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Domestic Violence and MARACs (Multi Agency Risk Assessment Conferences)

Department of Health document: "Striking the Balance" - Practical Guidance on the application of Caldicott Guardian Principles to Domestic Violence and MARACs (Multi Agency Risk Assessment Conferences)

 

The following guidance is provided with thanks to Wessex LMC

Domestic violence accounts for 16% of all violent crime and is defined as 'any incident of threatening behaviour, violence or abuse between adults who are or have been in a relationship together, or between family members, regardless of gender or sexuality.'

Remember where Domestic violence is present that is a significant risk factor for Child abuse.
The Adoption and Children Act 2002 includes in the definition of harm to children any 'harm suffered by seeing or hearing ill treatment of others, especially in the home.' 

The Victim Initial Risk Indicator Form is completed by police at the scene of domestic violence incidents and allows victims to be categorized as 'standard,' 'medium,' 'high' and 'very high' risk. A MARAC is a Multi-Agency Risk Assessment Conference and it aims to focus help those victims at high and very high risk by facilitating information sharing between key agencies and initiating the most appropriate intervention.
Information sharing - MARAC and a doctor's duty of confidentiality

The coordinator for health professionals on MARAC may seek information that is urgently required from the GP or may be contacted directly by a GP that discovers a patient is at risk.   A prompt response may be essential to prevent very serious harm.

A consent-based approach to the sharing of all sensitive patient information is the preferred practice, but may not always be possible or desirable. 

Doctors have conflicting duties to respect maintaining confidentiality and sharing data they judge to be in the patient's best interests.   This must be assessed carefully at the outset, taking into account professional guidance, contractual obligations and the relevant legislation eg the Data Protection Act, the Human Rights Act and the common law on confidentiality and negligence. 

It may be permissible to disclose the minimum data necessary to serve a legal purpose to a person who is legally permitted to carry out that purpose and who shares a similar duty of confidentiality to the doctor;

  • where there is a risk of death or serious mental or physical harm to an individual
  • where the safety of a child is at stake - the best interests of the child are always paramount
  • where seeking consent may increase the danger to an individual 
  • where seeking consent may impede the prevention, investigation or prosecution of a criminal offence
  • where it is overwhelmingly and substantially in the public interest

A proportionate disclosure to MARAC in high risk cases, without the consent of the patient, whether victim or perpetrator, would probably be permissible.  However, if there is any doubt in a particular case then contact the LMC office or seek legal advice before disclosure, unless the consequent delay is likely to result in serious harm. 

What do you do if you receive a MARAC report or a Domestic Violence Notification?
We would recommend that on receipt of the forms this information is shared within the practice and any relevant entries made in the notes of the individual concerned rather than scanning in of the whole report, but this will need individual judgement.  If it is scanned in then we would suggest that the fact that the report contains third party information is highlighted so that this is obvious for any cases of future release of notes.
It may be relevant to make a record in the notes of any children within the household or any other parties if felt relevant (especially vulnerable adults).  With any recording of this nature it is important to be mindful to the fact that records may in the future be released to the parties involved.

Useful Read Codes
13Hm - Subject of Multi-agency risk assessment conference
13VF (13VF.) At risk of violence in the home

For further information call the LMC Office 01622 851197

Updated on Thursday, 7 January 2016, 2908 views

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