Safeguarding consultations, calm, clear and on the record

What safeguarding looks like in the SCA

Safeguarding cases include a school calling about a child, a teenager asking for confidential contraception or testing, a carer who is struggling, a disclosure of female genital mutilation, or an older person whose care at home is slipping. Some are explicit from the brief. Others are hidden inside a different presenting problem, which is why it is worth asking yourself in every case: is anyone here at risk?

The GMC's guidance on protecting children and young people is clear that doctors must act on concerns about a child's safety or welfare, and that confidentiality does not stop you sharing information needed to protect a child from abuse or neglect. Local procedures decide who you contact; in practice that is usually the practice safeguarding lead and children's or adult social care.

How the RCGP domains apply

These summaries are ours. The domain names are the RCGP's; read its own descriptors on the marking and results page and in the SCA consultation toolkit. See how the SCA is marked for the grades and pass mark.

A practical structure

1. Notice and make space. If something does not fit, ask gently and give the person time. On video, check they are somewhere private and safe to talk.
2. Listen and clarify. Let them tell you in their words. Ask open questions; avoid leading ones.
3. Assess immediate risk. Is anyone in danger today? Children in the home? Thoughts of self-harm?
4. Explain confidentiality honestly. Say that you keep things private unless someone is at risk of serious harm, and what would happen then.
5. Agree the action. Who you will contact and when, what the person can expect, and how you will support them.
6. Safety-plan and follow up. How to get help urgently, who they can tell, and when you will next speak.

Common pitfalls

• Promising to keep a secret. If you later have to share, trust breaks. Explain the limits at the start.
• Investigating instead of referring. Your job is to recognise and act, not to establish exactly what happened.
• Forgetting other people at risk. Ask about other children in the household, or other adults who depend on the person.
• Dropping the presenting problem. The contraception, the test or the headache still needs a plan.
• Delay without a reason. “Let’s see how things go” is not enough when there is a clear concern.

Natural phrases

• “Are you somewhere you can talk freely at the moment?”
• “What you tell me stays between us, unless I’m worried someone could be seriously hurt. If that happens, I’ll talk to you first.”
• “You’ve done the right thing by telling me.”
• “Is there anyone else at home who could be affected?”
• “I’d like to talk to our safeguarding lead today. Here’s what that means for you.”

Practice cases with a safeguarding element

In these cases the safeguarding question is visible from the brief or the patient’s opening words. Other cases in the bank carry a concern that you have to find for yourself; we do not list those here.

• The teacher’s phone call · Telephone
• Fifteen-minute visits · Telephone
• "I’m fine, my mum’s just overreacting" · Video
• "I’ve been crushing Mum’s tablets into her tea — is that okay?" · Telephone
• "He’s lashed out at me again — I can’t cope, just sedate him" · Telephone
• "I’m 16 and pregnant — I want a termination, and I don’t want my mum told" · Video
• "I’m 15 and pregnant — my boyfriend’s 22, and I don’t want any trouble" · Video
• "I did something stupid and I’m terrified I’ve got HIV — can you test me, secretly?" · Video
• “Can I get the pill without my mum finding out?” · Video
• "My mate’s mum found vapes and some pills in my bag — it’s no big deal, everyone does it. You won’t tell my parents, right?" · Video
• "My niece is being taken ‘home’ this summer — I’m frightened they’ll cut her" · Video
• "You noticed during my smear — are you going to report me to the police?" · Video

Each case page shows the candidate brief you would read in the 3-minute window. The learning points sit behind a spoiler, so read the brief, practise, then look. The full case, with the role-player script and examiner checkpoints, is in The Hot Seat.

How to practise

Read a case brief, set a 12-minute timer and run it with a partner, the AI patient or out loud on your own. The Hot Seat holds the full case bank with a scorecard for each case. The Consultation Conversation Lab drills the Relating to others skills (cues, ideas and concerns, shared plans), and Worked Example Consultations show what a passing consultation sounds like from start to finish. Then put a few of these cases into your next mock exam.

Frequently asked questions

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