Child Safety for GPs and Health Visitors
Routine inquiry, IRIS, Red Book observations, and escalation to MASH. The role of primary care in safeguarding children online and offline.
As a GP or health visitor, you may be the only universal professional a family sees regularly during a child's earliest years. Working Together to Safeguard Children 2023 places safeguarding firmly within primary care's role: routine inquiry about domestic abuse, observation of parent-child interaction, and escalation through the Multi-Agency Safeguarding Hub (MASH) when concerns cross threshold. This guide focuses on the everyday clinical contacts where safeguarding intersects with digital risk: a parent disclosing online abuse from an ex, a teenager presenting with anxiety linked to sextortion, a Red Book check where bruising does not match the account given.
Why this matters
Primary care sits at the front door of every safeguarding system. A delayed referral from a GP or health visitor can mean weeks before intervention; a well-timed one can prevent serious harm. Online harm now reaches primary care directly — through self-harm presentations linked to harmful content, eating-distress linked to algorithmic content, and adolescent mental health crises following grooming or sextortion. Recognising the digital dimension shortens the route to help.
Quick wins
Add a single routine question about online life to your adolescent mental health template
Time: 10 minutes
Confirm you have your local MASH telephone number and out-of-hours route saved
Time: 5 minutes
Refresh your knowledge of the Mental Capacity Act and Gillick competence for adolescent consultations
Time: 30 minutes
Common challenges
Carrying out routine inquiry about domestic abuse when the child is in the room
Use the IRIS (Identification and Referral to Improve Safety) framework where your practice has implemented it. Ask in age-appropriate ways — 'Is there anything happening at home that's making things harder?' — and have child-friendly activities ready so you can speak with the parent privately for part of the consultation. Document carefully.
Recognising digital harm presenting as mental health or somatic symptoms
When an adolescent presents with sudden anxiety, school refusal, sleep disruption, or self-harm, ask routinely about online life: 'Has anything happened online recently that's been worrying you?' Sextortion in particular often presents this way and the child may not raise it without prompting. Pathways via CAMHS and the NSPCC helpline (0808 800 5000) are available.
Deciding when to refer to MASH versus seeking advice first
Where you believe a child is suffering or likely to suffer significant harm, refer to your local MASH the same working day, following up in writing. Where you are unsure, contact your safeguarding named GP or named nurse for advice before referral. Do not delay a referral for the sake of certainty; share what you know and your reasoning.