For someone experiencing domestic abuse, a routine appointment with their GP may provide an important opportunity to seek help, but recognising abuse is only the beginning.
The real question is whether healthcare professionals have the confidence, knowledge and specialist pathways needed to respond safely and effectively.
On 23 October 2026, the Department of Health and Social Care announced further details of Steps to Safety, a programme intended to strengthen the identification of and response to domestic abuse and sexual violence within general practice.
The initiative highlights the important role healthcare services can play in recognising harm, supporting survivors and connecting people with specialist assistance.
What Is Steps to Safety?
The programme is being introduced in phases, with the aim of establishing national provision in England by 2029.
Twelve integrated care boards have been selected for the first phase, with up to £34.4 million allocated over three years.
Participating GP practices will have access to independent domestic abuse and sexual violence specialist workers.
These professionals will support practices through training, specialist advice, referrals, advocacy, risk assessment and safety planning.
The intention is to make it easier for patients to disclose abuse and receive appropriate support without having to navigate complex systems alone.
Domestic Abuse Is Not Always Immediately Recognisable
Domestic abuse can involve physical or sexual violence, but it may also include psychological abuse, coercive control, economic abuse and other patterns of harmful behaviour.
Survivors may not describe their experiences as abuse.
They may present with anxiety, repeated injuries, sleep difficulties, chronic health concerns or other needs without initially disclosing what is happening.
Some may be accompanied by a controlling partner or have limited opportunities to speak privately.
Healthcare professionals therefore need to recognise possible indicators without making assumptions.
Professional curiosity, sensitive enquiry and a trauma-informed approach are essential.
Creating Conditions Where People Feel Able to Disclose
Asking about domestic abuse requires more than simply including a question in an assessment.
Professionals must consider privacy, safety, communication needs and the possibility that a disclosure could increase risk if handled inappropriately.
A person may not be ready or able to disclose abuse during their first conversation.
Others may disclose only part of their experience.
The response they receive can influence whether they seek further help.
Staff should know how to listen without judgement, respond sensitively and explain confidentiality and its limits.
They must also understand when safeguarding or other legal responsibilities require further action, even where consent to a particular referral has not been provided.
Why Specialist Pathways Matter
A disclosure should not leave the professional or survivor uncertain about what happens next.
Effective safeguarding responses depend on clear pathways to specialist services.
The Steps to Safety model recognises this by connecting general practice teams with independent domestic abuse and sexual violence workers.
Specialist support can assist with risk assessment, safety planning, advocacy and access to further services.
However, organisations must also ensure that staff understand their own responsibilities and that urgent risks are escalated appropriately.
A referral pathway is valuable only when it is understood, accessible and effective in practice.
Recognising the Wider Impact on Children and Adults
Domestic abuse can affect multiple members of a household. Children who see, hear or experience the effects of domestic abuse are recognised as victims in their own right under the Domestic Abuse Act 2021 where the statutory conditions apply.
Professionals should consider the impact on children, including their emotional wellbeing, safety and development.
Adult safeguarding responsibilities may also arise where an adult has care and support needs and meets the relevant statutory criteria.
Effective responses require consideration of the whole household, without losing sight of the wishes, circumstances and safety of the individual seeking support.
What Should Healthcare Organisations Consider?
The programme provides an opportunity for healthcare leaders to reflect on their existing safeguarding arrangements.
Five questions are particularly important:
1. Recognition: Are staff confident in identifying different forms of domestic abuse, including coercive control and economic abuse?
2. Response: Do staff know how to respond safely and sensitively to a disclosure?
3. Referral: Are specialist domestic abuse and sexual violence pathways clearly understood and accessible?
4. Information-sharing: Do professionals understand when and how information may need to be shared to protect people from harm?
5. Assurance: Does the organisation evaluate whether referrals and interventions are resulting in meaningful support?
From Recognition to Meaningful Intervention
The Steps to Safety programme represents a welcome effort to strengthen the relationship between healthcare and specialist domestic abuse services.
Its success will depend not only on identifying more people experiencing abuse, but on ensuring they receive safe, timely and appropriate support.
Safeguarding does not end when a concern is recognised or a referral is made. It requires us to consider what happens next and whether the person is safer as a result.
How RLB Safeguarding Can Help
RLB Safeguarding supports organisations through safeguarding training, consultancy, supervision and independent assurance.
We help professionals strengthen recognition, professional curiosity, escalation arrangements and effective responses to abuse and exploitation.
Source: DHSC: Steps to Safety Initiative