Information from the CCG safeguarding team Dr Linda Whitworth, Jean Rollinson, Lorraine Elliott, Louise Burton , Louise Wyatt and Marie Coyne NHS Greater Preston CCG and NHS Chorley and South Ribble CCG and NHS West Lancashire CCG Chorley House | Centurion Way | Leyland | Lancs | PR26 6TT Tel: 01772 214376 Please feel free to use this information for appraisal/in-house learning February 2015 Female Genital Mutilation (FGM) FGM is illegal, is a form of child abuse and a violation of the rights of the child. It reflects a culture of gender-based violence although the mutilation is usually arranged by the child’s mother. It is not countenanced by any religion. The major risk factor for a female child is coming from a practising community particularly if FGM has already occurred in the family. What to do in General Practice if worried a child may be subject to FGM or have been a victim of FGM If in doubt, children presenting with perplexing genital symptoms and signs should be urgently referred to a specialist paediatrician. GPs or Practice Nurses worried that a child may be at risk of FGM should always seek advice from their Practice Safeguarding Lead. When there is a suspicion or concern that significant harm will be experienced, professionals have a legal duty to report and refer cases, document responses, and share information between agencies following Local Child Protection procedures. How FGM might present in General Practice GPs should be aware of the health needs of their practice population including prevalence and likelihood of certain conditions such as FGM. Offering patients a holistic assessment at time of registration creates an opportunity to assess individual as well as wider family health needs and to enquire about FGM if indicated. Routine procedures such as cervical cytology and ante-natal booking questionnaires may identify adults who have already been mutilated and whose children may therefore be at risk but such women are often only identified when giving birth and good communication between midwives, obstetric units and GPs is essential to ensure the diagnosis is documented and appropriate action taken to protect the new baby and existing children. This must include a risk assessment and appropriate coding and flagging of records so that any GP or Practice Nurse in contact with the child/ren is made aware of the risk and can provide support and education to help prevent FGM in her offspring. Dr Linda Whitworth 1 A recent statement by the Department of Health and NHS England has advised that it is now mandatory to record FGM in a patient’s healthcare record Recording FGM: Read Codes v2 Family History of Female Genital Mutilation 12b.. History of Female Genital Mutilation 15K.. Female Genital Mutilation Type 1 K5780 Female Genital Mutilation Type 2 K5781 Female Genital Mutilation Type 3 K5782 Female Genital Mutilation Type 4 K5783 Deinfibulation of vulva 7D045 Deinfibulation of vulva to facilitate delivery 7F1B5 FGM Helpline (NSPCC) 0800 0283550 Link to revised guidance Multi Agency Practice Guidelines: Female Genital Mutilation 2014 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/380125/MultiAgencyPr acticeGuidelinesNov14.pdf I hope the following case scenarios are helpful to GPs to reflect on individually or to discuss in a practice meeting. Miss B Comes to tell you she is pregnant for the first time – she is worried whether she will be able to give birth vaginally or not. This is a good opportunity to ask the questions “Do you come from a community where FGM is carried out?” and/or “Is there any possibility that FGM/surgery may have happened to you?” If any doubt after examination ask for a senior gynaecological opinion. If FGM has been carried out remember that any existing children may be at risk as may the unborn child. You will need to share information appropriately. Plus remember to code as above. Mrs C A letter arrives from gynaecology stating that it was noticed that during routine pelvic floor surgery that this 45 year old lady had had FGM when younger. She has one daughter, now 19. You have never met either. Firstly this needs coding as a significant (past or active?) problem – see codes above. Please make sure your staff know to flag up FGM if spotted within a letter in case the GP has not done so. Hopefully they know to do this already for other safeguarding issues eg children’s clinic DNAs, toxic trio (drug and alcohol misuse, mental health problems and domestic abuse) risk factors in adults with child care duties etc… Consider the daughter (and her daughters!) – you could possibly flag her notes so she can be asked the question at an appropriate time eg future contraceptive consultation, talk to Mrs C and ask her directly about her daughter, or if anyone in the wider team knows her eg a health visitor they could maybe be asked to have the discussion? You may want to phone us for advice! Dr Linda Whitworth 2
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