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A new study from the Nuffield Department of Primary Care Health Sciences, University of Oxford, and the University of Bristol, shows that an adapted version of an established domestic violence training and support programme can significantly improve GPs’ ability to identify and assist patients experiencing domestic violence and abuse.

The study, published in BMC Primary Care, evaluated the impact of the IRIS+ programme. This initiative builds upon the original IRIS (Identification and Referral to Improve Safety) framework, a specialist domestic violence and abuse training, support and referral programme for general practices that has been validated through a randomised controlled trial. Unlike the original IRIS programme, IRIS+ extends its services beyond women survivors, offering assistance to male survivors, perpetrators and children and young people who are directly affected.   

Testing IRIS+ across GP surgeries in England and Wales, the study found that following the training, referral rates for women doubled compared to standard IRIS, while also enabling referrals for men and children.  

GPs reported increased knowledge and confidence in responding to domestic violence and abuse across all patient groups and, while GPs were responsible for most referrals, nurses and other surgery staff reported feeling better equipped to collaborate with GPs to identify at-risk patients. Interviews highlighted the value of continuity of care for enabling patient disclosure and identification of DVA – something made more difficult during remote consultations in COVID-19.  

IRIS+ was also seen as filling an important service gap for children and young people affected by DVA who may not meet child protection intervention thresholds. Close to 15% of all referrals during the study were for children and young people, while 10% were for men who were mostly referred as survivors. Interviews of children and male survivors reported significantly improved wellbeing from the support received through IRIS+.  

Dr Anna Dowrick, co-author of the study and Senior Researcher at the Nuffield Department of Primary Care Health Sciences at the University of Oxford, said: This study shows that IRIS+ is effective and feasible across diverse patient groups. Training GPs to look beyond women survivors can improve care for all patients affected by domestic abuse. IRIS+ fills an important gap by enabling early intervention, supporting general practise staff to assist patients and improving the resources available to people experiencing domestic violence and abuse. 

A further study, carried out by researchers at the University of Bristol’s Centre for Academic Primary Care, found that implementing the training across more GP practices may be cost-effective though, the researchers explain, larger trials are needed to evaluate effectiveness and cost-benefit for the NHS.  

The researchers conclude that further trials are needed to evaluate how effectively IRIS+ could be implemented on a wider scale and more research should be carried out to find effective approaches for identifying perpetrators within the health setting.  


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