by Dr Eszter Szilassy, Research Fellow, Centre for Academic Primary Care, University of Bristol
GPs and other primary health care professionals play a vital role in addressing domestic violence and abuse (DVA). This is especially true during the current coronavirus pandemic, when individuals and families are isolated from potential sources of help and support.
Home during lockdown may not be a safe place for those affected. In England, the National Domestic Abuse Helpline, run by Refuge, has seen a 50 per cent increase in calls compared to pre-COVID-19, along with a 400 per cent increase in web traffic.
We know that the pandemic is having a detrimental impact on the health and wellbeing of people affected by DVA and their children. Extensive periods of self-isolation and social distancing compounded by increasing uncertainty over jobs and financial security for families may be a dangerous and profoundly difficult time for many.
Phone and video consultations are being used by most general practices in the UK in place of face-to-face consultations, making it more difficult for doctors and nurses to ask about abuse and patients to disclose.
It is crucial that primary care clinicians continue to identify patients affected by DVA and refer them for specialist support. The Royal College of General Practitioners (RCGP) and IRISi, were quick to develop guidance, raising awareness about the heightened risks and providing advice on overcoming barriers to identification and referral at this time.
IRIS (Identification and Referral to Improve Safety), run by IRISi, is a training and support programme to help primary care teams identify and refer women affected by DVA. It involves training the whole primary care team at GP practices, including GPs, nurses, practice managers, healthcare assistants and ancillary staff, in identifying DVA in their patients.
Building on the national RCGP and IRISi COVID-19 guidance, we have developed new guidance to support practices who are taking part in the IRIS+ feasibility study.
IRIS+ is part of the Centre for Academic Primary Care’s REPROVIDE research programme. Its aim is to extend and adapt IRIS so that primary care teams can effectively respond to, and provide appropriate referral pathways for, women, men and children affected by DVA. It includes developing and testing an appropriate response and referral pathway for perpetrators and dedicated specialist support for children and young people.
Despite significant disruptions, we have been able to continue the delivery and testing of the IRIS+ intervention throughout the COVID-19 crisis by adapting clinician training and service support as well as our data collection methods to the circumstances of the pandemic.
Our adapted IRIS+ guidance for general practice teams will help clinicians conduct safe telephone and video consultations with patients who are known to be at risk of domestic abuse, and in response to suspected cases or self-disclosure.
IRIS+ is an opportunity to study how GPs can engage remotely with and support female and male patients affected by DVA and their children. We will analyse the data collected to identify and understand changes over the study period that may be related to the COVID-19 response. We are aiming to rapidly translate our findings about the feasibility and value of IRIS+ into national guidance.
With lockdown easing, we can expect to see a surge in cases of individuals affected by DVA in general practice. The need for guidance and evidence on how best to provide support has never been greater, the potential consequences never more stark.
REPROVIDE is a research programme funded by the National Institute for Health Research (NIHR) programme grants for applied research (PGfAR, RP-PG-0614-20012). It started in February 2016 and will run until July 2022. The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Find out more about COVID-19 research at the Centre for Academic Primary Care.