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£34.4 million, 12 areas, and the conversation your GP practice is now trained for

Qurexa Editorial Team23 October 20268 min read 0 0
£34.4 million, 12 areas, and the conversation your GP practice is now trained for

What happened

On 23 October 2026 the Department of Health and Social Care announced that a programme called Steps to Safety has started in 12 areas of England. It changes what a GP practice can do when someone says they are being abused. In a practice that is taking part, you can raise domestic abuse or sexual violence with any member of staff, not only your doctor. It covers abuse happening now and abuse that happened in the past. Staff are trained to spot the signs and respond carefully. If you agree to it, you are referred on to specialist support. Nothing is passed on without your agreement. The people you are referred to are called domestic abuse and sexual violence specialist workers, often shortened to DASV workers. They are independent of the practice. They train practice staff, take referrals, carry out risk assessments, build safety plans, speak up for patients trying to get help, and arrange access to specialist services. One of them becomes your single point of contact, so you do not have to keep explaining your situation to a new person each time. The 12 areas were picked in September 2026. They are integrated care boards, or ICBs, the NHS bodies that plan regional services: Cheshire and Merseyside; North East and North Cumbria; Essex; Norfolk and Suffolk; the Black Country; Birmingham and Solihull; Coventry and Warwickshire, which bid jointly with Herefordshire and Worcestershire; Surrey and Sussex; Kent and Medway; Bristol, North Somerset and South Gloucestershire; and Cornwall and the Isles of Scilly. This first phase has up to £34.4 million behind it over three years, rising from about £8.1 million in 2026 to 2027 to £13.2 million in 2028 to 2029. A second pot of £15 million over three years is going to every ICB in England, not just the 12, to strengthen local specialist services. It is shared out according to how many patients are registered with each ICB's GP practices. Steps to Safety is being introduced in three phases. It began in April 2026, and the aim is for the whole of England to have it by 2029. The government committed to it in its Freedom from violence and abuse strategy, published in December 2025.

Why this matters

A GP surgery is one of the very few places almost everyone visits at some point, and you do not need to tell anyone where you are going. Someone living with abuse may never walk into a police station or ring a helpline. But they will probably see a nurse about a sore shoulder or a chest infection. The problem has been what happens next. A member of staff might notice something is wrong and have no idea where to send the person. Or they hand over a leaflet with a phone number on it, which the person then has to hide. Steps to Safety is built to close that gap. Instead of a leaflet, there is a named person who takes the referral and stays with you. The design also deals with something people often worry about. Control is a central part of abuse, so a service that takes decisions out of your hands can feel like more of the same. That the referral happens only if you say yes, and that the worker is independent of the practice, are deliberate choices rather than small print. It is worth being clear about the limits. This is phase 1. If you do not live in one of those 12 areas, your GP practice is not part of it yet, and the 2029 date for national cover is a plan, not a promise.

What the evidence actually says

Steps to Safety is not a brand new idea. It builds on an existing model called IRIS, short for Identification and Referral to Improve Safety, which puts a trained advocate educator alongside GP practice staff. That is close to what a DASV worker does, so there is real research to look at. The strongest study was published in BMC Medicine in 2020 and summarised by NIHR Evidence. It looked at GP referrals of women aged 16 and over between 2012 and 2017, across 205 surgeries in five northeast London boroughs. In the four boroughs running IRIS, 144 practices saw referrals for domestic abuse rise 30-fold over four years. In the fifth borough, where 61 practices got a one-off education session instead, referrals did not rise at all. The researchers put the difference down mainly to staffing: a specialist person physically alongside the practice, employed by a local abuse service, connecting primary care to specialist help. Now the caveats, which matter just as much. The study did not follow what happened to those women afterwards. It did not measure whether their health improved, or whether they became safer. The authors said that needs more research. Referral numbers also stayed small next to how much abuse is thought to happen, because most abuse is never disclosed to anyone. The study was observational rather than a randomised trial, and the comparison group was a single borough. Some authors were involved in running IRIS at the time, which they declared. The summary is now more than five years old. One more finding is relevant today. IRIS was cut in about a quarter of the areas that introduced it, because funding did not last. That is worth holding in mind when a programme arrives with three years of money attached. So the fair summary is this: the evidence that this kind of scheme gets far more people referred to specialist help is good. The evidence that it makes people measurably safer or healthier has not been gathered yet.

Qurexa perspective

We deliver prescriptions and groceries to people's homes in Lincolnshire, so two things stand out to us. The first is honest and slightly awkward: Lincolnshire is not in phase 1, so if you are one of our customers, your GP practice is not part of Steps to Safety yet. We would rather say that plainly than let anyone expect something that is not there. The £15 million fund does reach every ICB in England, including ours, but the GP referral pathway itself is not here yet. The second is about what home delivery actually is. Our drivers are not trained safeguarding professionals, and we would never pretend otherwise. But a repeat delivery means the same person turns up at the same door regularly, and sometimes that is one of the few steady points of contact someone has. The principle worth repeating is this: the best place to mention abuse is often not a dramatic one. It is the ordinary appointment you were going to anyway.

Practical advice

If you are living with abuse, or think you might be: You can tell any member of staff at your GP practice. In the 12 Steps to Safety areas, staff have been trained for this. Outside them, most practices still have a safeguarding lead and local contacts. You do not need proof, photographs or a police report to say something. If you are worried about being overheard at home, ask the practice for a private appointment, ask them to ring you at a set time, or ask them not to post anything to your address. The National Domestic Abuse Helpline, run by Refuge, is free and open 24 hours a day on 0808 2000 247. Calls do not show on itemised phone bills. If you are in immediate danger, call 999. If you cannot speak, dial 999 then press 55, and the handler will treat it as a silent emergency call. Think about your device. Browsing history, messages and apps can be checked by someone else. Many support websites have a quick exit button, and you can look things up on a friend's phone or a library computer. If you work in a GP practice in one of the 12 areas, your ICB will have details of the training and the specialist workers. National training and resources are being developed with NHS England.

What to know

Steps to Safety started on 23 October 2026 in 12 areas of England. In a participating GP practice, you can raise domestic abuse or sexual violence with any staff member, and you are referred to an independent specialist worker only if you agree. Phase 1 has up to £34.4 million over three years, a separate £15 million goes to every ICB in England, and the aim is national cover by 2029. Evidence from the similar IRIS programme is encouraging on referrals, with a 30-fold rise in one large study, but it has not yet shown long-term health or safety benefits. Funding has been a weak point for this kind of scheme before. Free, confidential help is available now, wherever you live: the National Domestic Abuse Helpline on 0808 2000 247, 24 hours a day. In an emergency, 999, then 55 if you cannot speak. Sources: Department of Health and Social Care, 'Steps to Safety initiative introduced in 12 areas across England', GOV.UK, 23 October 2026, https://www.gov.uk/government/news/steps-to-safety-initiative-introduced-in-12-areas-across-england; NIHR Evidence, 'Support programme for GP practices increases referrals for domestic abuse', 19 May 2020, https://evidence.nihr.ac.uk/alert/support-programme-for-gp-practices-increases-referrals-for-domestic-abuse This article is for general information and does not replace advice from a doctor, pharmacist or other qualified healthcare professional. If you are in immediate danger, call 999.

#domestic abuse#GP practices#DHSC#NHS England#primary care#patient safety

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