child protection; Briony Ladbury RGN, RM, HV, FP nurse, BA (Hons) Interprofessional Studies (Protecting Children), ENB Specialist Practitioner Child Protection is a designated nurse in child protection and child protection manager at Croydon PCT.

One year on, the report into the truly dreadful death of 8-year-old Victoria Climbie is finally beginning to have an impact. The conclusions reached in the Laming report that the child protection systems failed her spectacularly have been widely accepted.1 In the report he expresses dismay about the low priority that child protection assumed and amazement that, without exception, none of the professionals in any of the agencies involved had the "presence of mind" to follow what he described as "relatively straightforward procedures". The message running through the inquiry is that the systems to protect children developed over the last decade are basically sound, but the actual practice by those directly delivering services leaves a lot to be desired. Accountability and communication were also judged to be flawed. Lord Laming speaks of an "organisational malaise" with regard to protecting children that is so widespread that the responsibility for the death of Victoria needs to be shared evenly between senior managers, service managers and practitioners at field level.

The impact of the Laming inquiry The Laming Inquiry has made an impact on the way we practice, It was an important influence on the Government's green paper Every child matters that was published in September 2003.2 Health practitioners, largely those working in the acute hospital setting, were heavily criticised in the Victoria Climbie Inquiry, but it is also fair to say that the primary healthcare teams involved invited some criticism too, pinpointing an apparent lack of child-centred practice. Victoria's new patient assessment on initial registration with a GP surgery showed little evidence of the practice nurse engaging with Victoria and this invisibility was mirrored when the family changed their doctor. Unfortunately, the new practice registered Victoria without seeing her at all. Many of the longer-term health recommendations in the Laming Report, to be implemented in January 2005, allude to the development of child protection practice within the primary healthcare team. In short, practitioners working in primary healthcare teams will need to be proactive in exercising their child protection responsibilities, and performance monitoring of child protection practice will be undertaken more rigorously in the future.

Changing Cultures and Realities The pace of change in primary care has been unrelenting. A highly skilled workforce is needed to meet the increasing demands from the public and politicians. Primary care workers must feel that they are being asked to be masters of everything. Child protection is an area of …