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Further Information

GP & Primary Care Practitioner

The page contains information to help support colleagues working in primary care with their safeguarding adult responsibilities.


Primary care learning from a safeguarding adult enquiry: a forgotten vaginal pessary

The safeguarding adult team recently reviewed the case of an elderly lady with dementia living in a residential care home.  This lady had presented with recurrent vaginal discharge and on examination by the GP was found to have a vaginal pessary in situ.  It transpired that this pessary had been in place for four years.

Further enquiry identified that insertion of the pessary was not coded appropriately in the medical records and as such the need for a recall and change of pessary was overlooked. 

The patient had registered at a new surgery on moving into residential care.  A further learning point was that under System One it appears that when a practice deregisters a patient, recall codes are automatically inactivated.  As such the new practice was not aware that the patient had a pessary in situ. 

 This case highlighted the positive role of the GP surgery in ensuring both the appropriate care and follow up of patients requiring vaginal pessaries for urinary incontinence and pelvic organ prolapse.

  • NICE (NG123) recommends that before starting pessary treatment it should be explained that the pessary should be removed at least once every six months to prevent serious pessary complications and women using pessaries should be offered an appointment in a pessary clinic every six months if they are at risk of complications, for example because of a physical or cognitive impairment that might make it difficult for them to manage their ongoing pessary care. (NG123 last updated 24/06/2019).
  • Does your surgery have a robust system for coding that a patient has a pessary in situ and is an active and appropriate recall code is in place?
  • If an active recall code is removed does the surgery ensure the reason why is recorded?
  • If you are a System One practice it is worth considering reviewing all old recalls when a patient registers and reactivating these if appropriate or aligning these with your own practice search codes to ensure important recalls are not missed.
  • How does the practice support newly registered care home residents?  Would it be possible for an appointed clinician to review the case notes for  newly registered  care home resident to ensure important conditions/issues  are not missed?


Supporting homeless people to register with a GP practice

The charity Groundswell works with people who experience homelessness, offering opportunities to contribute to society and create solutions to homelessness.  People who experience homelessness are entitled to register at a GP surgery.  They do not need a fixed address or identification.  Groundswell have produced “My right to healthcare cards” to empower individuals to register at a GP surgery.

Further information including a helpful video demonstrating use of the card can be found by clicking here.  Please consider raising awareness of this campaign in particular amongst your reception staff who are often the first point of contact for patients.


Does your GP surgery have a domestic abuse champion?  Free training available!

Domestic violence is an abuse of human rights and a major public health problem because of the long term consequences for people who have experienced it.  The RCGP advises that many people experiencing abuse believe that their GP can be trusted with disclosure and GPs can offer practical support to protect people who disclose abuse.

Domestic abuse champions are trained to develop knowledge on asking, responding, and supporting people affected by domestic abuse, and to use their knowledge to help their colleagues to respond effectively and appropriately.  The champion may be a GP but equally would suit a practice nurse or receptionist who has direct contact with patients.

Training is delivered over two full days. The next two dates are 22/29 April 2021. Training is free although a charge is made if delegates fail to attend without notice.

If you or one of your staff are interested in registering on the free training please complete the form and return it to da.change@norfolk.gov.uk 


Domestic Homicide Reviews

Learning for primary care Mary


NEWS | Posted Friday 5th February 2021

Your voice Your decision campaign

A new campaign from the Office of the Public Guardian has been launched which signposts people to information about Lasting Power of Attorney.
The website also provides information on misconceptions about LPAs, real life case studies and guidance on the process.
Click here for Power of Attorney campaign.

Vaccination and Assessing Capacity to Consent

The current Covid-19 climate reminds us of the importance of robust and clear guidance on assessing patient capacity to consent for vaccination.  The Safeguarding Adults National Network (SANN) have produced a useful vaccination assessing capacity to consent form. Download the Vaccination Assessing Capacity to Consent Form here.

The Norfolk and Waveney Health and Care Partnership have produced an excellent flowchart to help determine a patient’s ability to consent to a vaccination. Download the flow chart here



Adult Safeguarding Bulletin for Norfolk & Waveney (SPRING 2019)

Adult Safeguarding Bulletin for Norfolk & Waveney (WINTER 2018)(02) - Updated

Adult Safeguarding Bulletin for Norfolk & Waveney (SUMMER 2018) FINALv2


Adult Safeguarding: Roles and Competencies for Health Care Staff | Intercollegiate Document 

Safeguarding Adults Intercollegiate Document (AUGUST 2018)

DOREEN A Case for Thought (18.12.2018)V3


Safeguarding Adults at Risk | Generic policy

This policy has been designed for use by general practice and can be adapt as needed. NSAB would like to thank OneNorwich for their support in developing this document. 

Safeguarding Adults at Risk - General Practice Policy | (Word)

Multi-Agency Risk Assessment Conference (MARAC)

GP Information Sharing Guide for MARACs

MARAC GP Notification Letter Master


Mental Capacity 

Health Education England Level 3 Adult Safeguarding Training module on Mental Capacity for the e-learningforhealth platform. Click here for the Mental Capacity e-learningforhealth platform.

Carrying Out and Recording Capacity Assessments | 39 Essex Chambers (June 2020)

This purpose of this document is to provide for social workers and those working in front-line clinical settings an overview of the law and principles relating to the assessment of capacity. Its focus is on:

  • how to apply the MCA 2005 principles when assessing capacity; and
  • how to record assessments, primarily in the context of health and welfare decisions


Safeguarding Adult Reviews - Summaries for GPs

Mr AA SAR Learning Summary (v2 Final) 13-07-2018(3)

Mrs BB SAR Learning Summary (12-07-2018)(2)

Learning from SAR Maria (Suffolk Safeguarding Partnership October 2020) 


Self-neglect and Hoarding

NSAB SN-H Practitioners Guide JUNE 2018 (FINAL02.1) Published 26 June 2019


NSAB publicity material for PIP screens (MP4)

Please contact james.butler@norfolk.gov.uk


NSAB publicity material for PIP screens (JPEG)

Please contact james.butler@norfolk.gov.uk


NHS England 

Safeguarding Accountability & Assurance Framework (SAAF) (19 August 2019


Useful articles & links:

Sharing Reports about Domestic Violence and Abuse With General Practitioners | Katherine Pitt, et al. (2020)  BMC Family Practice.

Dilemma: Patient always attends with suspected abusive partner | A medicolegal adviser and GPs give their advice on how to help a patient with a suspected abusive partner who always accompanies them to appointments. Pulse, 3 September 2018.

Royal College of General Practice Adult Safeguarding Toolkit 

Royal College of Nursing Modern Slavery Guidance