FGM: what does our guidance say?

Our guidance is clear that female genital mutilation is a serious crime and a child protection issue.

You must keep up to date with and follow the law and other relevant regulations (paragraph 12 of Medical practice).

If you have any concerns that a child or young person is at risk of abuse you must report it unless it’s not in their best interests to do so (paragraph 32 of Protecting children and young people).

If you are concerned that an adult who has capacity is at risk of harm, then unless there is a specific legal duty that applies, you should not usually share information about them unless they consent. This applies even if their decision leaves them, but nobody else, at risk (paragraph 51, Confidentiality). If they do not have capacity to consent, and you are concerned that they are at risk of serious harm, then you must usually share information with an appropriate person or authority (paragraph 63, Confidentiality). For example, this might include sharing information with a senior colleague, or with a local authority safeguarding adults team.

Do I always have to report FGM to the police?

If you are working in England or Wales, you must report FGM under the mandatory duty, only in known cases of FGM in girls aged under 18. The duty applies where you have visually identified FGM in the course of an examination (to the best of your knowledge) or where a girl has told you about it herself.

It does not apply in the following circumstances.

  • Outside of England and Wales.
  • In relation to patients aged over 18.
  • Where you suspect but have not visually identified FGM (to the best of your knowledge) or been told about it by the girl herself.
  • Where you can identify that another doctor has already reported the same act of FGM to the police.

Even if the mandatory duty does not apply, you must follow our guidance on child protection if you think a child is at risk.

 

How does the mandatory reporting duty fit with my duty of confidentiality?

You must disclose information if it is required by law. You must tell an appropriate agency if you are concerned that a child is at risk of harm, unless it is not in their best interests to do so (paragraph 17  of Confidentiality and paragraphs 32 and 36 of Protecting children and young people).

The Home Office’s procedural guidance states clearly that the mandatory duty to report FGM in England and Wales does not breach any confidentiality requirement or other restriction on disclosure that might otherwise apply.

If you are sharing information about FGM because you are required to by law, or because you are concerned about the risk of harm to a child, you must:

  • disclose the information promptly
  • share all relevant information
  • make sure you don’t disclose more than you need to (paragraph 9d and 10 of Confidentiality).

You should also do the following, unless there is a compelling reason not to.

  • Discuss the disclosure with the child or their parents and explain why you are sharing information.
  • Explain what information you’re sharing, who you’re sharing it with, how it will be used and where to find independent advice and support (paragraph 38 of Protecting children and young people and see also paragraph 35).

Must I submit my patient’s data through the enhanced dataset?

All acute trusts, mental health trusts and GP practices in England must collect and submit information about FGM through NHS Digital’s enhanced dataset. This includes some patient identifiable data, such as patients’ names and NHS numbers and applies to patients of all ages.

NHS Digital is required by law to collect this information, so explicit patient consent is not required. But the Secretary of State for Health made a policy commitment that any objections to processing FGM data would be respected and acted upon.

Patients can object to their identifiable information being shared with NHS Digital. Or, if it has already been passed on, they can object to NHS Digital processing it further.

You should respect and help patients to exercise their legal rights to be informed about how their information will be used (paragraph 11a, Confidentiality). The Department of Health has produced a  (pdf) about FGM and other materials about the enhanced dataset that you may find useful to use as you do this.

What do I do if my adult patient has had, or is at risk of FGM?

Adults are not covered by the England and Wales mandatory reporting duty, but if you are working in England then you will need to collect and submit information via the enhanced dataset (see above).

If you are worried that an adult patient who has capacity to consent to sharing information is at risk of harm, then unless there is a specific legal duty that applies, you should not usually share information about them unless they consent. This is the case even if their decision leaves them, but nobody else, at risk (paragraph 51, Confidentiality).

It may be appropriate to encourage them to consent to you sharing information though, and for you to explain the possible risks of not consenting. You should also offer what support you can to help them make decisions in their own interests.

If you’re worried about an adult patient who does not have the capacity to consent to sharing information, and you think they are experiencing or at risk of abuse or neglect, then you must usually share information to an appropriate person or authority (see paragraph 63, Confidentiality).

What if I don’t report FGM in a child?

FGM is a criminal act. If you are working in England or Wales, and you know that a girl aged under 18 has had FGM carried out, then you have mandatory duty to report it to the police.

All doctors registered with us have a responsibility to follow our guidance on child protection and report concerns to a suitable authority (such as the NSPCC or the local authority) if they think a child is at risk.

You must disclose information where it is required to satisfy a specific statutory requirement (paragraph 17 of Confidentiality).

Serious or persistent failure to follow our guidance may put your registration at risk.

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