Lancaster review

I would recommend that the practice considers incorporating these into its computer templates. This should be preceded by general training on identification and management of disclosures of domestic violence so that the questions would only be asked in the appropriate setting and manner. Such risk factors may be picked up if enquiries are made about wider social circumstances at routine checks and again I would recommend that consideration is given to the incorporation of this.

If bruising is noted that indicated a suspicion or potential domestic abuse, questioning of the adult victim should happen as soon as possible.

Continue to raise awareness of signs of domestic abuse via safeguarding training

The referral form is in need of review to ensure areas of identified risk are focussed and of an assured standard. This will include recording and training aspects.

Awareness raising session for staff on Domestic Abuse and the effects on children especially early years children and babies and the effects on women. (How to spot potential signs and gain support access for parents and children.)

Third party reporting of Domestic Abuse to be written into the new DASH Policy and Supporting Procedures currently under review.

To set up archive evidence index for safeguarding.

I would recommend that consideration is given to incorporating the two screening questions into all chronic disease reviews.

Domestic abuse training that will address the importance of providing contact details of Women's Aid when domestic abuse is suspected but denied.

Ensure information is available regarding domestic abuse for patients in the accident and emergency departments.

That triage information is recorded on the clinical record system (rather than added to referral form). Citing who has provided the information.

E learning CP training for all staff annually rather than the 3 yearly updates at present this would go above and the current recommendations within the EYFS guidance

Specific training from Woman’s Aid on domestic abuse to continue to support A+E staff and Midwives and develop skills in the issue of Domestic Violence.

Currently the practice has neither a formal nor informal arrangement for regular information sharing with the attached Health Visitors. Consideration should be given to implementing regular two way communication

Ensure all health visitors and school nurses aware of the most recent guidance from DOH 2013 health visiting and school nursing programmes, no.5 Domestic Violence and Abuse Professional Guidance

Staff are aware of the importance of documentation and the need for a full history and details of attendance.

That consideration should be given to the use of multi-disciplinary working, increased access to clinical discussion.

UHMBFT A+E to work with Lancaster Women’s Aid to raise the awareness of the support available to victims of Domestic abuse.

I would recommend that consideration is given as to whether disclosures such as this should prompt any further enquiries.

Record keeping training - looking at basic entry details such as time of visits/contacts and also completion of the record regarding information about fathers/significant males living in a household.

To develop the Domestic Violence Link Nurse at Southport Accident and Emergency Department

To review the potential for isolation in the current environment of the Single Point of Access team in Lancaster and Morecambe – small office, lone working

UHMBFT clinical service team to work with the local MAPPA coordinator to strengthen information sharing of individuals who pose a risk to the others who may access care from UHMBFT.

I would recommend that practitioners when they receive an Emergency Department discharge for a child or adult ask themselves whether there may be safeguarding concerns. In the case of injury to an adult which arouses suspicion of domestic violence the "child behind the adult" should be considered and an appropriate risk assessment made.

Review the Accident and Emergency Domestic Violence protocol to include routine questioning

To review the interface with CRHT re referrals for urgent assessments.

I would recommend that risk to others is not only considered but specifically documented in Mental Health consultations as we already do for risk of self-harm.

To understand the capacity of urgent referrals and the use of telephone triage

Consider whether the Blue Light 71 needs to be revised to ensure risks and vulnerabilities are understood.

In my opinion it would be good practice to make inquiries as to who lives in the household as this may raise safeguarding issues.

All practice staff should have the relevant safeguarding training as recommended by the Intercollegiate Guidance for Safeguarding Competencies (2010). Staff should have training commensurate with their responsibilities - level 1 for all practice staff, level 2 for practice nurses and although GPs only require level 2 training for revalidation it is recommended that they undergo level 3 training as this includes multi-agency working relevant to their everyday practice.

To review stepped care model and the concept of resources influencing pathways.

Where there is a change in the original care plan such as this, then that information should be communicated back to the referrer to ascertain whether this is acceptable as the referrer is the person who has actually seen the patient.

Communication in general between the practice and Mental Health team should be looked at to enable any other potential problems to be identified.

I would recommend that the responsible CCG considers implementing this as a matter of urgency.