Research highlights

• More training and support for GPs.  
• Better care for patients.
• Major cost savings for the healthcare providers and wider society.
• Significant impact on UK and international health policies.

Domestic violence and abuse (DVA) impacts over a million of women in the UK every year and is a major health concern. Aside from physical injuries, affected women can suffer chronic health issues including neurological symptoms and mental health problems.  

Historically, clinicians and GPs had not responded effectively to these needs because they had little or no training, failed to identify patients who had been abused and were unsure how to manage follow up after women had spoken up. 

Bristol research that has paved the way for the IRIS (Identification and Referral to Improve Safety) programme that has transformed this situation by providing GPs with targeted training and a new referral pathway to specialist third sector domestic violence agencies.

IRIS has changed clinical policy and practice in England and Wales, improved patient outcomes and is informing the rollout of similar initiatives around the world. 

Trials prove effectiveness of intervention 

The Bristol team led the development, trialling and implementation of the IRIS programme across 46 areas of England and Wales, including training in over 1,000 general practices.  

The first trials established that a training and support programme for primary care staff improves recorded identification of DVA and referral to domestic violence agencies. Linked research included a cost-effectiveness study of the trial, a qualitative study of the experiences of survivors of DVA receiving IRIS support and a further cost-effectiveness analysis of post-trial implementation across the NHS. 

Following the success of the IRIS trial, the team also created the ‘IRIS – strengthening impact’ (IRISimp) programme’ to roll out the IRIS model into general practices across the country.

The two-year collaboration with the Health Foundation led to the commissioning of the IRIS model by clinical commissioning groups (CCGs) and local authorities. Additional developments include IRIS ADVISE – an adaption of IRIS for sexual health care that has been evaluated in east London and Bristol. 

Wide reaching impact 

By 2020, 48 regions in England and Wales had commissioned the IRIS programme. This resulted in training for 1,036 general practices and support for over 20,000 women who were referred to domestic violence support services.

Evaluation by the Bristol team showed that patients reported a more appropriate response from clinicians when they spoke up about domestic violence. Of 1,500 women who received IRIS-driven support, 98% said they were pleased to have been referred.

Another 80% said they felt safer, more confident, better able to cope and optimistic about the future.  There is also strong evidence IRIS reaches an older demographic of women, a previously ‘invisible’ group of survivors that didn’t tend to use specialist DVA advice services. 

NHS staff reported benefits of the IRIS programme too – 19 out of 20 clinicians said they would recommend IRIS training to a colleague, while GP reception teams said their confidence to respond appropriately to patients rose from a rating of 4.2 to 8.3 out of 10. 

The success of the IRIS programme has also influenced national health policy, including the National Institute for Health and Care Excellence’s (NICE) guidelines on DVA care, the Home Office’s Violence Against Women and Girls Strategy (2016-2020) and the National Strategy on Violence against Women, Domestic Abuse and Sexual Violence (2016-2021) in Wales.  

The impact is spreading to international policy as well. The World Health Organisation has drawn heavily on the University’s IRIS research to make recommendations about the training of healthcare providers. IRIS now informs programmes in Europe, Palestine, Brazil, Nepal and Sri Lanka.  

Crucially, Bristol’s modelling is supporting the business cases for these programmes with estimates that show that the annual cost saving associated with IRIS is greater than £2,400,000 per year in the UK.

This analysis could support a further expansion of IRIS-influenced guidelines across the country and globally, benefitting of thousands more women who are suffering DVA and don’t yet have access to appropriate care.