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Medina Johnson is the Chief Executive of IRISi, and Gene Feder is a Professor of Primary Care at Bristol University Medical School. They provided this blog for us as part of our 16 Days campaign around the Health response to domestic abuse.

Not a seasonal carol but all together now:

There’s a hole in our training dear tutors, dear tutors,

There’s a hole in our training, dear tutors, a hole.

With what shall we fix it trainee medics, trainee medics?

With what shall we fix it, trainee medics, with what?

(and here’s the bit that doesn’t scan!)

With training, a simple care pathway and direct referral to a specialist advocate,

With training, a simple care pathway and direct referral to a specialist advocate,

With that!

Ever get the feeling we’ve been here before?

For years our medical school curricula have chosen to exclude training on DVA (domestic violence and abuse) and for years health care professionals have been missing thousands of patients with experience of DVA.  This is not a statement of blame but one of fact. None of us, whatever the discussion or wherever we work, want to begin a conversation with someone if, through our lack of skills, training, experience and onward support, we can’t deal with where it will lead us and may leave our conversation partner feeling worse than they did before the conversation had started. This is a dilemma we hear regularly from health care professionals who have a suspicion, a clinical inkling, that they are seeing patients who they are concerned are experiencing current DVA or the effects of historic DVA, don’t know how to ask them about this, don’t know what to do with what they are told and don’t know what to offer next.

Our first call to action is to invite all medical, dental, nursing, midwifery, physiotherapy and occupational therapy courses to review their curricula and ensure that teaching on DVA is integrated into epidemiology, history taking, diagnosis and treatment of patients. In a recent study of UK medical schools, of the 25 that responded, 21 had some teaching of DVA in the curriculum, but 11 had two hours or less in the five year course.

Our second call to action is to commissioners within Clinical Commissioning Groups, Public Health teams, Health Boards, Local Authorities, Police and Crime Commissions and wider. Why wouldn’t you want to fund a local programme of training, where clinicians are taught to ask, respond, refer and record, coupled with a clear referral pathway?

Standalone DVA training for health staff, which does not have a robust evidence base, doesn’t work. The IRIS model does. We know that sounds a bit simplistic, but the whole reason we developed the IRIS model is because training on its own generally doesn't shift what clinicians do. The reason IRIS is successful is because training is tightly integrated with a referral pathway and ongoing support to practices. Each locally commissioned programme is delivered by a strong partnership between a local clinical lead and a specialist advocate educator usually based in specialist, third sector VAWG organisation.

In the seven years since IRIS became a commissionable model, over 800 general practices in England and Wales have become IRIS DV Aware Practices and over 8,000 women have been referred to their local IRIS AE.  We estimate that over a further 29,000 women will have had a discussion about DVA with their primary health care clinician, will have received signposting information and will know that there is support available if they need it and when the time is right for them.

The IRIS model has now extended to sexual health services and we are working on projects exploring this approach in pharmacy and dentistry.

For more information, please email us: info@irisi.org or see www.irisi.org