20th September 2019
Annie Howells is the Programme Director for IRIS. The IRIS model is a domestic abuse and violence training, support and referral programme for GP practices. In this blog Annie reflects on the best practice in responding to domestic abuse in primary care.
We know that domestic violence and abuse (DVA) is a major public health problem with devastating health consequences for women, men and children. DVA has far-reaching consequences for families and communities and is an enormous cost to the NHS. The NHS is often the first point of contact for people who have experienced violence and the response they receive is critical. In fact, the initial reaction of the person they tell and the follow-up within and beyond the NHS can have a profound effect on their future and can impact on their ability to re-establish their life. It is clearly essential that primary care responds to and helps prevent further DVA. So, what should this response look like?
To begin with, primary care teams need training, not one-off training but on-going training and support that provides information, resources and practical tools for the whole team. This enables clinicians to recognise the signs of DVA, to start making sense of patients presenting symptoms and begin to understand the potential reasons for repeat visits to the surgery:
“By becoming more aware of the signs and symptoms that suggest abuse…I became much more aware of patients who were living with abuse and the negative impact that this was having on their health outcomes…the penny drops” - GP on the IRIS programme
To respond appropriately is having the knowledge of how to ask patients about their experiences of DVA in the first place. Through training and on-going support, clinicians gain essential skills in how to ask direct questions about patients’ experiences of DVA. It also prepares them to be ready to hear the answer and to give supportive key messages to patients when they most need it. We know that clinicians want to support their patients affected and so we need to be providing tools and resources to enable this.
A best practice response clearly includes offering patients a referral to a specialist, independent, DVA service. The more knowledge the primary care teams have of this service the better. Following simple care pathways, which must account for children and risk, appropriate support can be accessed for survivors and perpetrators. Primary care is a busy place and the simpler the referral process the more accessible it becomes. A referral to a named advocate within a specialist service is better for everyone; the clinician, the advocate and most importantly the patient. The advocate can then walk alongside the patient and provide the specialist support they deserve.
An embedded relationship between the health sector and specialist DVA sector is essential for primary care to respond appropriately to DVA. Working together enables an on-going conversation, a consistent partnership approach that puts patients at the centre. This is integral to delivering a best practice approach, it allows for experts in the right places making services accessible and making a difference to the lives of people who really need it.
"I just cried. I was just so relieved that somebody, that somebody just said something. And he (the GP) gave me the box of tissues and I just sat and cried and cried and cried. And he said, 'Tell me when you're ready.' And I poured it all out and that's when he said about the specialist worker. He said, there is somebody out there to help me. I'm not on my own. And if I want help, it's there and not to be ashamed of it. Which I was, really ashamed of it. And he said, 'You're not on your own. We can get you this help.' And he did. He really did." - Survivor who disclosed to an IRIS trained GP