Addressing perpetrators of domestic abuse through GP healthcare: A good practice example
“The next step needs to be more perpetrator responses in every area”
General practice (GP) healthcare may be the only statutory service that people causing harm in relationships will encounter. Research shows that people worried about their behaviour are more likely to reach out to health services for help, particularly general practice healthcare and mental health services.
This creates a powerful opportunity for earlier intervention, but until now this opportunity has been largely untapped.
This impact report from our Recognise, Respond, Refer pilot in Newcastle, explores how general practice healthcare can play a central role in identifying people causing harm and connecting them to support to change earlier and reducing harm caused.
Front cover of the report, Addressing perpetrators of domestic abuse through general practice healthcare: A good practice example.
Strengthening the response of GP healthcare to people causing harm
One third of referrals to the Make a Change behaviour change programme are self-referrals. For someone to refer themself to a behaviour change programme, they first need to have some recognition that their behaviour is causing harm.
GP appointments are brief, and clinicians manage a wide range of health concerns. Any response to domestic abuse therefore needs to be realistic, proportionate and integrated into existing practice. This enables healthcare professionals to identify concerns and connect patients to expert domestic abuse services.
Working with key touchpoints, like GP healthcare, is foundational for bringing about this awareness in people who may be causing harm and connecting them to the behaviour change programmes, such as Make a Change, which currently operates in Coventry, Durham, Newcastle and Sunderland.
A complementary approach within a wider system
Make a Change complements interventions addressing survivors, including the IRISi model and emerging IRIS+ model. Drawing on learning from these models, it strengthens the system’s response to those using harmful behaviours, while maintaining a clear focus on safety and perpetrator accountability.
It also aligns with the government’s steps to safety initiative, which establishes pathways for patients to domestic abuse support through general practice healthcare. To be effective, Steps to Safety must be supported by:
Co-production between GP healthcare leaders and specialist domestic abuse services, ensuring system responses and pathways are shaped by both clinical leadership and domestic abuse expertise tailored workforce training that builds skill and confidence
Access to safe, accredited perpetrator interventions
Without this, there is a risk that health services are asked to intervene without clear, safe pathways to refer into.
What we found
The impact report highlights several important findings:
Confidence to respond increased significantly following training
GP healthcare became a new and meaningful referral pathway into behaviour change – maintained well beyond the pilot
Referrals also generated additional support for survivors, strengthening the wider system response. Crucially, the pilot showed that it is possible for primary care professionals to ask about harmful behaviour – when supported with the right training and consistent referral pathways.
Why it matters
Too often, systems respond only after harm has escalated. This work demonstrates:
Health services have a vital role in recognising, responding to and referring people using harmful behaviours towards an intimate partner, creating opportunities for earlier intervention and behaviour change
When perpetrator responses go alongside support for survivors, this strengthens survivor safety and autonomy
System change through a whole-practice approach – not just training – is needed to enable safe responses
Importantly, responding to perpetrators strengthens support for those experiencing harm. Referrals from GP healthcare in Newcastle generated additional support for victims and survivors through Changing Lives, the local specialist service providing an integrated support service (ISS) for survivors identified through Make a Change. In line with the Respect Standard, the ISS for survivors is a vital element of the programme.
General practice healthcare has the potential to connect people across the whole system to appropriate domestic abuse services. When done safely – when the intervention with the person using harm is undertaken in a way that does not increase risk to the survivor but further bolsters support for the survivor – this can have a powerful ripple effect.
Endorsements
Jess Asato MP, Chair of the All-Party Parliamentary Group on Perpetrators of Domestic Abuse:
“I am pleased to welcome this report from Respect's Make a Change programme. GP surgeries are often where domestic abuse, be it from a victim or from someone concerned about their behaviour, is first revealed.
This important project that builds on what we know works, demonstrates the significant impact that using Recognise, Respond, Refer can have on health professionals working in general practice.
The training clearly gives staff the knowledge, and therefore the confidence, to raise the subject of domestic abuse, which ultimately protects victims from further harm, and encourages perpetrators to address their behaviour.
The next step needs to be more perpetrator responses in every area, to ensure that people causing harm who are identified via primary care can access a high quality programme close to where they live.”
James Booth, Co-Chair of the National Network of Named GPs (Safeguarding):
"GPs and their teams have a key role to play in the identification of domestic abuse and helping victims to find safety and support. We must also be able to identify and respond to those who perpetrate abuse, and Respect’s Recognise, Respond, Refer training helps build the confidence of general practice staff to do just that. We welcome new resources, services and education to build on this important work."
Hilary Lloyd, Chief Nurse, North East and North Cumbria Integrated Care Board:
“Domestic abuse has a devastating impact on individuals, families and communities. The NHS has an important role to play in helping to prevent harm and support people affected.
This work shows the important role general practice can play in recognising harmful behaviour, starting difficult conversations and connecting people with specialist support. The Recognise, Respond, Refer approach gives primary care teams a practical way to do this. The experience in Newcastle shows the difference that the right training, confidence and referral routes can make.
By working with Respect and our local domestic abuse partners, we can help people who are causing harm to change their behaviour, while ensuring the safety and support of victims and survivors remains at the centre of our approach.”