Dr Beth Durrell Potter
Following the recent release of guidance and information surrounding the reporting of FGM, Dr Beth Durrell offers a round-up of doctors' responsibilities.
FGM remains a topical issue that understandably makes headlines. It was made a crime in the UK in 1985, with subsequent legislation also making it illegal to take a child abroad to be subjected to FGM.
A recent amendment to the Female Genital Mutilation Act 2003 meant that from 31 October 2015, healthcare professionals (and certain others) in England and Wales who 'discover' that an act of FGM appears to have been carried out on a girl under the age of 18 have a legal duty to notify the police. The accompanying multi-agency statutory guidance was subsequently released in April 2016.
Discovery and duties
'Discovery' in this context arises if a girl tells you that she has been subjected to FGM, or if you observe physical signs indicating that FGM has taken place, not arising from surgery necessary for her physical or mental health, or arising from labour or childbirth.
You don't have to be certain, and the duty also applies if FGM appears to have been carried out. Unless your suspicion arises as part of an examination already underway, you shouldn't carry out an examination in order to confirm whether FGM has occurred.
Contacting the police
If you have concerns about a possible case of FGM, you must contact the police. The Home Office recommends using the 101 non-emergency police telephone number (although the report can be made in writing). Provide your name, contact details, role and place of work, the girl's name, age and address, and why the report is being made.
You should also tell the police what safeguarding action has been undertaken, or will be undertaken, and ensure that your safeguarding lead is updated. The Act states that an FGM notification will not breach the duty of confidentiality.
Best practice would be for this to be done by the end of the next working day, but the Act requires that the notification is made within 28 days of the discovery.
The Act states that an FGM notification will not breach the duty of confidentiality.
The procedural information makes clear that, in line with safeguarding best practice, you should contact the girl and/or her parents/guardians to explain the report, what it means and why it's being made. If possible, this should be done before or when the report is made.
In some cases, you may be concerned that this may risk serious harm to the child, or the family leaving the country. In these cases, you shouldn't discuss the report with them. Consult your safeguarding lead if you are in doubt.
If you're told by a third party that a girl has undergone FGM, the mandatory obligation does not apply. You should, however, ensure that you follow local safeguarding procedures.
Girls at risk
In some cases, you may be concerned that a girl is at risk of FGM. In this case, you might need to consider an application for an FGM protection order. If you become aware that a girl is at risk of serious immediate harm, you should make an urgent report to the police.
Discussion and documentation
It's important that you make a comprehensive record of the consultation. Be sure to include the details of the FGM, the safeguarding action, any discussion with the girl/parents and the reporting to the police.
Failure to notify
Failure to notify would be a breach of the statutory duty. The Act doesn't specify a sanction, but it may result in referral to the GMC.
To determine the scale of FGM in the UK, data has been submitted to the HSCIC by acute trusts since April 2014, and by GP practices in England and mental health trusts since October 2015. Information should be submitted when a woman is having treatment related to FGM, when a woman with FGM gives birth to a baby girl or where FGM has been identified by the woman or a care provider. According to HSCIC, around 1400 cases of FGM were reported between July and September 2015.
- FGM is a criminal offence, and healthcare professionals are required by law to notify the police if they discover that a child under 18 has had FGM.
- Making this notification is not a breach of the duty of confidentiality.
- If you have any concerns in relation to making such a disclosure, you may wish to contact your safeguarding lead and the MDU for further advice.
Dr Beth Durrell Potter
BSc(Hons) MB ChB MRCPsych PGDip(Mental Health Law)
Beth qualified from Manchester University in 2002 and completed her psychiatry training in the North West. She obtained a CCT in general adult psychiatry and worked as an inpatient consultant before leaving to join the MDU as a medico-legal adviser. She holds a postgraduate diploma in mental health law.
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