GPAtlas🧭 When to suspect
Safeguarding adults is about protecting an adult's right to live in safety, free from abuse and neglect. As a GP you are often the visiting practitioner on a care-home round, or the clinician who sees a resident in surgery, and you are frequently the person best placed to notice that something is wrong. Suspect a safeguarding issue whenever there are signs, a disclosure, or concerns about the abuse or neglect of a resident. None of the indicators below is proof of abuse on its own – each is a signal to follow the safeguarding pathway.
Every action rests on the six Care Act 2014 principles – Empowerment, Prevention, Proportionality, Protection, Partnership and Accountability – and on the Making Safeguarding Personal (MSP) approach, which keeps the resident's own wishes and outcomes at the centre rather than doing a process to them. The statutory enquiry duty sits with the local authority under section 42 of the Care Act 2014.
The central clinical skill is the consider–suspect gradient: to consider abuse means it is one possible explanation for what you have found; to suspect abuse means you hold a serious level of concern. If there are several indicators and at least one is a 'suspect' indicator, you suspect. Throughout, the GP's job is to recognise, make safe, document and refer – not to investigate.
| Type of abuse or neglect | What it can look like in a care home |
|---|---|
| Physical | Unexplained bruising, cuts, burns, grip marks or fractures; restraint without authorisation; misuse of medication to control behaviour. |
| Psychological / emotional | Being shouted at, humiliated, threatened, isolated or denied choice; becoming withdrawn, subdued or fearful of a particular person. |
| Financial / material | Missing money or possessions, unexplained transactions, a will changed under duress, or misuse of a lasting power of attorney. |
| Sexual | Sexualised language; unexplained genital or anal injury, bleeding or an STI in a resident who lacks capacity to consent; an intimate relationship with a member of staff. |
| Discriminatory | Unequal treatment, harassment or denial of care linked to a protected characteristic (Equality Act 2010). |
| Neglect / acts of omission | Pressure ulcers, dehydration, malnutrition, poor hygiene; missed or wrongly given medication; withheld aids (glasses, hearing aids, dentures). |
| Self-neglect | A resident's own inability or refusal to attend to their care or health – assess capacity and the reasons before deciding how to respond. |
| Organisational | Poor staffing, restrictive routines, or no system for residents' money – a problem of culture, not one individual. |
The Care Act recognises further categories. Where the perpetrator is personally connected to the resident (for example a relative), this is domestic abuse, and may continue a pre-existing abusive relationship; modern slavery is also a Care Act category. Abuse may be perpetrated by staff, visitors, family members or other residents.
Source: NICE NG189 · Care Act 2014 statutory guidance
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