It is the responsibility of all healthcare professionals to safeguard those in their care and recognise female genital mutilation (FGM) as abuse.
Elaine Biscoe, our National Nursing Advisor, has summarised the implications for those working in primary care and outlines CQC’s expectations.
It is estimated that thousands of women living in the UK have been victims of FGM, a practice classed as torture by the United Nations.There are no health benefits and girls and women suffer physical, psychological and psychosexual complications. These include severe pain, infection, haemorrhage, anxiety, depression, kidney damage, infertility, and death.
Serious Crime Act 2015
FGM has been illegal in the UK since 1985. In November 2015 the Serious Crime Act strengthened legislation by adding extra requirements for health care professionals to report FGM.
The Act:
- Granted lifelong anonymity to alleged FGM victims.
- Made it an offence for parents to fail to protect their child from FGM.
- Introduced FGM Protection Orders, which can prevent potential victims from travelling abroad.
- Created a mandatory reporting duty for nurses, midwives, doctors, social workers and teachers to report to the police whenever they observe physical signs of FGM on a person under the age of 18, or where a girl tells them it has been carried out on her.
- Made it an offence for FGM to be committed abroad against UK residents.
Identifying FGM
A variety of presentations may prompt a clinician working in primary care to suspect a woman or child has been subjected to FGM. This includes repeated urinary tract or vaginal infections, urinary incontinence, dysmenorrhea and difficulty becoming pregnant.
The Department of Health FGM safeguarding pathway, which is relevant for all primary care staff, gives guidance on how to proceed. This includes initially asking the woman whether she comes from a community where cutting or circumcision is practised.
Daughters of women who have undergone FGM are at risk of being taken abroad to undergo FGM. Nurses in general practice who provide pre-travel consultations for patients requesting vaccinations should be alert to patients travelling to destinations where FGM may be practised.
Requirements on clinicians to report FGM
In addition to the requirements of the Serious Crime Act, it is now mandatory for all GP practices and Acute and Mental Health Trusts to submit FGM data to NHS Digital. Specific read codes have been produced for GPs and nurses to document FGM in patient records. Under 18s who may be at risk of FGM should be referred using standard existing safeguarding procedures, usually to children’s services.
CQC inspection
Regulation 13 states that “Systems and processes must be established and operated effectively to prevent abuse of service users”. The relevant key line of enquiry (S3) is in the Safe domain and asks “Are there reliable systems, processes and practices in place to keep people safe and safeguarded from abuse?”
CQC expects:
- All staff to have received relevant training in local safeguarding processes so they can recognise abuse and how to report and manage concerns.
- Practices to consider how staff are supported to fulfil the legislative requirements and how to refer women and girls for the subsequent physical and psychological consequences.
- The safeguarding lead to ensure that policies are accessible to relevant staff and contain information on local referral pathways. Good practice would be to adapt the practice policy to reflect the legislation and to discuss this at in-house safeguarding and clinical meetings.
- Practice policies to include how to share information with other healthcare professionals such as health visitors and school nurses and how to use appropriate read codes to document FGM.
Resources
GP mythbusters
SNIPPET GP mythbusters RH
Clearing up some common myths about our inspections of GP and out-of-hours services and sharing agreed guidance to best practice.