What are the rules for GPs around FGM?
Dr Helen Salisbury and Dr Sharon Dixon clarify what you need to know
In October, the requirements for reporting female genital mutilation (FGM) changed: now GPs must report any incidences of FGM in under 18s to the police, as well as collect data on cases of FGM in women of all ages. These are separate requirements and require different actions from GPs. Here are the rules as they stand and what you have to do to follow them.
What is the law in the UK on FGM?
Under UK law (FGM Act 2003) it is an offence to perform, arrange or assist any girl or woman to have FGM in the UK, or to arrange for it to happen abroad to a UK national or someone normally resident here. Under the Serious Crime Act 2015 it is also an offence not to protect a girl under the age of 16 from having FGM performed.
The potential penalty for a conviction under the FGM Act is 14 years in prison, a fine or both.
What do I have to report?
From 31 October this year, it has been mandatory for all GPs (and other health and social care professionals) in England and Wales to directly report cases of FGM to the police if a girl under 18 informs them she has had FGM, or they observe physical signs which suggest that FGM has been carried out. This referral to the police needs to be made personally and promptly, and you should also follow local safeguarding procedures. If the possibility of FGM in a girl aged under 18 is raised in a different way (for example, disclosure from a friend, sibling or parent) the police do not need to be informed but an urgent safeguarding referral must be made.
What data do I have to collect?
Also from October 2015, GP practices must collect data for the FGM Enhanced Dataset. You have to submit data returns on all cases of FGM to the HSCIC (through a clinical audit platform), wherever and whenever it happened, and however the case is identified. The information required includes name, date of birth, postcode and NHS number of all women and girls with FGM. The stated aim of this dataset is to understand the extent of FGM in the UK, to estimate needs and plan services. This information will be anonymised by the HSCIC and the guidance states that it will not be passed to anyone outside the HSCIC, including police or social services. The Department of Health advises us that consent is not needed, although under the data protection act we have a responsibility to inform our patients about what is happening to their data and how they can object if they are not happy with this (‘fair processing’). The DH provide a leaflet (available free in a number of languages and called ’more information about FGM’) and they suggest giving this to a woman fulfils fair processing requirements.
DH guidance suggests two options for women if they object to the submission of their data. An objection can be considered locally at the GP surgery, and the decision whether or not to submit data should be recorded in their notes. The second option allows the patient to write to the HSCIC after data submission to ask that her data be removed.
Concerns have been raised about the requirement to submit patient-identifiable information. These include the potentially damaging impact on patient trust and the worry that patients may, as a consequence, not access the care that they need. Opportunities for safeguarding could be missed if women choose not to discuss this difficult topic with their GP because of doubts about confidentiality.
It is a legal requirement to comply with the dataset and mandatory reporting procedures, and failure to do so could result in doctors being reported to the GMC and NHS England.
Dr Helen Salisbury is a GP and Communication Skills Course lead in Oxford.
Dr Sharon Dixon is a GP in Oxford and local FGM lead.