A newly appointed practice nurse starts her first week at a GP surgery. Her manager tells her to complete Level 3 safeguarding training before her probation review. She searches online, finds conflicting information about what Level 3 means, whether e-learning counts, and which document to follow. Three hours later, she still does not know if she is looking at the right framework.
This confusion is common across the NHS. Two separate intercollegiate safeguarding frameworks exist, one for adults and one for children and young people. Both use the same five-level structure, but they apply to different staff groups, different competencies, and different regulatory contexts.
Both frameworks were updated recently. The adults document was revised in July 2024. The children’s framework was published in its 5th edition in autumn 2025. Most online content still references documents that are now out of date. This guide explains both frameworks clearly, maps every level to real staff groups, and gives you practical guidance to identify your level, evidence your competency, and stay compliant.
The NHS Intercollegiate Safeguarding Framework is a set of nationally agreed competency standards defining what every healthcare worker must know about safeguarding, based on their role. The word “intercollegiate” means the framework is produced jointly by multiple royal colleges and professional bodies working together.
These include the Royal College of Nursing (RCN), the Royal College of Paediatrics and Child Health (RCPCH), the Royal College of General Practitioners (RCGP), the Royal College of Physicians, the Faculty of Forensic and Legal Medicine (FFLM), and more than a dozen other organisations.
Two separate documents make up the framework:
Document 1: Adult Safeguarding: Roles and Competencies for Health Care Staff Published by the RCN, 2nd edition, July 2024. Covers all adults aged 18 and over.
Document 2: Safeguarding Children and Young People and Children and Young People in Care: Competencies for Health Care Staff Published by the RCPCH, 5th edition, autumn 2025. Covers everyone under 18. This edition merges the previous 2019 children’s safeguarding document and the 2020 Looked After Children document into one framework.
Each document sets out five competency levels plus a separate board level for executives and non-executives. The levels run from Level 1 (all staff) to Level 5 (designated professionals with strategic system-wide responsibility).
The framework does not define a single training course. It defines the minimum knowledge, skills, and attitudes every member of staff must demonstrate, based on who they work with and what their role requires.
Before a nationally agreed framework existed, safeguarding training varied widely between NHS organisations. Different trusts set different standards, different formats, and different expectations. That inconsistency created real risk. Patients in some settings received better protection than those in others, depending on where they were treated.
The framework standardises the minimum competency expected at every role across every NHS setting, from a hospital porter to a designated doctor at an Integrated Care Board (ICB).
CQC Regulation 13 sets the fundamental standard for safeguarding in health and social care. The intercollegiate framework gives organisations and individual practitioners the practical tools to meet that standard.
The NHS Safeguarding Accountability and Assurance Framework (SAAF), now in its 5th edition (April 2026) and signed off by the Chief Nursing Officer for England, Duncan Burton, sets the governance structure for safeguarding across the NHS. The intercollegiate framework sits within that structure as the agreed professional competency standard. These are two distinct documents serving different functions.
NHS Standard Contract Schedule 32 requires all providers of NHS-funded services to ensure their staff meet the intercollegiate competencies. Failure to comply carries direct consequences: CQC inspection findings, revalidation gaps for registered professionals, and organisational liability when a safeguarding failure occurs.
The intercollegiate framework is professional guidance, not statute. That distinction matters. Being professional guidance does not make the framework optional. It gains its force through multiple routes, and every NHS staff member is expected to comply.
Here is the distinction clearly set out:
| Category | Examples |
|---|---|
| Law (statute) | Children Act 1989, Children Act 2004, Care Act 2014, Health and Care Act 2022 |
| Statutory guidance | Working Together to Safeguard Children 2023 |
| Professional guidance | The intercollegiate safeguarding documents |
These are not interchangeable terms. A law must be followed without exception. Statutory guidance must be followed unless there is a clear reason not to. Professional guidance sets the expected standard for competent practice.
The 2025 children’s ICD states directly that the guidance is not statutory, and that health care providers are responsible for ensuring training is appropriate for their staff and the patients they serve.
Working Together to Safeguard Children 2023 requires NHS providers to ensure staff achieve the intercollegiate competencies. That requirement gives the framework indirect statutory weight in children’s safeguarding contexts.
The framework is not the only safeguarding compliance requirement. Prevent training, Mental Capacity Act competencies, and Disclosure and Barring Service (DBS) checks sit alongside it, each with their own separate obligations.
Both frameworks share the same level structure: five levels plus a board level. Despite sharing this structure, the two documents are produced by different organisations, cover different populations, and map different staff groups to each level.
The shared structure looks like this:
Your level is set by your role and your contact with patients, not your seniority or job title alone. A consultant surgeon and a hospital receptionist work in the same building. They hold different levels because they have different safeguarding responsibilities, not different ranks.
Here is a full breakdown of every level:
Level 1 applies to every person working in a health setting, whether clinical or not. This is the absolute minimum for all NHS staff.
Receptionists, porters, domestic staff, caterers, maintenance workers, transport staff, administrative staff, community pharmacy counter staff, peer support workers, board-level executives and non-executives.
Recognise potential indicators of abuse, harm, and neglect. Know who to contact and what to do if you have concerns. Understand local policies and procedures. Know how to escalate if action is not taken.
Level 2 applies to staff with regular contact with patients, their families, or the public, including those who do not deliver direct clinical care.
Pharmacists, audiologists, optometrists, nursing associates, dentists, dental care professionals, phlebotomists, 111/999 communications centre staff, ambulance staff (non-paramedic roles), healthcare students, GP practice managers, safeguarding team administrators, and staff working in virtual or online health settings.
Everything at Level 1, plus a deeper understanding of abuse types and indicators, how to document and escalate concerns, understanding of mental capacity legislation, how to refer to social care, and how to support patients who face barriers to engagement such as coercive control or communication needs.
Level 3 is required by all registered clinical staff who assess, plan, intervene, or evaluate the needs of patients where safeguarding concerns exist.
GPs, registered nurses, midwives, paramedics, health visitors, school nurses, care home managers, pharmacists with a lead role in adult protection, psychologists, sexual health staff, adult learning disability practitioners, substance misuse practitioners, urgent and unscheduled care staff, and mental health practitioners working with adults where significant risk to children exists.
All Level 1 and 2 competencies, plus the ability to conduct safeguarding enquiries, contribute to multi-agency assessments, undertake capacity assessments where appropriate, apply forensic awareness relevant to the role, contribute to case reviews and serious incident processes, provide clinical supervision, and lead or participate in peer review.
The RCGP 2024 safeguarding standards confirm that all GPs, practice nurses, and clinical staff in general practice operate at Level 3. GP practice safeguarding leads remain at Level 3. Named GPs for safeguarding across a primary care area are Level 4.
Level 4 applies to named professionals in NHS provider organisations. These are specialist safeguarding roles with internal leadership and advisory responsibilities.
Under the children's framework: Named doctors, named nurses, named midwives (in organisations providing maternity services), named health professionals in ambulance organisations, named GP for safeguarding.
Under the adult framework: Lead doctors, heads of adult safeguarding, named GPs for organisations commissioning primary care.
All preceding level competencies, plus: leading training needs analysis, commissioning and delivering safeguarding training, undertaking and contributing to case reviews, providing specialist advice to colleagues and the board, leading safeguarding quality assurance processes, and supporting internal investigations.
Level 5 applies to designated professionals. These are strategic, system-wide roles working for or on behalf of Integrated Care Boards (ICBs).
Designated doctors for safeguarding children, designated nurses for safeguarding children, designated professionals for children in care, and designated professionals for adult safeguarding.
All preceding level competencies, plus: strategic leadership across the whole health community, leading the health contribution to child safeguarding practice reviews and safeguarding adult reviews, providing expert advice to ICB boards and commissioners, overseeing safeguarding quality assurance across all commissioned providers, and leading multi-agency safeguarding networks.
Board level applies to NHS trust chairs, chief executives, executive and non-executive directors, and commissioning body directors, including those in independent and voluntary sector providers.
Level 1 competencies plus specific board-level knowledge covering statutory safeguarding duties, partnership arrangements with local authorities and the police, governance and accountability structures, performance indicators, regulatory expectations from CQC, and an understanding of gross negligence as it relates to organisational safeguarding.
Minimum 2 hours over 3 years, delivered as a tailored package combining Level 1 content with board-specific material. A generic e-learning module alone does not cover the board-level requirements.
Named and designated professionals are two distinct roles with different employers, different responsibilities, and different positions within the NHS structure. Confusing the two is one of the most common errors in online safeguarding content and in some organisational policies.
Named professionals work within NHS provider organisations, such as acute trusts, community trusts, and mental health trusts. Their role is internal. They promote good safeguarding practice within their organisation, advise clinical colleagues, ensure training is in place, and contribute to quality assurance processes. They report to the medical director, nurse director, or board lead with primary responsibility for safeguarding. Named professionals must have an enhanced DBS check, as their posts constitute regulated activity.
Designated professionals work for or on behalf of ICBs. Their role is strategic and system-wide. They provide expert advice to ICB commissioners, health and wellbeing boards, local safeguarding partnerships, and NHS England. They lead the health contribution to child safeguarding practice reviews and safeguarding adult reviews. They oversee safeguarding quality across all providers commissioned within their area.
Designated professionals should have direct access to the ICB Accountable Officer or chief nurse. The ICB Accountable Officer should meet regularly with designated professionals to review safeguarding across the local health economy.
Here’s a quick look:
Your level is determined by three factors: who you work with, what your clinical or leadership responsibilities are, and whether your role involves assessing, planning, or intervening in safeguarding concerns.
Use this step-by-step decision flow to identify your level:
Your employer is responsible for confirming your required level through a Training Needs Analysis (TNA), linked to your job description and annual appraisal. You record your training on the Electronic Staff Record (ESR). Training records are portable and transfer between NHS organisations throughout your career.
Completing a training course gives you a certificate. Evidencing safeguarding competency is a broader process. CQC inspectors do not check certificates alone. They ask staff to demonstrate their understanding of abuse indicators, reporting procedures, and local safeguarding processes.
Competency is evidenced through a combination of the following:
Log all safeguarding learning on ESR, including e-learning completions, face-to-face sessions, webinars, conferences, and reflective case discussions. Records made on ESR transfer with you throughout your NHS career. This is your training passport.
At Level 3 and above, maintain a personal learning log. This records what you have learned, how your learning has changed your practice, and the hours accumulated. The NHSE SW framework provides template logs for this purpose.
Levels 3, 4, and 5 must discuss safeguarding competency at every annual appraisal. For Level 4 and 5 roles with defined clinical responsibilities, for example child protection medical assessments or initial health assessments for children in care, appraisal should include peer review.
Every revalidation cycle (3 to 5 years) must explicitly consider safeguarding competency, including multi-agency working experience, reflective practice, and clinical skills relevant to the role.
GPs demonstrate competency through GMC revalidation, increasingly through structured reflective learning templates rather than hours alone, following the RCGP 2024 shift to a reflection-based model. Nurses and midwives evidence competency through NMC revalidation requirements.
Under CQC’s Single Assessment Framework, the “Safe” and “Effective” key questions both examine whether staff are trained, competent, and able to demonstrate their safeguarding knowledge in practice.
Most content about NHS safeguarding levels online is out of date. If a page still references the 2019 children’s intercollegiate document or the 2018 adult document as current, the information no longer accurately reflects the framework.
Here is a summary of every major update:
The RCN published an updated 2nd edition of Adult Safeguarding: Roles and Competencies for Health Care Staff. This supersedes the first edition from August 2018. The competency structure and training hours remain similar, but the document reflects updated legislation including the Health and Care Act 2022, current governance changes, and updated practice expectations.
This is the most significant change to the framework in years. The RCPCH published the 5th edition on a dedicated website at child-health-safeguarding.rcpch.ac.uk. The 5th edition:
The 2020 Looked After Children document is now archived and replaced.
The RCGP published dedicated safeguarding standards for all GP practice staff, covering Levels 1 to 3 as a single whole-life document incorporating both adult and child safeguarding. A dedicated Safeguarding Hub and Toolkit launched alongside the standards, with three core e-learning modules. Training requirements for GPs now focus on reflection and structured learning rather than hours completed alone.
The NHS Safeguarding Accountability and Assurance Framework was updated to its 5th edition, signed off by the Chief Nursing Officer for England. This is the governance framework that sits above the intercollegiate documents and sets accountability structures for ICBs and providers.
Your safeguarding level is determined by your role. Use the decision flow in this guide to identify where you sit. Then use the correct document for your area of practice: the RCN 2024 adult framework for roles working with adults, and the RCPCH 2025 children’s ICD for roles involving children and young people. Staff working across both age groups need to evidence competency in both.
Free e-learning for Levels 1 to 3 is available for both adults and children’s safeguarding through e-Learning for Healthcare (e-LfH) at e-lfh.org.uk. NHS staff access this via ESR. Non-NHS staff in commissioned organisations access it via OpenAthens.
The full 2025 children’s ICD is hosted at child-health-safeguarding.rcpch.ac.uk. The 2024 adult document is available on the RCN website at rcn.org.uk. The RCGP safeguarding standards for general practice are at rcgp.org.uk.
If you work in GP practice, the RCGP Safeguarding Hub and Toolkit launched in October 2024 provides three core e-learning modules and structured reflective learning templates covering both adult and child safeguarding for all practice roles at Levels 1 to 3.
A: Yes. Level 1 applies to every person working in a health setting, including non-clinical staff such as receptionists, porters, domestic staff, and administrators. There are no exceptions within the framework. Your employer is responsible for ensuring you complete the appropriate level of training for your role.
A: Completing Level 3 subsumes Levels 1 and 2. You do not need to complete separate refresher training at the lower levels. The same principle applies throughout the framework: a higher level always covers the competencies of all preceding levels.
A: These are two separate documents produced by different organisations. The adult framework is published by the RCN and covers adults aged 18 and over. The children's framework is published by the RCPCH and covers everyone under 18. They share the same five-level structure but have different staff group mappings and different competency content.
A: All staff should refresh every three years as a minimum. At Level 3 and above, you should also evidence safeguarding learning annually through your appraisal. Levels 4 and 5 must review competency at every revalidation cycle, which runs every 3 to 5 years.
A: E-learning counts at Levels 1 and 2. At Level 3 and above, e-learning counts as preparation or supplementary learning, but at least 50 percent of your training time must be participatory. That means face-to-face training, multi-agency sessions, group case discussions, or supervised reflective practice.
A: GPs operate at Level 3 under the RCGP 2024 safeguarding standards, which cover both adult and child safeguarding in a single document. GP practice safeguarding leads also remain at Level 3. Named GPs for safeguarding across a commissioned primary care area are Level 4 and need to follow the separate intercollegiate documents for that role.
A: Named professionals work within NHS provider trusts and hold internal, organisation-level safeguarding leadership roles at Level 4. Designated professionals work for or on behalf of ICBs and hold strategic, system-wide safeguarding leadership roles at Level 5. They have different employers, different scopes, and different reporting lines.
A: NHS staff record safeguarding training on the Electronic Staff Record (ESR). Records made on ESR transfer with you throughout your NHS career. At Level 3 and above, you should also maintain a personal education, training, and learning log to support your annual appraisal and revalidation evidence.
A: Yes. The adult document was updated to a 2nd edition in July 2024. The children's framework was published as its 5th edition in autumn 2025, incorporating looked after children competencies for the first time in a merged document. Any content referencing the 2018 adult document or 2019 children's ICD as current is now out of date.
A: Yes. NHS Standard Contract Schedule 32 requires all organisations providing NHS-funded services, including independent providers and voluntary sector organisations, to ensure their staff meet the intercollegiate competency standards. Operating outside the direct NHS structure does not exempt an organisation or its staff from compliance.
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