IRIS Programme: Can we improve the healthcare response to domestic violence and abuse?

Domestic violence and abuse (DVA) is a significant public health problem, with devastating impacts on the women affected, and substantial associated health and societal costs. Some 1.3 million women aged 16-59 years (7.9% of the population) in England and Wales are affected by DVA (Office for National Statistics).

IRIS (Identification and Referral to Improve Safety) is a primary-care-delivered, evidence-based intervention to improve the health, safety and experience of women affected by domestic violence and abuse.

IRIS encapsulates a training, support and referral programme that encourages clinicians to ask about DVA when clinically relevant; recognise DVA in a woman’s life; discuss its impact on her health/wellbeing; and offer referral to a specialist DVA service within that clinical setting.

Our Phase IV implementation study, using interrupted time series design across 205 east London general practices, determined the real-life impact of rolling out IRIS training in general practice on identification and referral of women experiencing DVA.

Our research on IRIS implementation showed:

• practices with IRIS saw a 30-fold increase in referrals received by DVA service providers
• practices without IRIS saw no increase in referrals
• a 6-month disruption to IRIS led to a 70% reduction in referrals, demonstrating that continuous funding and staffing of IRIS as a system level programme is needed.
• the IRIS programme is cost-effective for the NHS and cost-saving for society.

Since 2007, IRIS has been commissioned in 40 Clinical Commissioning Groups (CCGs) across England, including 33 outside the North Thames region. Approximately 800 general practices have been trained, with a reach of over a million women.

On average, 223 referrals were made yearly in IRIS-trained practices across Hackney. This scales to ~17,000 referrals nationally per year using the 2017 population statistics.

In January 2020, the London mayor’s Violence Reduction Unit announced a £1 million investment to expand IRIS training from 10 to 17 London boroughs.

We are working with our AHSN, UCLPartners, to increase awareness and implementation of the IRIS intervention with the STPs/ICSs in our region.

A GP described IRIS as: “…undoubtedly the most successful project of its kind…”.

The IRIS study 'Improving the healthcare response to domestic violence and abuse in UK primary care: interrupted time series evaluation of a system-level training and support programme' (BMC Medicine, March 2020) was awarded the 2021 RCGP Research Paper of the Year.

Queen Mary University of London

Newham Clinical Commissioning Group

University of Bristol