Escalation routes, safeguarding leads and professional challenge

Receptionists and care navigators must know how to raise adult safeguarding concerns during working hours, out of hours and when the usual manager is not available.

Escalation should be clear

Safeguarding concerns must not rely on one person's confidence or whether the named lead is present. Practices should have visible escalation routes, named deputies and a clear process for urgent situations.

Escalating a concern is not an accusation. It ensures the issue is reviewed by someone with the responsibility and access to further information.

Escalation may involve

• The practice safeguarding lead or deputy for advice, review and onward safeguarding decisions.
• The duty GP, clinician or practice manager when there are clinical, access, record or immediate safety implications.
• Local authority adult safeguarding routes where the concern may meet local thresholds or requires external assessment.
• Police, ambulance or emergency services when danger is immediate or a crime is in progress.
• Information governance or records support when proxy access, online access or record visibility could create risk.

Professional challenge

If a concern is minimised and you still think the adult may be at risk, keep the concern visible. Use the practice escalation route, ask who will take the next action, and record who you spoke to and what was agreed.

Challenge should be respectful and factual. Rather than arguing "this is definitely abuse", describe the specific risk signs: the patient sounded frightened, a third party controlled the call, safe contact was requested, or records show repeated missed care.

If you remain worried after raising a concern, professional challenge means respectfully keeping the risk visible until someone takes responsibility.

Disagreement resolution