Dr Beth Durrell Potter
As a student you may not face all the big issues in medicine directly, but it's still a good idea to expand your understanding. Dr Beth Durrell summarises a doctor's responsibilities surrounding FGM.
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.
Doctors encountering FGM in patients have to consider lots of different issues, and it's an area that highlights your responsibilities in a number of areas.
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.
'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.
What should you do?
A medical professional who discovers an act of FGM is required to contact the police. The Home Office recommends using the 101 non-emergency police 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 check that your safeguarding lead is updated. 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.
As a student, if you have concerns about a possible case of FGM, you should inform your supervisor without delay.
If you're told by a third party that a girl has undergone FGM, the mandatory obligation to report doesn't apply. You should, however, ensure that you follow local safeguarding procedures.
As the GMC guidance on confidentiality points out, there are specific situations when you can disclose confidential information without the patient's consent, such as if it's in the public interest.
In keeping with this, the 2003 Act is clear that an FGM notification will not breach the duty of confidentiality.
If you have concerns about a possible case of FGM, you should inform your supervisor without delay.
Consent and communication
You don't need the girl's consent in order to make the disclosure, as you have a legal duty to notify the police.
However, 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.
A sensitive approach to the conversation is important. In some cases, you may be concerned that discussing the notification may risk serious harm to the child, or the family leaving the country. In these cases, you shouldn't discuss the report with them. Again, consult your safeguarding lead if you are in doubt.
It's important that you make a comprehensive record of any 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.
Girls at risk
In some cases, a doctor may be concerned that a girl is at risk of FGM and 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.
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.
- 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.
In all likelihood, the chances that you'll encounter FGM during the course of your studies are fairly slim. But understanding the principles involved can help you see how to apply them in different situations and in a wider context, as well as broadening your knowledge of a serious topic.
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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