Most common narrative, N=16*
Very serious and long-term parent drug/alcohol use, mental health problems and domestic violence
Extensive contact with CSC child protection services, police and drugs and alcohol services
Siblings taken into care or died
Concerns about physical neglect and emotional abuse
GPs believed that circumstances had recently improved for the children and felt hopeful about capacity to parent in the future
But new stability was seen as fragile and optimism about future was cautious and uneasy
Perceived need for continued vigilance to spot relapses (further neglect/emotional abuse) and prevent poor child outcomes
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Second most common narrative, N=12*
Lack of boundaries for children; poor school attendance, missed medical appointments, concerns about nutrition and clothing
Families suffered from: unemployment; inadequate housing; poverty; parental alcohol use or mental health problems; and overwhelming physical health and behavioural problems
Concerns about neglect and emotional abuse
Accounts of intermittent and inadequate involvement from child protection services
Children described as ‘vulnerable’ and often as currently involved with CSC as a child in need
Problems experienced by GPs as overwhelming and frustrating
Worry about families ‘tipping over the edge’ at any moment
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Third most common narrative, N=9*
Concerns focused on possible physical or sexual abuse
Participants were very uncertain whether suspicions ‘amounted to anything or not’ and believed that physical or sexual abuse probably had not occurred
They described having just enough concern to take further action
In the context of this low level of concern, GPs described CSC response as unnecessarily heavy handed and punitive
After varying amounts of time (a few days to a year), participants reached the decision, usually in conjunction with CSC, that the child was not likely to have been physically or sexually abused. In the four cases of injured children, participants described on-going concerns about parental supervision (i.e.,neglect)
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Least common narrative, N=3*
These narratives were characterised by concerns about maltreatment described as ‘obvious’ or ‘barn door’ with a high level of suspicion from participants and decisive referrals to CSC or secondary healthcare
Narratives were characterised by participants believing that referral to social care or other agencies would result in appropriate and timely services
These cases were only mentioned in passing and usually as a contrast to one of the other family types, about whom participants talked in detail and at length
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