, the clinician, and the child. They serve as the foundation for multi-agency collaboration.

Key components to document:

• The concerns raised and your clinical findings.

• Exact phrases or descriptions used by the parent or child.

• Whether consent to share information was obtained—and if not, why.

• Your decision-making process and whom you contacted.

• Safety-netting advice and follow-up plan.

FINAL THOUGHTS FOR IMG GP TRAINEES

Safeguarding is not about punishment or blame—it is about early support, safety, and collaboration. While these conversations can be emotionally charged and culturally complex, they are also deeply rewarding and vital to good primary care. With empathy, clear communication, and practice, IMG trainees can become confident and competent in delivering safeguarding discussions that protect children and support families.