Norfolk review

The Home Office Multi-agency Statutory Guidance for the Conduct of Domestic Homicide Reviews Section 2 subsection 4 should be amended to specifically include GP practices as having a duty to participate in a Domestic Homicide Review and to have regard to any guidance issued by the Secretary of State

A clause should be added to the NHS GP contract to stipulate their active participation in Domestic Homicide Reviews and Safeguarding Adult Reviews

That Intercollegiate Guidance for adult safeguarding which informs national training should include specific focus on domestic abuse including the Home Office definition of domestic abuse31, recognition of risk, and a process to escalate those risks and concerns.

The MARAC process should be reviewed to ensure that information concerning risk relevant to the service user is passed safely and promptly to any services to which they have been referred, as well as their GP practice.

A multi-agency protocol should be put in place to set out a process for sharing information with partner agencies when a Domestic Violence Prevention Notice or Prevention Order is being considered and/or put in place to support effective implementation and monitoring of the Order.

Mental ill health, depression or anxiety presentations to GPs, other health and social care practitioners and wider partners should ensure that the known links between these conditions and domestic abuse are recognised and that:
• assessments include sensitive routine enquiry about domestic abuse
• appropriate action is taken if abuse is identified

The Domestic Abuse & Sexual Violence Board to form a working and consultation group to examine the most practical and effective method of supporting GPs and their clinical staff to:
• implement a system of identification and risk assessment for patients who disclose, or who may be experiencing domestic abuse
• ensure a process for referring to specialist support and safety planning
• explore feasibility of providing in-house counselling services

Learning from this Review should be disseminated and generate a review of service delivery to those with the coexisting issues of domestic abuse, mental ill-health, and/or substance misuse, and be informed by service users themselves. The aims of this review should include:
• coordinating service provision to improve access and engagement
• ways and means of maintaining active engagement of the service user through the most appropriate agency and means of contact
• developing a clear policy for how to deal with non-attendance or failed contact, with a process for escalation where this gives cause for concern
• Consideration of referral to Adult Safeguarding.
(The review may wish to consider the whole system and holistic approach advocated by Alcohol Concern's Blue Light Project).

The Norfolk & Suffolk Foundation Trust to ensure that the Safeguarding Team have access to all patient record systems to effectively identify when a patient has been referred to any branch of their service and to MARAC, and to alert the service of the MARAC referral and outcome quickly to ensure appropriate and timely services to high risk victims of domestic abuse

The Trust should work together with CCGs to review the referral timescale choices to provide appropriate and timely options for referrers and their patients and to ensure that this is communicated to front line practices.