As a minimum requirement the normal patient registration arrangements should be followed when the person registering is a child. However, there are circumstances that practices should be aware of, in relation to safeguarding guidance.

The legal definition of a child is 0 to 18 years of age; however young people may be able to make independent decisions from as young as 12, depending on the circumstances. Section 11 of the Children Act 2004 places a statutory duty on the NHS to safeguard and promote the welfare of children. The Victoria Climbie Enquiry Report 2003 (9.104) stresses the importance of GP registration for every child. It sets out the importance of knowing the identity of those registering the child and their relationship to that child.

If a child under 16 attempts to register alone or with an adult that does not have parental responsibility, the Practice Child Safeguarding Lead should be alerted.

For purposes of safeguarding children, the following should be considered whilst recognising that patients must still be registered in the absence of documentation and policies must be applied in a non- discriminatory manner.

The practice should seek assurance through:

• Proof of identity and address for every child, supported by official documentation such as a birth certificate, (This helps to identify children who may have been trafficked or who are privately fostered.)
• An adult with parental responsibility should normally be registered at the practice with the child . The ID of the adult is useful as it can be matched to the birth certificate details. However, the practice should not refuse to register a child if there is no-one with parental responsibility who can register, as it is generally safer to register first and then seek advice from the Safeguarding Practice Lead, Health Visitor or Practice Manager. (This situation may alert you to a private fostering arrangement which constitutes a safeguarding concern).
• Offering each child a new patient registration health check as soon as possible after registration
• Seeking collaborative information (supported by official documentation) relating to:
• Current carers and relationship to the child
• Previous GP registration history
• Whether the child is registered with a school and previous education history
• Previous contact with other professionals such as health visitors and social workers
• Children who have been temporarily registered with the practice should be reviewed regularly and proceed to permanent registration as soon as possible and ideally within three months of initial registration. Likely length of stay should be determined at initial registration and patient registered as temp/permanent as appropriate.
• Children of parents or carers, who have been removed from the list for any reason, must not be left without access to primary care services.
• Where parents or carers have been removed from the list due to aggressive and or violent behaviour a risk assessment should be completed to identify any risk to their children and the appropriate referrals made.

Practices should be alert to potential risks such as those described above when young people aged between 16-18 years of age register alone and dealt with in line with practice safeguarding procedures and escalated outside of the practice through the local procedures if appropriate.