Safeguarding work is professionally important and often time consuming. Practices regularly contribute to case conferences, reports, strategy discussions and information sharing for both children and adults at risk. The BMA’s position is that GPs should be appropriately paid for safeguarding work undertaken outside core contractual requirements, including safeguarding reports and attendance at case conferences.
At the same time, safeguarding is a core professional responsibility. GPs should continue to act in-line with GMC guidance and local safeguarding procedures where there are concerns about a child, young person or adult at risk. The issue of payment does not remove those professional duties.
What is the current issue?
The question of payment for safeguarding work has been raised repeatedly over many years. In some areas, practices have received funding for aspects of this work through local collaborative arrangements, but this is not consistent across England.
The BMA has recently reiterated its view that GPs should be paid for safeguarding work they undertake in relation to both children and adults.
LMC position
SSLMCs supports the principle that GPs should be properly reimbursed for safeguarding work undertaken for other agencies.
That said, safeguarding work also carries major professional and reputational importance. GPs should not step back from appropriate safeguarding participation where patient safety or welfare is at stake. The right approach is to continue meeting professional responsibilities, while also challenging unfunded transfer of work and pressing for proper commissioning and reimbursement.
What are practices expected to do?
Practices should continue to follow relevant safeguarding procedures and GMC guidance. For children and young people, the GMC is clear that all medical professionals must act on concerns about safety or welfare.
In practice, this may include:
- sharing relevant information where justified
- contributing to safeguarding discussions
- attending case conferences or strategy meetings where appropriate
- preparing reports or summaries when requested
- engaging with local safeguarding processes for children and adults at risk
For adult safeguarding, the BMA also provides guidance on the doctor’s role, including confidentiality and information sharing where abuse or neglect may be an issue.
Can the LMC agree fees on behalf of practices?
No. The LMC cannot set or agree safeguarding fees on behalf of individual practices.
The LMC can, however:
- advocate collectively for proper reimbursement
- raise the issue with ICBs and local authorities
- support practices with general advice and signposting
- press for a commissioned local service where funding and commissioner support can be secured
Historically, attempts have been made in some areas to develop locally commissioned arrangements for this work, but these have not always been taken forward because funding was not prioritised.
What if a practice is asked to do work that feels unfunded or excessive?
It is reasonable for practices to be clear about the workload involved and to ask whether there is an agreed funding route or local arrangement.
Practices may wish to:
- clarify exactly what is being requested
- identify whether the request relates to immediate safeguarding duties or a broader administrative ask
- ask which organisation is responsible for funding the work
- keep a record of repeated or burdensome requests
- raise patterns of concern with the LMC
Where the request relates to an immediate safeguarding concern, patient safety comes first. Where it relates to recurrent system design or routine transfer of unfunded work, that should be challenged through contractual and commissioning routes.
Why does this matter now?
The issue may become more pressing as ICBs reduce staffing and restructure services. A reduction in safeguarding support functions, including access to named safeguarding professionals or advisory input, risks shifting more work and more risk onto practices without equivalent funding or support.
That wider system risk is not unique to one area, and the LMC is concerned that general practice may be expected to absorb additional safeguarding workload as commissioner capacity reduces.
What happened in the BMA legal challenge?
Some colleagues may remember the BMA’s High Court challenge in Northamptonshire in 2020. As noted in the original LMC letter, that case did not give the BMA a sufficient basis to take the issue further.
The practical point for practices is that the wider policy argument about fair payment remains live, even though that litigation did not produce the change the BMA had sought.
What is SSLMCs doing?
SSLMCs will continue to press for appropriate reimbursement for safeguarding work undertaken by general practice and to raise this with relevant ICBs and local authorities across the Confederation.
Where helpful, we may also share template wording that practices can adapt locally when responding to requests for unfunded safeguarding work.
Key points for practices
- Safeguarding remains an important professional responsibility.
- GPs should continue to act in line with GMC guidance and local safeguarding procedures.
- SSLMCs supports appropriate reimbursement for safeguarding work undertaken by practices.
- The LMC cannot itself set fees for individual practices.
- Recurrent unfunded requests should be identified, recorded and raised.
- Wider system changes may increase pressure on practices, which is one reason this issue needs continued collective challenge.