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Your story matters; let us listen

In this blog, two members of our Whole Lives Scotland team, Jen and Lindsay, explain why it is so important we hear from survivors across Scotland to inform our work. 

Have you experienced domestic abuse in Scotland? Your story matters; let us listen.

Scotland has much to be proud of when we talk about how we support survivors of domestic abuse. There is gold standard legislation that recognises the whole family impact of abuse, backed up with an informed and proactive police force. We have a network of passionate and skilled Women’s Aid and other domestic abuse specialists’ organisations providing first class support and practice, as well as ground-breaking research. But we can always do better. And it’s that desire from everyone working in domestic abuse, from policy to practice, to improve how we support survivors despite the immense challenges in trying times that makes Scotland special. And we can’t do that without listening. To partners and organisations, but most importantly, to survivors.

“I never went to the police, never went to the hospital.  I thought ‘I need to deal with this, I need to deal with this, I need to deal with this’. And although I knew who to access. I couldn’t do it.”

In 2018, SafeLives was awarded funding from the National Lottery Community Fund, enabling us to work with four local authorities in Scotland to help them look at what’s working in the area for victims of domestic abuse, and what could be better.

Here at SafeLives, we don’t carry out any frontline work. We use data and evidence to transform system wide responses to abuse, supporting practitioners and ensuring the voice of those with lived experience is at the heart of everything we do. For this project we’ve been speaking to practitioners and looking at statistics, reading strategy and policy and hearing first-hand from workers what is helping and what could be done better. We are also consulting with people who have lived experience, exploring this in workshops and focus groups. Some of them are carrying on this work with us in co-production groups, looking at our findings and the tools and resources we plan to offer each area in response, and helping us understand if we’ve got the right idea.

Hearing about someone’s experience of support is incredibly important. But what is equally necessary is to understand what happened for those who didn’t or couldn’t get help. We don’t think that people are hard to reach, we believe that for some it’s the systems that make it hard. 

In order to make sure we hear all voices; we’re running a national survivor survey across Scotland from the 15th of October for anyone who has experienced domestic abuse. It is completely confidential and will be used to build a picture for Scotland and directly inform what we do.

We’re asking – what did you need in those moments that wasn’t there? What made a difference to you? How can we make sure that those who need help get the right help at the right time?

“They were so supportive.  They had obviously seen all different areas of abuse, so they, I didn’t have to over explain myself. They got me.”

Complete our survivor survey

Find out more about our Whole Lives Scotland work 

 

 

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The importance of specialist mental health interventions for children experiencing domestic abuse

Janina Engler-Williams is a Research Analyst at SafeLives. In this blog she explores our Children's Insights dataset, and what the data shows about the benefits of specialist mental health support

The link between mental health and domestic abuse is one that is both crucial and complicated. As highlighted in our seventh spotlight, domestic abuse often has a long lasting and damaging effect on the mental health of survivors. Anybody can be affected by abuse – just like anybody can experience mental health issues – and as a result, providing mental health support to survivors of domestic abuse requires interventions which take into account their unique and specific circumstances.

This is particularly true of children and young people experiencing abuse at home. Recognising the negative effects exposure to abuse can have on the mental health of young people is vital to understanding how best to respond to the whole family. We recently published our Insights children and young people national dataset, drawn from specialist children’s domestic abuse services across the UK supporting survivors below the age of 18.

One of the most striking insights from our data was that a third of children and young people who had been exposed to abuse in their household were suffering from mental health issues. For children being subjected to direct abuse at home, the proportion was even higher, with caseworkers identifying that two in four children accessing support had mental health issues.

Notably, the figures for children and young people experiencing mental health issues as a result of abuse are similar to those in the adult dataset, an important indicator that we need to be taking the mental health of survivors under 18 just as seriously as adult survivors. However, it is also important to highlight how mental health issues can look different for young survivors, in order for services to fully understand how to tailor mental health support specifically to them.  

A good example of this is making the link between domestic abuse, negative behaviour and mental health. Case workers found that almost half of the children in our dataset said that they had self-esteem issues and low confidence upon accessing support. A third of young people were also demonstrating risk taking behaviour, and two in three boys in our dataset were displaying destructive coping mechanisms. Shockingly, case workers found that one in five children also felt a sense of blame or responsibility for the abuse they were witnessing.

We know from our Insights dataset that when mental health interventions that are specifically tailored to the needs of children and young people are implemented, the results are overwhelmingly positive. In particular, interventions that address the whole family as well as the living and learning environment of the child are central to providing effective mental health support. This could include delivering joint parent and child support sessions, and ensuring mental health interventions are delivered alongside interventions that focus on family relationships.

Our data revealed that almost all children and young people who received 1-2-1 support sessions as part of mental health support, reported an improvement in their wellbeing directly as a result of this. Almost all the children in our dataset who were supported to access some form of counselling felt less of a sense of blame afterwards. Four in five children were demonstrating healthier coping mechanisms after specialist support and three quarters felt happier in their living and learning environment after mental health interventions.  

Children and young people are dealing with a myriad of complicated social and emotional pressures in the classroom, playground and at home every day. Understandably, these factors alone have an impact on young people’s mental health. However, what our latest dataset reveals is that children and young people living in an environment where they are constantly scared and exposed to abuse face additional vulnerabilities to their mental health which need to be taken into account. The mental health needs of young survivors cannot be tackled in isolation, and our children and young people’s dataset gives us an important insight into how interventions which include family, friends and the learning environment of children are crucial to giving young people the support they need to tackle their mental health challenges and move forward to live a happier healthier life. 

The difference data can make

Emma Retter, Research Analyst at SafeLives, looks at how the collection of data can provide the vital support survivors need. 

The UK definition of domestic abuse is “any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality. The abuse can encompass, but is not limited to psychological, physical, sexual, financial, emotional.” It includes coercive control, which is an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.

Each year an estimated 2 million adults in England and Wales experience some form of domestic abuse – 1.3 million female victims/survivors and 695,000 male victims/survivors.[1] These figures are likely to be an underestimate, because all types of domestic violence and abuse are under reported in health and social research, to the police and to other services.

Data collection, therefore, is not simply a numbers game when it comes to domestic abuse. When it is collected by health staff in a consistent, effective and clear way, it creates a story. This story becomes a narrative that informs us about a community and can provide answers to what support is needed for the survivors of domestic abuse in that community. Without data, we have little evidence to show the excellent work being done in many areas of health for survivors. We also have little evidence to make a case for the extra work, extra funding and extra services that are needed for those survivors that are falling through the gaps in support. And as we know, health services have a key role in finding these gaps. This blog will look at why the collection of data can provide the vital support survivors need and give a few examples of what the most effective data is to collect within a health setting.

Health Data and ‘Hidden’ Victims

Survivors of domestic abuse do not always telephone the police for help. The latest Crime Survey for England and Wales, released in November 2018, informed us that only around one in six survivors told the police about the abuse they were suffering.[2] We know that the police refer two thirds of all survivors to Marac[3]. So how do we find and provide support to the other survivors out there? How do we understand their story and the specific support that they need? And how do we know if there are services there to support them?

SafeLives have produced a series of Spotlights[4] which brings together insight from survivors, practitioners, academics and other experts, alongside our own data and focuses on these groups of victims who may be 'hidden' from services or face additional barriers to accessing support. The first spotlight focuses on older people and domestic abuse. SafeLives found that older victims experience abuse for twice as long before seeking help as those aged under 61 and nearly half have a disability. It was also found that older clients are hugely underrepresented among domestic abuse services.[5] If a patient discloses domestic abuse to a health setting, simply capturing their age can make all the difference to the local and national picture. It is usually younger women and children who are shown in campaigns around domestic abuse.  Older people can sometimes be forgotten about. But, if your health practice captures the age of a survivor of abuse and begin to see a pattern emerging of domestic abuse in an older generation, this can lead to the older survivors having more targeted specific support. Domestic abuse workers, such as a Health Independent Domestic Violence Advisor (Idva) in the hospital, or an Iris Advocate Educator in the GP, can use this data to ensure their service is fully accessible to older victims. If there is no domestic abuse worker in the health setting, this information can be incredibly important to show that support within a health setting can reach these older survivors of domestic abuse. Commissioners can use this data to come to an informed decision about where money and funding should be placed.

SafeLives Cry for Health[6] report gave a wealth of evidence to show that health settings are able to reach a different profile of people than community-based services. As one Senior hospital Idva stated:

“I think we are meeting people who are hidden from society”

Health services are key to capturing individuals who are sometimes cut off from society. When these individuals access a health service and are asked about domestic abuse, a disclosure and referral to the right support can be life changing. However, the picture that can be drawn from understanding a little more about each patient who discloses abuse can be life changing for a community. A few examples of the eight spotlights include: Disabled people, Young People, ‘Honour’ based violence and forced marriage and LGBT+.

What Data to Collect?

There is no universal best way to collect data. What is important is that data is collected is confidential. Any notes made regarding the abuse must not be accessible anyone outside of the patients health care as this can put an individual at serious risk of harm.  

How a health setting collects data will change with the health setting, the area and the systems that are in place in the service. However, there are a few key questions that can really make a difference to the provision of domestic abuse support to an individual and in a community:

Action Taken

Information as to where the patient has been referred to and action taken by health professionals is important to record for the patient’s safety. If a referral to a multi-agency setting or a specialist service is made, it is important that the health setting has confirmation that the referral has been accepted.  Making a note of who you are referring patient’s to also highlights links between specialist services and health settings. This can lead to joined up working between health settings and specialist services which can further the support and safety of patients and staff alike.

Demographics

The gender, age, sexual orientation and ethnicity of a patient is important to capture. These demographics can have an impact on how a patient feels regarding access to support and the specific support they need. A male survivor of domestic abuse may have very different needs to a female survivor. A 16-year-old survivor may have very different needs to a 45-year-old survivor. A Black or ‘Minority Ethnic’ (BME) survivor of abuse may have different needs to that of a non BME survivor. It is important all survivors of abuse receive the support specific to them. Without knowing the demographics of survivors of abuse, we are unable to provide the right support. By collecting this demographic data and piecing together who the clients are that are approaching health for support, the right support at the right time can be put in place for all survivors of abuse. 

Children

The presence of children in the household or soon to be in the household is important, not only to ensure that children can receive support but for safeguarding purposes.

Relationship to Perpetrator        

Does the patient live with the perpetrator? Is the perpetrator the patient’s carer? Are there multiple perpetrators? These questions are important for the safety of the survivor. It is also important in relation to the support given. A patient facing violence from their son or daughter may need very different support to someone being stalked by their ex-partner.

Is there a risk of Forced Marriage or ‘Honour’ Based Violence?

In order for the specific support that survivors need in relation to forced marriage and ‘honour’ based violence, it is vital that this information is collected.

Pathfinder Good Practice

Practice in terms of data collection around domestic abuse has differed in all of the Pathfinder sites. No two sites or teams have been the same! We thought we’d use one example here of a Safeguarding team at one of the sites.

The safeguarding team currently uses a simple excel spreadsheet to track the demographics of patients who are victims of abuse, which departments the patients are being referred from, notes on the disclosure by the patient and finally, the actions of the hospital. This simple excel spreadsheet not only shows the support the client needs and the actions of the staff, but it also allows the Safeguarding team to see where referrals are coming from and, more importantly, which departments are not referring domestic abuse and so may need some more training!

We all know and understand how busy health professionals are. However, recording a few simple details on an excel spreadsheet each time a disclosure relating to domestic abuse takes place can really make the difference to patients in health settings and may lead to lives being saved.

Back to hospital Pathfinder profile.


[1] Home Office (2019), The economic and social cost of domestic abuse

[2] Domestic abuse: findings from the Crime Survey for England and Wales - Appendix tables, Appendix Table 25:  Why the victim did not tell the police about the partner abuse experienced in the last year, year ending March 2018 CSEW1, November 2018 https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/datasets/domesticabusefindingsfromthecrimesurveyforenglandandwalesappendixtables

[3] Latest Marac National Dataset, 12 months 01/04/2018 to 31/03/2019, SafeLives, http://www.safelives.org.uk/practice-support/resources-marac-meetings/latest-marac-data

[6] SafeLives, A Cry for Health, Why we must invest in domestic abuse services in hospitals, November 2016 http://www.safelives.org.uk/sites/default/files/resources/SAFJ4993_Themis_report_WEBcorrect.pdf

Establishing best practice response to domestic abuse within acute health

Donna Allender is the Pathfinder Domestic Abuse Project Lead Officer for the Somerset Clinical Commissioning Group (CCG). Having previously led the development of the Health IDVA service within an acute hospital she is keen to capitalise on the expertise of the Pathfinder consortium in scoping a sustainable domestic abuse model across targeted health services with the Somerset CCG area.

In Somerset an estimated 13,200 women have been impacted by domestic abuse within the last year, 2139 of these are accessing support via our community-led domestic abuse service, 58% of which are police led referrals.

With only 1 in 5 survivors of abuse reporting to the police, there are an estimated 11,062 women potentially requiring early intervention and prevention. Thus it is vital that health play a proactive role in identifying and responding to patients exposed to domestic violence and abuse.

Whilst this report identifies the risk to women within our communities it in no way excludes the impact on children or the estimated 7,700 males that have been exposed to domestic abuse within the last year.

The estimated annual cost of domestic abuse to services within Somerset is £33.5 million (not including the human and emotional cost). £15 million of this is related to healthcare.

In the spirit of sharing best practice, I detail some of the activities that Somerset has progressed within our Acute Hospitals. It is by no means exhaustive and requires continual assessment and revision. With an annual average of 100,000+ patients passing through the Emergency Departments of our Acute Hospitals, embedding the NICE Quality Standard 2016, in a way that is effective and efficient is an evolving process.

First and foremost it was important to understand the challenges within the clinical setting; environmental time pressures, medical priority, patient interface, safeguarding knowledge and skills. It was noted that whilst there was a breadth of experience in delivering a measured, empathic first response to patient care and that all teams were fully aware of their statutory safeguarding responsibilities. Opening up the topic of domestic abuse, responding effectively to disclosure, assessing risk and referring to appropriate services was an area that many practitioners still felt very uncomfortable about.

We also identified that whilst robust safeguarding policies and procedures existed, domestic abuse was a feature rather than a detailed protocol for response. Domestic abuse was included in mandatory safeguarding training. However, again as a feature rather than a targeted programme designed to progress clinical enquiry, risk assessment and referral to specialist support.

The value of building relationships with the clinical team cannot be underestimated. Demonstrating a willingness to understand the day to day challenges and devising workable solutions that support medical teams to deliver interventions in a timely and appropriate way, not only enables the Trust to more specifically embed the NICE quality standard - driving measurable improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – but also supports the clinician in feeling confident when delivering meaningful patient engagement.

One of our overarching aims was to embed an Emergency Department response that communicated to our patients that we recognise the impact of violence and abuse on health and wellbeing. That they are not alone and that we can offer appropriate routes to help and support.

Single Person Triage

At registration, all patients are informed that we conduct single person triage and that those accompanying them will be asked to remain in the waiting room until the triage outcome has been determined. Of course, we operate this within reason. If patients have additional support needs that require a carer to be present then this is accommodated.

Clinical Enquiry

At the point of triage, all patients 16 years and above, male and female are routinely asked about domestic abuse. However, this is largely designed to inform the patient that we are listening, available and confident in our response to violence and abuse at home.

Given that a high percentage of domestic abuse survivors presenting within health are often in a pre-contemplative stage, i.e. either not identifying that their experience is classified as domestic abuse or simply not be ready to engage in support. We must open up the question beyond the traditional ‘Are you at risk of domestic abuse?’

The way we ask the question is dependent upon the presenting situation, for example; our guidance for triage is:

“Given the widespread nature of violence and abuse, we routinely screen for risks at home”, “Is there anyone at home that has threatened to hurt you or someone that you care about?”

Whereas our guidance for maternity may be framed in the following way:

“Women exposed to abuse at home are particularly vulnerable to pre and post-natal stress”, “Is there anyone at home that makes you feel unsafe? Anyone who’s behaviour concerns you”?

More generic lines of enquiry may be:

“Not everyone recognises that they are in an abusive relationship”, Does anyone consistently put you down or belittle you? Threaten or intimidate you?

“How are you coping at home? Is there anything that you are worried about? Anyone that makes you feel unsafe or that you are frightened of?”

Clinical Capsules

Our enquiry does not stop at triage. When the patient moves into other areas of the Emergency Department for further assessment, clinicians have access to a clinical code that is embedded into their clinical recording pathway. If concerns have been identified at triage or the presenting complaint has a number of safeguarding indicators that denote domestically abusive activity, the clinician can use the code and a series of simple questions appear within the clinical notes.

  • When was the last escalated incident, what happened?
  • Is this the first injury that the patient has sustained? How does it compare to previous injuries?
  • Does the abuser intimidate or threaten the patient?
  • Would the patient describe their abuser as controlling or psychologically abusive?
  • Are the abuser's behaviours getting worse, are the incidents of conflict happening more frequently?
  • Identify the location of the alleged abuser, and if the patient is frightened of them?
  • What is it that the patient is frightened of?

The questions are designed to offer a framework of assessment that is conversational, whilst prompting disclosure that informs us about the severity and frequency of the abusive activity surrounding the patient.

If the patient consents to engage with the domestic abuse specialist, the clinician can generate an automatic referral to the safeguarding team via the electronic clinical record.

First Response

Supporting clinical enquiry is our Emergency Department First Response Procedure. A simple yet detailed protocol on how to respond to disclosure, assess risk and refer to specialist Health IDVA support.

Advice ranges from reassuring the patient that their disclosure will not be shared with the abuser, encouraging engagement with the hospital IDVA service, to specific risk assessment and safety planning measures. Links to this pathway are available.

Level 3 Safeguarding Training for Domestic Violence and Abuse

A key element in driving best practice response is of course training; the content of the training is designed to meet the NICE Quality Standard, universal level 1 & 2 targeted training for domestic violence and abuse and Level 3 Adult Safeguarding Competencies (which is an intercollegiate document).

This is a full day of mandatory training for the Emergency Department that aims to embed best practice by enhancing knowledge, skills and confidence when delivering safe actions and interventions to patients at risk of violence and abuse. It includes interpersonal violence and the role of the Emergency Department, establishing professional curiosity, domestic violence and abuse (Honour Based Violence, Sexual Violence, Older Patients at Risk, Complex Need), clinical enquiry, risk assessment and referral pathways.

Service feedback:

Having an IDVA working directly with the ED team has been invaluable. A comprehensive training programme delivered by the IDVA empowered staff to carry out routine enquiry and manage patient disclosures sensitively. As the project has evolved the IDVA was able to share powerful accounts of successful interventions that the staff had been involved with and the positive impact the support of the IDVA had then made to the patients. Having this special advocate embedded as part of the team and making safeguarding around domestic violence part of our everyday culture cannot be underestimated.

- Nurse Consultant Emergency Medicine

The Health IDVA role has continually developed within the Trust, providing a clear process for evidence-informed practice within the organisation. The IDVA has shared valuable skills and knowledge with the safeguarding team, ensuring that the service is not only sustainable but that survivors of domestic violence and abuse may access a responsive and supportive service even in the absence of the IDVA. This service is now indispensable, ever-evolving, and as a trust, we are very excited about where this development is taking us.

- Associate Director Quality Governance and Safeguarding

Back to hospital profile.

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Q&A with Dr Tara Jones - Surrey's GP response to domestic abuse

 

Dr Tara Jones is a designated GP across the county of Surrey. Here she is being interviewed at a Pathfinder event by Monika Lesniewska, a consultant at SafeLives, about her and her general practice’s response to domestic abuse. 

TJ: In Surrey, the majority of our county hasn’t got IRIS, but I work in the area where we do have IRIS[i].

ML: So, what are some of the differences you see between the practices that do have IRIS and ones that do not?

TJ: For us, we just had a big domestic abuse deliberation day in Surrey in the last couple of months and one of the statistics that came out of that was that 85% of GP referrals into specialist services came from the Surrey CCG area which is the one that has IRIS. This doesn’t surprise me in the least. I think the one thing to be conscious of is that GPs have done a lot of signposting in the past, but it hasn’t gone down as a formal referral. So, they may have given a card or a leaflet but that isn’t captured. So, what’s different with IRIS is that it is capturing those formal referrals, which means you can evidence that GPs are doing that. That said, even where we haven’t got IRIS, I think there's that message of 'be prepared to ask the question and know what to do'. For me as a GP, and talking to other GPs, we’re used to not knowing everything but what we do say is ‘I can’t solve that, that’s not my area of clinical expertise but I know where you refer you onto’. So, awareness of what your local services, how to access them, what they can provide- we’re lucky in Surrey but I know that in some of our neighbouring areas the DA services are only available to work with high-risk cases. So, something to consider when referring patients is what sort of services are offered to them. So, you don’t get a formal referral pathway but it’s taking that same approach if I'm asking the question 'what can I then offer?'.

ML: So do you think that strengthening multi-agency work with the specialist services could be beneficial for practices?

TJ: We’ve done quite a lot of work within our safeguarding training of DA awareness and that’s been supported by our specialist services and that’s made a real difference. Bringing quite senior member of teams into our training. They can talk about their service because they’re best placed to tell us what services they offer. I think that’s been really, really helpful. Although some of our areas don’t have IRIS, it’s done a huge amount for them to know these are the services, this is how you access them and this is what is offered if you do send someone to them. I think that’s been really helpful.

ML: Other than that, what are some examples of good practice you have come across in your work?

TJ: What’s been interesting is where you do training and you train two GPs or two GP practices and some will go on to make lots of referrals and some won’t make any at all. And we’ve been talking about how to get round that and actually why that might be. I think one of the things to can do is get to know the practices. That’s hard in a big area but actually it builds those relationships.

ML: And how do you get to know practices, especially in large areas like Surrey?

TJ: We introduced a network of safeguarding forums. We took two lots of training- one is a formal lecture theatre-based full-day event, and then we have forums. We’re actually doing the forums at the moment- they’re based in each CCG area so they’re quite localised, they happen at lunchtime so they’re much more informal. For us, they’re often an opportunity to get to know the practices and the colleagues from those practices. We can also get to know what the local issues are, because our domestic abuse services are slightly different in different areas so work out ‘why is this slightly different here or what issues are coming up here’. Getting a sense of what the local landscape is. If you’re covering a big area, it’s different to if you’re in one small London borough. But if you’re covering a whole county, there are massively different issues depending on different parts of the county. I'm involved in the domestic homicide reviews and it’s very interesting- we had two running simultaneously. One, the GP engaged with the perpetrator-it was great work, really good continuity, really good support. It was an unusual domestic homicide review in that there was no background of domestic abuse. The other one could not have been more different- there was no recognition that someone was experiencing domestic abuse. So going through the DHR process and seeing how different that response was and led me to think what can we do to iron out those differences as much as we can. 

ML: Can we support or challenge perpetrators in health services?

TJ: It’s interesting. Like I said, this was a very atypical case, but it was interesting to hear comment about how much can we do in primary care. Having been a GP for over 20 years actually how often did I even think or have a suspicion… maybe the victim had said something. How often did I know with certainty that an individual was a perpetrator? Very, very rarely. So in terms of that, how much work can we do? I'm not sure.

ML: How can GPs surgeries monitor and support children?

TJ: I think again it’s about identification but also a slightly difficult thing of having a woman who has made a disclosure to you and now you’re saying she has children and that’s created a potential safeguarding issue- how do you deal with that? We’re just at the moment starting a model a lot more early help at the lower level of safeguarding. It’s about explaining why we’re sharing information and why it’s going to be helpful. It’s the recognition but also, again, what services are there and if I'm saying to a victim ‘I want to offer you this to support your children’ if I can explain that and sell it as to why it’s helpful to you and your children, instead of I'm making a referral to children’s services and the first thing people think is ‘you’re going to take my children away’. It’s that explaining what role social care can have. I think that the early side will be beneficial there because it never even goes there so it destigmatises it.

ML: Do you think the fact that GPs can have more of a relationship with a patient makes a difference there?

TJ: I do. The only thing that I do caution a little bit is that primary care isn’t like what it was even 15, 20 years ago. There isn’t always that continuity, but we can achieve continuity when we choose too. If I really want to see someone again, I will make sure to book them to come back. You're not going to have that in A&E or an outpatient mental health service. although it’s not a given the way it was 15 years ago, it’s still possible. I think that’s why GPs are still very trusted by patients, because you do build a relationship with them over time.

ML: So do you think that the most vulnerable victims and children or those at highest risk could be the ones that do have that continuity?     

TJ: That’s something we really try to encourage and that’s something good to get out there. We know we can’t do that for everyone and lots of patients don’t need it or even want it- lots of patients want the convenience of an appointment with anybody at a particular date or time. But I think that encouraging continuity where there are complexities or vulnerabilities is something we should be doing.

Back to the GP Pathfinder profile page.


[i] The IRIS model is a domestic abuse and violence training, support and referral programme for GP practices. The practices are given training and referral pathways to specialist domestic abuse agencies. This model of best practice and has been evaluated to be effective in increasing referrals to domestic abuse agencies from trained GP surgeries.

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