GP training & referral pathway for women experiencing DVA

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The context

Research in England found people commonly attend their GP after a housing problem occurs, but before they’ve been to housing options services. Scottish research shows health activity increases leading up to a homelessness assessment. This suggests GPs have a key role in preventing homelessness. But this is also true for GPs -local, universal professionals – in relation to many other social harms. The social franchise model, IRIS (Identification & Referral to Improve Safety), recognises the unique prevention potential which GPs have around domestic violence and abuse (DVA), and supports them to act on it.

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The intervention

The IRIS Programme is a specialist DVA training, support and referral programme for GPs that’s been positively evaluated in a randomised controlled trial. The initiative is maintained by IRISi, a social enterprise established to promote and improve the healthcare response to DVA: a risk factor for chronic ill health and premature death in women. IRIS is commissioned and delivered in 40 UK areas, in collaboration with third sector agencies specialised in DVA, including Llamau, in Gwent.

As a universal service, GPs will encounter many women experiencing DVA. According to the Department for Health and Social Care, 80% of women in a violent relationship seek help from health services: often a woman’s first, or only, point of contact. And for some women in a controlling relationship, going to the GP may be the only time they see a professional alone. But GPs aren’t necessarily aware of the signs of abuse, may not feel comfortable asking, or entitled to ask, questions about it, or know what to do if someone confirms this is happening.

The IRIS Programme provides practical and ongoing training to GP teams enabling them to recognise signs of abuse, ask the right questions, and act on what they are told through a simple, one-page referral pathway. The model entails a clinical lead (CL) - a local, practising clinician - and an Advocate Educator (AE) employed by an independent domestic abuse service. In Gwent, one clinical lead and 4 AEs, based at charity Llamau, cover 54 surgeries, each of which contributes to fund the scheme. The CL and AE provide training on a three-tiered model to all surgery staff.

The AE can respond quickly, arranging to meet the victim at a safe place, such as the surgery, so they can tell a perpetrator (often the partner) that they are attending a GP appointment. The AE provides emotional support, risk and safety planning and assesses any wider needs a person may have, for example, advice on financial, legal or housing issues. The AE can then support people into other relevant services. This provides a key opportunity to explore safer housing options, such as legal remedies, sanctuary schemes or managed moves, before a situation escalates into homelessness.

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The outcome

In two years before IRIS began in Gwent, Llamau received three GP referrals for domestic abuse support. Six months after joining the IRIS Programme, they’d received 159 referrals. 99% of women accepted support, and none were already receiving other support.

AEs supported 46% of those women with housing risk directly, whilst 79% received support on wider issues which can undermine housing sustainment (such as benefits/arrears and mental health). 84% remained safely in their community through support to access legal routes, injunction/occupation orders and safety planning.

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Key insights

• as trusted, universal, local professionals, GPs are uniquely positioned to ‘ask and act’ – but high quality training and a quick, simple pathway into responsive support are also vital for this to work
• IRIS enables GPs to ‘ask and act’ on domestic abuse, creating a space to intervene earlier to prevent escalation of harm; it also offers a replicate-able model (training, pathway, dedicated worker) for engaging other public bodies in preventing other harms - such as homelessness
• whilst IRIS comes with a cost, research shows it’s cost effective for the NHS and cost-saving for society

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Find out more…

About IRIS in Gwent: Nicola Fitzpatrick, Head of Service, Llamau
nicolafitzpatrick@llamau.org.uk

About IRIS/commissioning the programme locally: Geisa D’avo, Comms & Marketing Manager IRISi,
geisa.davo@irisi.org