An example of why IRIS works and what happens when healthcare professionals are equipped to see what’s hidden
A GP in Merseyside has spoken openly about how specialist domestic abuse training reshaped their clinical practice and helped uncover violence hiding in plain sight.
Dr S, a locum GP, believed domestic abuse was not something they would have encountered in their surgery. But after completing the Identification and Referral to Improve Safety (IRIS) training earlier this year, they began to see their patients differently. Within weeks, they identified their first case: a woman who had been experiencing ongoing abuse from her daughter and son-in-law.
“I was naive,” they said. “I didn’t realise the extent of control so many people exert behind closed doors. After the training, I was able to see my patients in a whole new light.”
That patient, Jayne*, had attended the practice for years with anxiety, depression and other mental health concerns. Like many survivors, she had never disclosed abuse to her GP. She assumed that support was only available if the perpetrator was a partner. She also feared professional stigma, confidentiality breaches and the possibility of losing her job.
But when Dr S gently asked about her home life, she opened up. Within the same consultation, they explained the IRIS programme and referred her to the in-house Advocate Educator. Her first support session was booked that same week.
Jayne now meets the Advocate Educator regularly at the GP practice, which feels safe and discreet. There, she receives emotional support, counselling referrals, legal advice and safety planning. Over just a few months, she has begun to re-engage socially, set boundaries and reduce the negative thoughts that once overwhelmed her. She describes the change as someone “breaking down the walls” she felt trapped inside.
Dr S has also changed their approach. They now routinely identify and refer patients experiencing domestic abuse and encourage non-clinical staff to be trained as well. “I used to think I didn’t have any DA patients,” they said. “Now I know I do. And I know what to do.”
A growing body of evidence — and yet no action
Jayne and Dr S’s story is not unusual. But it remains uncommon in health settings. Despite clear evidence that healthcare environments are vital spaces for early identification and intervention, systemic change remains out of reach.
The Domestic Abuse Commissioner’s recent report, Learning from Loss, exposes how the state is failing to prevent the deaths of women at the hands of partners and ex-partners. The report makes clear that many of these deaths could have been prevented if health professionals had been equipped, trained and supported to act. It echoes what we at IRISi have been saying for years. Healthcare is one of the most powerful, yet underused, settings for preventing harm and saving lives. Still, it is neglected.
The NHS 10-Year Plan is further proof of that neglect, as it contains only a single passing mention of domestic abuse. Gender-based violence, sexual violence and trauma-informed care are almost entirely absent. This, despite the Department of Health’s own data showing that 80% of women experiencing domestic abuse will turn to health services, often as their first or only point of contact.
These missed opportunities reinforce the gap that IRIS and ADViSE programmes have long sought to fill.
A proven, cost-effective solution already exists
IRIS is not theory. It is a practical, evidence-based model embedded in general practice and independently evaluated multiple times. Each trained clinician identifies at least one survivor. Many identify more. As of March 2024, IRIS-trained staff identified and supported almost 44,000 survivors.
The overwhelming majority of patients referred through IRIS and ADViSE had never accessed specialist support before, and the impact is measurable. In the year ending March 2024, 74% of service users said IRIS improved their mental health, and 80% said it made them feel safer. General practices that implement IRIS are 30 times more likely to refer patients for specialist domestic abuse support. The programme is 4.8 times more cost-effective than the flu vaccine. Each pound invested generates £16.79 in public savings and delivers a social return of £10.71 – See the evidence behind IRIS’s success – read the full reports here.
Jayne’s story shows what this looks like in practice. Fewer GP appointments. More confidence. A sense of being seen and supported. Dr S can now adapt consultations for patients presenting potential signs of domestic abuse. They also feel supported, not burdened. And they receive regular updates about patients they refer — something that rarely happens elsewhere.
We are done waiting
We have seen our data quoted in report after report. We have seen our model referenced in government papers. But our work is not commissioned sustainably. And the very systems that could make a difference continue to operate in siloes.
We are grateful for the Domestic Abuse Commissioner’s call to action. We share her demand that the next national VAWG strategy must connect directly to NHS policy. And we echo her words. The NHS must play its part in keeping victims and survivors safe.
Healthcare already has the reach. IRISi has the model. Survivors have the right to be heard and helped. We urge NHS England, the Department of Health and Social Care, Integrated Care Boards and all policymakers to stop treating this work as optional. It is essential. And the evidence is already here.
*Names have been changed to protect identity.
