Information From The CCG Safeguarding Team FGM Feb 2015

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
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
0800 0283550
Link to revised guidance Multi Agency Practice Guidelines: Female Genital Mutilation 2014
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