• ‘Best practice’ programme that has helped GPs refer thousands of victims of domestic violence to specialist services announces ambitious plans to expand

    A highly successful, evidence-based domestic violence and abuse identification and referral programme (IRIS – Identification and Referral to Improve Safety) developed by researchers at the University of Bristol has launched as a social enterprise today, with plans to scale up its activity and grow the programme across the UK and internationally.

    The IRIS programme provides training and support to GPs, practice nurses and other primary care clinicians to help them identify and refer women with experience of domestic violence and abuse (DVA) to specialist domestic violence services. It also provides information and signposting for male victims and perpetrators.

    The plans for expanding the service include growing the IRIS programme across all clinical commissioning group (CCG) and sustainable transformation partnership (STP) areas to encourage commissioning on an STP-wide basis in England, and across Health Boards in Wales. There are also plans to explore opportunities in Scotland and Northern Ireland, and further afield in Europe, and the occupied Palestinian territories and Brazil, where work has already begun to support delivery of an adapted IRIS model for health care services.

    The service is a collaboration between primary care and third sector organisations specialising in DVA. An advocate educator, based in a local specialist DVA service, is linked to general practices and works in partnership with the local clinical lead to co-deliver the training to those practices. She also supports patients referred from those practices.

    The programme was evaluated in a randomised controlled trial, which demonstrated NHS and societal cost savings of £1 and £37 respectively per female patient aged 16 and over per practice per year (all female patients, not only those affected by DVA). It became a commissionable programme in 2010. Since then, it has directly helped over 8,000 women in 34 local areas in England and Wales access specialist support through their GP. Over 800 general practices have engaged in IRIS training and are now ‘IRIS DV Aware Practices’, in which a further 29,000 women are estimated to have discussed DVA with a primary care clinician.

    Medina Johnson, Chief Executive of the new social enterprise, called IRISi, and a founding member of the IRIS programme said:

    “Domestic violence is a major public health and societal problem. DVA is a gendered crime and, while it affects one in four women and one in six men during their lifetime, DVA against women is more frequent and more severe with long-lasting effects that have an impact on children, other family members and friends too. It costs the NHS £1.7 billion a year and the annual cost to the UK economy is £18 billion.

    “The need for IRIS has never been greater. While we are proud of our record of IRIS programmes delivering results to date, there are over 8,000 general practices in England alone, ten times the number where IRIS is currently being implemented. At least 25% of women in each of these practices will have experience of DVA and could benefit from IRIS. The potential to make a difference is huge and the savings to the NHS and society proven and clear. IRIS is simply the right thing to do. This is why I am excited to be launching IRISi today and entering this new phase in our development to promote and improve the health care response to DVA.”

    Gene Feder, a GP and Professor of Primary Care at the University of Bristol’s Centre for Academic Primary Care and architect of the IRIS programme, said:

    “IRIS is a crucial response to the high DVA prevalence and its devastating impact on health and wellbeing. Operating as a social enterprise will give us the necessary business, quality improvement, development and legal frameworks to scale up the programme to meet future demand. We know that with more refinements we can continue to grow as we begin to proactively market our approach with best practice social franchising and extend beyond general practice to other health care settings.”

    John Piesse, Head of Primary Care Commissioning at NHS Enfield, CCG said:

    “Over the last four years NHS Enfield CCG has commissioned IRIS, through Solace Women’s Aid, to train and empower our general practice staff to identify and support those at risk and with experience of domestic violence and abuse.  This is a much-needed response within health.

    “Through the dedication and commitment of IRIS and Solace Women’s Aid colleagues we have been able to safeguard and support victims and their families and continuously explore ways in which we can improve our response to this local health and social care priority.”

    Dr Clare Ronalds, IRIS Manchester’s GP Clinical Lead, said:

    “IRIS changes lives. It makes it possible for GPs and nurses to do something that before was ‘too hard’. It teaches us to recognise the huge impacts of domestic abuse, how to ask about it safely, how to respond, and most importantly, how to refer to the IRIS advocate educators. The feedback I have received from GPs who have taken part in the training and who are implementing IRIS has been overwhelmingly positive and they consistently highly recommend it to colleagues.”

    IRISi was launched on November 21st 2017 at the Health Foundation in London. The team will be awarded a University of Bristol Vice Chancellor’s Impact Award at a ceremony in Bristol on November 23rd.

    For information on commissioning an IRIS programme, where programmes are running and on IRISi, contact info@irisi.org or visit www.irisi.org.

    For help and support on domestic violence, these services provide free helplines:

    National Domestic Violence 24 hr Helpline for women experiencing abuse: 0808 2000 247

    Men’s Advice Line for men experiencing abuse: MondayFriday 9am-5pm: 0808 801 0327

    National LGBT Domestic Abuse Helpline: 0800 999 5428

    RESPECT Phoneline: Confidential helpline offering advice, information and support to anyone concerned about their own or someone else’s violent or abusive behaviour. MondayFriday 9am-5pm: 0808 802 4040


    About IRISi

    IRISi is a social enterprise established to promote and improve the health care response to gender based violence. IRISi:

    • supports the local commissioning, implementation, maintenance and growth of the IRIS programme, including bid development, training for trainers, ongoing support, national analysis and monitoring
    • collaborates with partners to develop innovative, evidence-based health interventions for those affected by gender based violence
    • provides expert advice and consultancy in the field of DVA and healthSee www.irisi.org and @irisintervent

    What patients say

    I have never made any decisions in my life. After discussing my issue with the GP who made a referral to IRIS who also got me counselling, putting all three support together I have been given that much confidence that I have finally made the very first decision in my life –  to leave my husband and leave the abuse behind. This would not have been possible had my GP not asked me about things at home. Thank you for helping me aim to change my life.” IRIS service user, 2013

    I was embarrassed that my doctor asked me, and so pleased at the same time, he knew there was another reason for my depression and anxiety.” IRIS service user, 2016

    Without the question in the first place being asked I would never have thought there was so much help and support – me and my sons are now safe and well – thank you so much.” IRIS service user, 2015

    I really appreciate the time and expert understanding [of] the support worker, she has been extremely supportive, understanding, and has definitely given me very useful information that has made me feel safer, and provided the knowledge of where and what to do if I should need to get help when I feel frightened and in a crisis. It is certainly helped for my wellbeing. Thank you.” IRIS service user, 2014

    “This is a fantastic service I would have been lost without it. I can’t say enough positive things about the project. Experiencing domestic abuse is a horrific experience and this is an invaluable service. I have had some bad experiences with the NHS, although this has restored my confidence.” IRIS service user, 2015

    What clinicians say

    There are very few things that I come across now that make me think I may need to approach things differently, but this is one of them.” Clinician, 2014

    Best, most informative and inspirational training I have been on in 30 years. Fantastic service, gives me hope for humanity, you’re doing an amazing job.” Clinician, 2016

    I think there should be more mandatory training on domestic violence and abuse. I have already identified a patient whilst sat here that would really benefit from these services.” Clinician, 2016

    I had very little knowledge of DV or how to help and despite wanting to help I didn’t know how to. I now feel much happier to give it a go! Very knowledgeable trainers, very enthusiastic. Made a difficult topic extremely easy to understand. Gave us an ability to share thoughts and experiences. Handouts were very thorough and useful information was provided. The sections on How to deal with perpetrators was most helpful as I don’t think I’d have known where to start. Also, other less obvious signs and symptoms to watch out for … The training was spot on. Thank you very much for such a valuable and brilliantly delivered session.” Clinician, 2016

    Good to know we have excellent services available to victims. Referral process is news to me! Previously all referrals I made were down a different pathway. Definitely easier to refer.” Clinician, 2016

    About the Centre for Academic Primary Care, University of Bristol

    The Centre for Academic Primary Care (CAPC) is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching.

    Domestic violence facts

    Domestic violence and abuse is defined by the UK government as ‘any incident or pattern of incident 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’.  https://www.gov.uk/guidance/domestic-violence-and-abuse#domestic-violence-and-abuse-new-definition

    Globally, direct experience of being subjected to domestic violence is greater among women then among men. In the UK, 27 per cent of women and 13 per cent of men have experienced some form of domestic abuse in their lifetime; 44% of female murder victims compared to 6% of male victims are killed by a partner or an ex-partner (Home Office, 2015). Intimate partner violence is responsible for more ill-health and premature death in women under the age of 45 than any other well-known risk factors including high blood pressure, obesity and smoking (VicHealth, 2004).

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