Somerset review

That all files are reviewed with senior staff before closure

Feedback and debrief to be offered to the general practice prior to final publication, including the good practice regarding the historical summary of medical records and seeking clarity if there was any history of domestic abuse.

That a review is undertaken of hospital discharge notices and that all relevant information is sent to the GP e.g. especially including disclosure by the patient of any unusual behaviour or experiences e.g. violence or fear of violence, referrals to specialist agencies for alcohol or substance misuse or DVA advice.

That the training and familiarisation regarding professional MARAC referrals and issues around DVA are continued.

For individuals or families who access part of the medical services from the armed forces, consideration should be given as to how this information should be shared with the primary care GP to inform holistic assessments of need, Where there are identified risks or suspected abuse this should follow the child protection and adult at risk safeguarding referral procedures.

The photocopy of the hospital admission record given to the DHR Review demonstrated a very poor standard of record keeping. The form was not completely filled in, the writing was illegible in many areas and the key piece of information regarding DVA disclosure was written in a margin sideways and was missed on the first pass by the DVA author who was specifically looking for this type of reference. Instruction should be given to all Emergency Department staff on the importance of full, good quality, complete, legible records for the purposes of onward referrals and potentially later investigations into processes.

Circulate lessons learnt from DHRs regarding the need to clearly document who is the primary carer for children.

That every time a disclosure of DVA is made appropriate referrals are made immediately and not left to a third party or agency to pick up.

Share good practice with GP practices.

That GPs follow up hospital attendance discharge notices with the hospital and or patient. Especially regarding those patients who have a known history of DVA, long term prescription of anti-depressant medication, substance misuse, or mental health issues.

MARAC and MAPPA processes do not currently cover those cases that are not considered high risk or have not yet been referred by any agency dealing with the victims or offenders. A PND flag would alert officers on first attendance that there is further information on DVA and follow it up quickly giving focus and direction, identifying all agencies involved.

The identification of a specific family welfare officer on all MOD stations would be invaluable to exchange information and concerns to police forces even if outside the remit of MAPPA and MARAC. A national approach is needed to MAPPA and MARAC and it should include the MOD. Currently police forces manage by local agreements only. MOD personnel to be trained in the MAPPA and MARAC referral process.