In the fourteenth of our 16 blogs for 16 days, Jacqueline Gantley, Clinical Lead for IRIS in Wales, talks about the incredible impact the programme has had both personally and professionally.
I spent 32 years working as a GP in central Cardiff. Throughout my career my main professional interests were child development and behavior and women’s physical and mental health. I was for many years the Safeguarding lead at my practice. Despite this I had a very poor understanding of the true prevalence of domestic abuse and its potentially profound effects on my patient’s health.
Like the majority of my colleagues if patients did disclose any episodes of abuse, I would direct them to a national helpline number or possibly our practice health visitor if young children were in the home. I don’t recall any mention of the links between health and DVA during me under or post graduate training.
I first heard about IRIS through a friend at my book group. She was working with our local Police and Crime Commissioner (PCC). He had heard about the success of the scheme in Bristol and was keen to collaborate with health services to bring the training to South Wales. IRIS offers bespoke training for general practice teams to recognize the impact of DVA and crucially provides prompt specialist support to survivors.
South Wales unfortunately has some of the highest recorded incidents of DVA in the UK. South Wales police receive a call every 15 minutes about an episode of abuse, approximately 96 calls every day of the year. The commissioner felt an early intervention project with a strong evidence base may help to reduce these episodes. Despite this prevalence very few referrals for support were being received by local services from primary care. Between 2011 and 2014 local support services in Cardiff received only 7 referrals from GP teams.
In 2014 a steering group lead by the PCC and involving local service providers and health representatives agreed to set up a pilot project covering 25 practices in Cardiff and Vale. Funding was provided by the PCC.I am delighted to report I was recruited in September 2014 as the Clinical lead for this pilot.
Training started in spring 2015.By the end of our first year we had received 127 referrals and by the end of year 2 we had received 265.These referrals produced a very high level of engagement with specialist support services.
In Autumn 2015, again with funding from PCC we were ready to start training in the Cwm Taf area just north of Cardiff. This time the Health board decided to joint fund and provide training to all 40 practices. By the end of our first year we had 135 referrals and 287 by end of year 2.
I was surprised from the very first training session how impactful and focused it seemed to be. The training is co delivered with very skilled advocate educators (AE) who quickly become a vital support to both survivors and practice teams.
I have been very fortunate to work alongside some really committed and highly competent AEs.
In addition, Medina from IRIS team nationally has provided steadfast support and encouragement throughout our progress in South Wales. My co clinical lead Dr Laura Wass has also provided vital input.
By 2017, due to our exceptional results, we were able to secure funding from both Health boards to allow us to roll out to all practices throughout Cardiff and Vale and Cwmtaf.We have now trained close to 100 practices.
One of the challenges of delivering the sessions has been overcoming the almost universal reluctance of practices to sign up for the initial training. GP teams are under enormous pressure with very many calls on their limited time. As a result, we have had to be very flexible to get the first session booked. However, no such problem has arisen with booking session 2 or 3. Teams are really keen to complete the training and encourage any colleagues who missed the first session to subsequent training.
By October 2019 we had received 806 referrals from Cardiff and Vale practices and 627 from Cwmtaf practices. 12% of our referrals have been for survivors over 60. We have even received a referral for one lady aged 89. 79% of patients referred had known mental health issues and 60% had children in the home. Unexpectedly we had high numbers of cases from our most affluent areas and over 60% of cases were first time disclosures.
There are three key lessons that I would highlight. Firstly, try to find out locally who are the key people who will assist you, but also watch out for those who will block you. It is not always the people you would expect.
Secondly, the success of the scheme is based on the relationships forged with practices. This role relies on having highly motivated AEs, in this I have been blessed.
Finally, in my view IRIS is a rare example within the health sector of intelligent kindness in action.
It provides practices with both the skills and support to transform the response to this vital health issue. It allows patients to disclose abuse and receive prompt specialist input.
Well over a thousand survivors and their children have received this support in our area of South Wales. Our ongoing challenge is to sustain this success and hopefully bring the scheme to the whole of Wales.
Myself and my team are certainly up for this battle on behalf of our practices and our survivors.
Jacqueline Gantley is the Clinical Lead for IRIS in Wales.
