• Sharon Dixon, Lisa Hinton, and Sue Ziebland.
• Nuffield Department of Primary Care Health Sciences, University of Oxford; GP partner, Donnington Medical Partnership, Oxford.
• Br J Gen Pract. 2020 Oct 1; 70 (699): e749-e756.

BackgroundFemale genital mutilation (FGM) includes all procedures that intentionally harm or alter female genitalia for non-medical reasons. In 2015, reporting duties were introduced, applicable to GPs working in England including a mandatory reporting duty and FGM Enhanced Dataset. Our patient and public involvement work identified the exploration of potential impacts of these duties as a research priority.AimTo explore the perspectives of GPs working in England on potential challenges and resource needs when supporting women and families affected by FGM.Design And SettingQualitative study with GPs working in English primary care.MethodSemi-structured interviews focused around a fictional scenario of managing FGM in primary care. The authors spoke to 17 GPs from five English cities, including those who saw women who have experienced FGM often, rarely, or never. Interviews were audio recorded and transcribed verbatim for thematic analysis. Lipsky's theory of street-level bureaucracy was drawn on to support analysis.ResultsManaging women with FGM was experienced as complex. Challenges included knowing how and when to speak about FGM, balancing care of women and their family's potential care and safeguarding needs, and managing the mandated reporting and recording requirements. GPs described strategies to manage these tensions that helped them balance maintaining patient-doctor relationships with reporting requirements. This was facilitated by access to FGM holistic services.ConclusionFGM reporting requirements complicate consultations. The potential consequences on trust between women affected by FGM and their GP are clear. The tensions that GPs experience in supporting women affected by FGM can be understood through the theoretical lens of street-level bureaucracy. This is likely to be relevant to other areas of proposed mandated reporting.© British Journal of General Practice 2020.

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