Domestic Violence & Abuse inquiries

You asked

To improve GP awareness of symptoms and behaviour associated with DVA through IRIS training. 

The CCG should ensure that all appropriate staff in General Practice are IRIS trained and confident in making safe enquiry into domestic abuse where clinically indicated

Our response

IRIS (Identification and Referral to Improve Safety) is a General Practice based Domestic Violence and Abuse (DVA) training, support and referral programme for General Practice staff which is commissioned by MHCC.  Find your local IRIS site – IRISi  All 85 Manchester GP practices have received IRIS training which includes identifying the symptoms and behaviour associated with DVA.  The training is regularly reviewed to include learning from domestic homicides and other statutory reviews.  The training is also provided as an update session every 3 years and any new starters can access training at ‘mop up’ sessions offered locally.  The effectiveness of training is evidenced by increased referrals by Primary Care to IRIS over the years, last year GPs made 741 referrals.

To disseminate learning from the DHR via Safeguarding Newsletter, CCG 

The learning within the 7-minute briefing was circulated 26.11.2018 by the Director of Corporate Affairs MCCG and all learning from DHRs is included within the IRIS training delivered to practices.

The findings from the review are shared with Primary Care with the expectation that all presenting needs of patients are considered and that professional curiosity is exercised to contribute to risk assessment.

The learning from DHRs is included within IRIS update training for primary care staff.  Professional curiosity and indicators of DVA are included within IRIS training and also within other safeguarding training such as Neglect and Early Help and the Adult Self-Neglect training.  The findings were sent to primary care by email on 5.8.19 by the MCCG safeguarding team.

Ensure that GPs inform patients of services they can access during the period they are waiting for a mental health outpatient appointment

With any GP consult needing a referral to mental health services it is expected/standard practice that the consultation would include safety netting i.e. what to do if things deteriorated with specific signposting to services appropriate to the patient’s circumstances. The CCG commission mental health services which includes access to services for safety netting.

Review how GP practices can engage with those patients that are traditionally difficult to engage including review areas of best practice and consider how an outreach approach may be implemented.

It is recognised that some patients may not attend appointments and require extra support to meet their health and care needs. We have developed a local and a Greater Manchester procedure to enable General Practice to manage the non-attendance of adults with care and support needs. Good practice approaches to engaging patients has been included in the self-neglect training we have run for GPs along with a self-neglect podcast and Greater Manchester flow chart  Good practice on how to engage patients is also included within IRIS training.

Primary Care to be updated on self-neglect as a safeguarding issue and equipped to make a social care referral for self-neglect/vulnerability rather than only considering a mental health referral.

The MCCG Designated Team have run self-neglect training to equip general practice staff with the skills to recognise and respond to self-neglect as a safeguarding issue.  This training has run from February 2020 until the end of the last quarter and we plan to provide an update session two yearly.  The training included how to apply the mental capacity act and when and how to escalate cases.  To accompany the training a Managing non-attendance policy and a self-neglect flow chart was produced along with a podcast which is available online has identified Self-neglect as a priority for this year and the Designated Team are taking a lead on this piece of multi- agency work.

Ensure that patients with a drug dependency have a medication review at least annually.

The majority of patients with a drug dependency are now supported by Change Grow Live in Manchester who prescribe and monitor, regularly review medications used in drug treatment, offer referrals to rehabilitation services, sign post to needle exchange and provide holistic advice and support.  Change Grow Live | Charity | We can help you change your life.