In safe hands? Domestic abuse survivors' experiences of general practice

Healthwatch Surrey looked into whether GP services were able to provide support to people experiencing domestic abuse. Primary care is an important point of contact for people to ask for help when experiencing domestic abuse. Whilst people had disclosed to Healthwatch Surrey that they were being abused, they hadn’t talked about their experience of getting support from general practice. Healthwatch asked 117 GP practices across Surrey to provide us with their domestic abuse data and only 2 were able to provide it

. The aim of this research project was to explore whether general practice is meeting the needs of people who are experiencing domestic abuse within Surrey, and what improvements can be made to better meet these needs. Healthwatch obtained the views, insights and opinions of both domestic abuse survivors and members of the GP practice teams across Surrey. Via an online survey and a series of focus groups and interviews, Healthwatch sought to gain a deeper understanding of all stages in the survivor’s interactions with general practice.

Healthwatch identified 7 barriers to people disclosing that they were experiencing domestic abuse, which we have categorised into those related to institutional factors and processes, and those linked to survivor perceptions and beliefs.

1. Lack of professional curiosity – GPs not questioning the reason behind presentations and a tendency to prescribe medication as the only solution. Survivors asked that members of the GP team improve their knowledge of the different forms of domestic abuse and take opportunities to ask questions that may facilitate disclosure.
2. Appointment booking and confidentiality – lack of confidential space and discretion from reception staff, concerns about the digital trail left by online booking systems, and lack of timely and unhurried face to face appointments with a preferred GP. Survivors asked for easy access for an unhurried appointment without having to specify the reason why they want to see the doctor.
3. Perceived lack of understanding – an underlying fear of not being believed and a perception of a lack of GP understanding of all forms of abuse. Survivors asked for members of the practice team to develop more awareness of the trauma of domestic abuse and the skills and knowledge to manage their needs, the ability to see the same GP in order to build a relationship and to not to have to repeat their story multiple times, and a domestic abuse specialist and/or advocate within the practice.
4. Fear of authority – feelings of intimidation around GPs.
5. Perpetrator’s presence – not being able to disclose with their perpetrator physically present or inhibited by their perpetrator being registered at their GP practice or with the same GP. Survivor perception and beliefs
6. Generational and cultural attitudes – beliefs around not discussing domestic matters outside the home.
7. Recognition of domestic abuse – lack of awareness that what was being experienced was domestic abuse.

Survivors said that before disclosing they were experiencing domestic abuse, they were concerned they would not be believed, particularly if their abuse was non-physical, or they were male or a parent. After disclosing, most said their concerns were realised as there was a lack of understanding or knowledge and, in some cases, stereotyping and prejudice. 

Some survivors cited issues of ‘problematising’ or being labelled with a specific medical condition or problem (and then being treated for that problem, not supported to deal with the abuse). Survivors also said that staff at the GP practice did not have adequate knowledge about domestic abuse in order to provide support, and, on occasion, provided harmful or unsafe advice. 

Post disclosure 68% of respondents to the survey said that they were not signposted to specialist help from an independent domestic abuse and violence service once they had shared their domestic abuse experience with their GP. 89% of respondents said that a GP or another member of the practice team had not directly referred them to specialist help. Survivors asked for referral rather than signposting as they did not feel able to get help themselves.

Survivors identified a lack of communication between GP practices and specialist domestic abuse services as a key issue. Healthwatch also noted differences and inconsistencies in systems for managing referrals and follow up. Survivors asked for improved communication between the GP practice and specialist domestic abuse services, better use of technology to signpost to domestic abuse specialist services anonymously, and more standard follow up to be embedded in best practice.