A highly successful, evidence-based domestic violence and abuse identification and referral programme (IRIS – Identification and Referral to Improve Safety) developed by researchers at the University of Bristol has launched as a social enterprise today, with plans to scale up its activity and grow the programme across the UK and internationally.
The IRIS programme provides training and support to GPs, practice nurses and other primary care clinicians to help them identify and refer women with experience of domestic violence and abuse (DVA) to specialist domestic violence services. It also provides information and signposting for male victims and perpetrators.
The plans for expanding the service include growing the IRIS programme across all clinical commissioning group (CCG) and sustainable transformation partnership (STP) areas to encourage commissioning on an STP-wide basis in England, and across Health Boards in Wales. There are also plans to explore opportunities in Scotland and Northern Ireland, and further afield in Europe, and the occupied Palestinian territories and Brazil, where work has already begun to support delivery of an adapted IRIS model for health care services.
The service is a collaboration between primary care and third sector organisations specialising in DVA. An advocate educator, based in a local specialist DVA service, is linked to general practices and works in partnership with the local clinical lead to co-deliver the training to those practices. She also supports patients referred from those practices.
The programme was evaluated in a randomised controlled trial, which demonstrated NHS and societal cost savings of £1 and £37 respectively per female patient aged 16 and over per practice per year (all female patients, not only those affected by DVA). It became a commissionable programme in 2010. Since then, it has directly helped over 8,000 women in 34 local areas in England and Wales access specialist support through their GP. Over 800 general practices have engaged in IRIS training and are now ‘IRIS DV Aware Practices’, in which a further 29,000 women are estimated to have discussed DVA with a primary care clinician.
Medina Johnson, Chief Executive of the new social enterprise, called IRISi, and a founding member of the IRIS programme said:
“Domestic violence is a major public health and societal problem. DVA is a gendered crime and, while it affects one in four women and one in six men during their lifetime, DVA against women is more frequent and more severe with long-lasting effects that have an impact on children, other family members and friends too. It costs the NHS £1.7 billion a year and the annual cost to the UK economy is £18 billion.
“The need for IRIS has never been greater. While we are proud of our record of IRIS programmes delivering results to date, there are over 8,000 general practices in England alone, ten times the number where IRIS is currently being implemented. At least 25 per cent of women in each of these practices will have experience of DVA and could benefit from IRIS. The potential to make a difference is huge and the savings to the NHS and society proven and clear. IRIS is simply the right thing to do. This is why I am excited to be launching IRISi today and entering this new phase in our development to promote and improve the health care response to DVA.”
Gene Feder, a GP and Professor of Primary Care at the University of Bristol’s Centre for Academic Primary Care and architect of the IRIS programme, said:
“IRIS is a crucial response to the high DVA prevalence and its devastating impact on health and wellbeing. Operating as a social enterprise will give us the necessary business, quality improvement, development and legal frameworks to scale up the programme to meet future demand. We know that with more refinements we can continue to grow as we begin to proactively market our approach with best practice social franchising and extend beyond general practice to other health care settings.”
John Piesse, Head of Primary Care Commissioning at NHS Enfield, CCG said:
“Over the last four years NHS Enfield CCG has commissioned IRIS, through Solace Women’s Aid, to train and empower our general practice staff to identify and support those at risk and with experience of domestic violence and abuse. This is a much-needed response within health.
“Through the dedication and commitment of IRIS and Solace Women’s Aid colleagues we have been able to safeguard and support victims and their families and continuously explore ways in which we can improve our response to this local health and social care priority.”
Dr Clare Ronalds, IRIS Manchester's GP Clinical Lead, said:
“IRIS changes lives. It makes it possible for GPs and nurses to do something that before was ‘too hard’. It teaches us to recognise the huge impacts of domestic abuse, how to ask about it safely, how to respond, and most importantly, how to refer to the IRIS advocate educators. The feedback I have received from GPs who have taken part in the training and who are implementing IRIS has been overwhelmingly positive and they consistently highly recommend it to colleagues.”
IRISi was launched on Tuesday 21 November at the Health Foundation in London. The team will be awarded a University of Bristol Vice Chancellor’s Impact Award at a ceremony in Bristol on Thursday, November 23.
For help and support on domestic violence, these services provide free helplines: