Background: Recent high-profile medico-legal cases such as the death of Victoria Climbie and the subsequent Laming report have highlighted widespread deficiencies in child protection practice. Junior doctors are the frontline staff regularly facing issues with potentially major legal implications, including child protection, Gillick competence, consent, and professional responsibility/accountability. It is therefore important for them to be aware and understand the Children Act, common medico-legal principles and practices, particularly in the current, increasingly litigious climate.
Aims: (1) To determine junior medical staff's knowledge of legal issues involved in child protection and common basic legal situations, and (2) to assess whether experience and training improved this knowledge.
Methods: A standardized structured interview was developed exploring common issues with important legal implications for paediatric practice. It focused on: legal issues in child protection, the Children Act, awareness of the General Medical Council (GMC), principles of professional responsibility/accountability, the Bolam principle for good medical practice and Gillick competence. Basic demographic data were recorded. We attempted to contact all 180 paediatric junior medical staff in Wales by telephone.
Results: Interviews were conducted with 119/180 (66%) doctors: 46/56 specialist registrars (SpRs; 82%) and 73/124 senior house officers (SHOs; 59%). SpRs scored a median of 6.5 correct responses from a possible of 12 (range 3-11), compared with a median of 5 (range 1-11) by the SHOs (P < 0.0001; Mann-Whitney test). A third of SHOs and a fifth of SpRs were unaware that the GMC was the organization responsible for good medical practice in the UK. Similarly, a fifth of all juniors were ignorant of the legal age for consent. Approximately two-thirds of the SHOs and half of the SpRs were ignorant that the police and social services have the legal power to protect the child in child protection cases. Alarmingly, none of the SHOs and only 11% of the SpRs were aware of the Bolam principle. SpRs scored significantly higher on topics of Gillick competence, legal right to see medical notes, consent, Children Act, burden of proof in civil and criminal court, and on Bolam principle. They also had received training more frequently than SHOs, which, when combined with their greater experience, probably explains these statistically significant differences.
Conclusion: Few junior staff have adequate knowledge of the basic legal principles and practice as they relate to children. Widespread deficiencies concerning the understanding of the Children Act and child protection powers exist.