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Recognise and respond: White Book update guides GPs

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The statistics on family and domestic violence in Australia are sobering.
 
It is estimated that one in six women aged over 18 have experienced physical or sexual violence by a current or previous partner since turning 15.
 
In 2020, police-recorded incidents of family and domestic violence-related sexual assault increased by 13% from the previous year, while family and domestic violence-related deaths in women remain high.
 
Evidence also shows that the pandemic has brought with it an escalation of violence and abuse, verifying predictions of a spike during COVID-19 stay-at-home restrictions.
 
Around two-thirds of women who experienced physical or sexual violence by a current or former co-habiting partner have reported that the violence started or escalated since the start of the pandemic.
 
It is why RACGP President Dr Karen Price believes GPs have an ongoing and important role in identifying and providing support for patients experiencing abuse and violence.

‘Australia has been in the grips of a domestic violence and abuse crisis for a long time, and the pandemic has made matters worse,’ she said.
 
‘As a practising GP, I’ve seen how the pandemic has impacted relationships and families, with many facing isolation, financial pressures, and the burden of home schooling.
 
‘It’s a perfect storm for people living with abusive or violent partners or other family members.’
 
To further support GPs in assessment, management and prevention, the RACGP has launched the fifth edition of Abuse and violence: Working with our patients in general practice (White Book).
 
Developed by GPs and experts and based on current evidence base, the White Book is designed to be a practical and valuable resource for health professionals.
 
GPs are often the first port of call for people experiencing, and survivors of, abuse and violence. The White Book presents comprehensive guidance on this sensitive area of care, outlining the signs for GPs to be aware of.
 
‘As one of the only health practitioners that provides ongoing, holistic care to a patient throughout their life, GPs are uniquely placed to help people experiencing abuse and violence,’ Dr Price said.
 
‘Often patients won’t come to their GP asking for help, but rather their GP is trained to notice when something isn’t right.
 
‘We recognise the signs and are well placed to start the conversation with a patient to find out what’s going on.’
 
Federal Health Minister Greg Hunt has also welcomed the new guidelines.
 
‘We know family violence and abuse can sadly be part of the lives of Australians across the country,’ he said.
 
‘We also know victims and survivors often turn to their GP for support, and that their GP’s response can make all the difference.
 
‘The update of this key resource for GPs will ensure our nation’s doctors have best practice guidance on how to recognise and respond to people experiencing family and domestic violence.’
 
To improve access to care and strengthen the GP−patient relationship, family and domestic violence experts have been calling for MBS-subsidised Family Safety Plans – an initiative Dr Price supports.
 
‘Currently there are barriers to care for people experiencing violence and abuse, which can easily be removed if the criteria for General Practitioner Management Plans are expanded to include those experiencing family violence,’ she said.
 
‘Patients would also benefit from access to Medicare patient rebates for longer consultations, so they can take the time needed to have a conversation with their GP and talk about their concerns.
 
‘These simple changes will mean more patients can access the care and support they need when they need it – it’ll make a big difference for individuals and families.’
 
The new edition of the White Book has been expanded to include six new chapters:
 

• Supporting men who experience intimate partner abuse and violence
• Trauma-informed care in general practice
• Adolescent-to-parent violence
• Dating violence and technology-facilitated abuse
• LGBTIQA+ family abuse and violence
• Intimate partner abuse and violence − education and training for healthcare professionals

The guidelines also include models of care specific to other vulnerable populations, such as migrant and refugee people, elderly people, and Aboriginal and Torres Strait Islander people.
 
According to Professor Kelsey Hegarty, Co-Chair of the White Book Expert Advisory Group and Director of the Safer Families Centre of Research Excellence, trauma-informed care is an important part of GPs’ stewardship.
 
‘This White Book is based on recent evidence synthesis and global guidelines collected by the Safer Families Centre, particularly around what victims/survivors want from health professionals, enabling the advice to be firmly patient-centred,’ she told newsGP.
 
‘Strengthening of the responses to diverse populations is a very welcome addition, and the focus on trauma- and violence-informed approaches is essential.’
 
Professor Hegarty’s work with the Safer Families Centre includes the recent development of The Readiness Program. The national training program has been specifically tailored to primary care, in the wake of GPs reporting a lack of access to existing training resources as a barrier in their readiness to address family and domestic violence.
 
The White Book recommends that a comprehensive, whole-of-practice, systems approach to education and training can ‘improve healthcare professionals’ knowledge, attitudes and beliefs, as well as their clinical readiness to respond to partner violence’.
 
This includes collaboration with the Safer Families Centre as part of The Readiness Program, to ensure GPs can recognise, respond, refer and record domestic and family violence using a trauma-informed approach.
 
‘Because GPs often see members of the same family, we also play an important role in assessing violence and safety within families,’ Dr Price said.
 
‘A GP will support a patient experiencing abuse by referring them to relevant support services, as well as managing the physical and mental health consequences.’
 
The update of the White Book was supported with funding from the Federal Department of Health, and is available on the RACGP website.
 
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abuse and violence family and domestic violence trauma-informed care White Book

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