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How general practice can respond to violence against women and girls

Violence against women and girls (VAWG) is a global violation of human rights that damages health and wellbeing across the life course and across generations. Except in its most obvious manifestations as acute injury or distress, VAWG has been largely hidden from the awareness of health services.

At a UK national policy level, this started to change with mandatory reporting policies on female genital mutilation, the Royal College of General Practitioners (RCGP) safeguarding standards and toolkit, and the National Institute for Health and Care Excellence (NICE) domestic abuse guidelines. However, evidence-based guidance is not yet systematically implemented in clinical education and practice.

National and local VAWG prevention policies are siloed, despite the overlap of different types of VAWG, often affecting the same families, and often part of intersectional vulnerability, amplifying other sources of inequality: class, deprivation, ethnicity, gender identity, disability, and poor mental health.

VISION Director and Professor of primary care at the University of Bristol, Gene Feder, and his Bristol colleagues, argue that the role of general practice needs to be based on the evidence for effective interventions. Despite the relatively recent recognition that violence prevention and mitigation is part of health care, that evidence has grown rapidly over the past two decades. It is strongest for the training of primary care teams linked to a referral pathway to the specialist domestic abuse sector in the UK as well as post-disclosure specialist support for survivors.

Experience of domestic violence and abuse is difficult to disclose and may endanger the patient if the abuser learns of disclosure. Disclosure may be even less likely with the increase of remote and digital access to general practice. Therefore, training for all clinicians should include how to ask about abuse, including in online or telephone consultations, how to appropriately and safely respond to disclosure, and to safely document in the medical record.

Although associated with inequality, VAWG is present in all communities. Prevention and mitigation needs to be across all sectors, with investment in interventions with individuals, families, communities, and tackling structural drivers of violence. General practice must be part of this societal response.

Key messages

  • There is overlap between different types of violence often affecting the same children, families, and households.
  • Intersections of deprivation, disability, poor mental health, and racism amplifies the effect of violence and trauma, also reducing access to general practice support.
  • Violence against women and girls (VAWG) requires a team-based general practice response underpinned by trauma-informed training and referral pathways to specialist services, often in the voluntary sector.
  • Effective responses to VAWG needs to be rooted in trauma-informed care, facilitated by relational continuity and enabled by face-to-face consultations.
  • Clinician experience of violence and abuse needs to be addressed in training and support.

To download: Violence against women and girls: how can general practice respond?

To cite: Violence against women and girls: how can general practice respond? Gene Feder, Helen Cramer, Lucy Potter, Jessica Roy and Eszter Szilassy. British Journal of General Practice 2025; 75 (756): 297-299. DOI: https://doi.org/10.3399/BJGP.2025.0244

For further information, please contact Gene at gene.feder@bristol.ac.uk

Photograph licensed under Adobe Stock subscription

Making change happen in primary care: the story of IRIS

VISION Director and Professor of Primary Care at the University of Bristol Medical School, Gene Feder, was a keynote speaker at the webinar: Making change happen in primary care – The IRIS story, on 28 November 2023.

With his co-presenter, Medina Johnson, CEO of IRIS, they shared the story of the concept and ambition that led to the beginning of the social enterprise established in 2017 to promote and improve the healthcare response to domestic violence and abuse (DVA).

DVA is a violation of human rights that damages the health of women and families. The health care sector, including primary care, has been slow to respond to the needs of patients affected by DVA, not least because of uncertainty about the effectiveness of training clinicians in identification and engagement with survivors of abuse.

To address that uncertainty, Gene and Medina conducted a cluster-randomised trial in Hackney and Bristol, finding that both identification and referral to specialist DVA services substantially increased in the intervention practices.

In the webinar they mapped the (not always smooth) trajectory from trial results to a nationally available programme commissioned by Integrated Care Boards (ICBs) and local authorities in over 50 areas to date, including getting into guidelines/policy, further implementation research, negotiating with commissioners, and setting up a social enterprise (IRISi) to drive the scaling up of the intervention.

For further information please watch the webinar video below.

For any questions or comments, please contact IRISi at info@irisi.org

Remote GP contact limits domestic violence care

General Practice has a central role in identifying and supporting those affected by DVA. Pandemic associated changes in UK primary care included remote initial contacts with primary care and predominantly remote consulting.

This paper explores general practice’s adaptation to DVA care during the COVID-19 pandemic. We found that the disruption caused by pandemic restrictions revealed how team dynamics and interactions before, during and after clinical consultations contribute to identifying and supporting patients experiencing DVA. Remote assessment complicates access to and delivery of DVA care.

This has implications for all primary and secondary care settings, within the NHS and internationally, which are vital to consider in both practice and policy.

For further information please see: General practice wide adaptations to support patients affected by DVA during the COVID-19 pandemic: a rapid qualitative study | BMC Primary Care | Full Text (biomedcentral.com)

Photo by National Cancer Institute on Unsplash