Violence against women and girls (VAWG) is often called a hidden epidemic. It cuts across every community, fuels inequality, and leaves lifelong scars on health and wellbeing. Yet, as a new British Journal of General Practice article argues, the NHS response – and particularly the role of general practice – is still too often fragmented, underfunded, and inconsistent.
The piece, co-authored by Professor Gene Feder – a founding architect of the IRIS programme and a member of the IRISi board – makes the case for a coordinated, trauma-informed primary care response, backed by sustainable funding and embedded referral pathways to specialist support.
The power of general practice in addressing domestic abuse
Evidence is clear: when GPs and practice teams are trained to recognise abuse and refer patients to specialist support, lives change. The IRIS programme – commissioned by local authorities and Integrated Care Boards (ICBs) across the UK – is one such model. In the past year alone, it has enabled more than 16,000 survivors to access help from trained domestic abuse advocates. But this progress is under threat.
“In the absence of an NHS-wide commitment to funding the response to VAWG, coupled with continuing cuts within the domestic abuse sector, this evidence-based programme is threatened with closure in many areas,” the authors warn.
Without dedicated referral pathways, general practices risk being left without the support they need to respond safely and effectively.
Beyond domestic abuse
The article also highlights that GPs have a crucial role in responding to other forms of VAWG – from sexual violence to harmful practices – but that the evidence base for interventions outside domestic abuse is less developed. Referral to Sexual Assault Referral Centres (SARCs) and early recognition of patterns of harm within families are critical steps.
Children, too, are at the centre of this conversation. The 2021 Domestic Abuse Act recognises them as direct victims when they live in households affected by abuse. Yet many fall below children’s services’ thresholds, leaving families without help unless primary care teams take the initiative.
A trauma-informed future
The authors call for a universal, trauma-informed primary care response that recognises intersecting inequalities such as poverty, racism, disability, and poor mental health. They stress the need to make services more accessible for patients with complex needs and to ensure clinicians themselves are supported, acknowledging the impact of vicarious trauma and lived experience of abuse among healthcare staff.
For IRISi, the message is clear: we already have a proven, scalable model for how general practice can lead the way in tackling VAWG. But without sustainable investment, the NHS risks losing a vital part of the safety net for survivors.
As the article concludes, VAWG prevention must be “across all sectors, with investment in interventions with individuals, families, communities, and tackling structural drivers of violence”. General practice cannot – and must not – be left out of that response.
