“My hands are very sore and cracked — my friend says I need a cream”

Modern slavery often presents as an ordinary problem with a companion who controls the consultation. Cues: someone else answering or insisting on interpreting, booking and holding the phone, many adults at one address, inconsistent stories, withheld documents, debt bondage, long hours, restricted movement, fearfulness and untreated injuries or work-related conditions. Always try to see the person alone for part of the consultation, check they can speak freely, and use a professional interpreter, never a companion. Ask direct, simple questions. If there is immediate danger, call 999. Otherwise explain options and seek consent: adults need to consent to a National Referral Mechanism referral, which is made by designated first responder organisations (police, local authorities, and specified charities — GPs are not first responders); the Modern Slavery & Exploitation Helpline (08000 121 700) gives 24-hour advice to victims and professionals. Involve the practice safeguarding lead; modern slavery is a category of abuse under Care Act statutory guidance, so an adult safeguarding concern can be raised. Confidentiality can be breached without consent where there is a risk of serious harm to the patient or others (GMC). Agree a safe contact route and code word, document carefully, and keep the door open if she declines.