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1.5.7 Guidance for Practitioners where a Request for a Change in Staff Personnel is made by a Patient and/or Family Member

This chapter was introduced into the manual in July 2012.


This guidance is issued following a recommendation made within a case review undertaken by the Northumberland Safeguarding Children Board Serious Case Review Committee. The recommendation states:

'The Strategic Safeguarding Manager on behalf of the Northumberland Safeguarding Children's Board should issue guidance to FACT Social Work Teams, GP's, and Health Visitors reminding staff of the importance of continuity in the medical assessment and oversight of children. Any requests for changes in medical practitioner should be carefully considered and this decision should involve Health colleagues as appropriate and the core group (should the child be subject to a child protection plan).'

Continuity of the same professional personnel where there are welfare concerns for a child is very important. Continuity gives the best chance to a growing and trusting relationship with the child and family and allows for a detailed understanding of the child's needs within the context of their developing history. Although medical notes and case files will provide some history this is greatly enhanced by personal knowledge.

It is accepted that occasionally there will be the need for a change in staff due to unforeseen or planned absence. However there will be occasions when a request is made by the family for no apparent good reason other than they are finding the involvement of the staff member challenging. This may be an early indicator of resistance or non-cooperation with a plan. It should be borne in mind that where this appears to be the case an uncompromising position from the agency may, paradoxically, prove to be counter productive particularly if the result is a withdrawal of cooperation from the family. Notwithstanding this, it is recognised that the persistent refusal of family members to accept specific workers in these circumstances is difficult to manage and needs to be carefully considered within formalised supervision processes or peer support systems in order to evaluate the validity of the request, undertake an assessment of benefits against risks to the child and where agreed ensure a seamless transfer of responsibilities is achieved.

Where the medical practitioner or other professional is working as part of a care team or core group the issue should be discussed within the group and a decision reached on the basis of what is in the best interests of the child concerned.

End