Helping GPs support victim-survivors of family and sexual violence

How a pilot program is equipping general practices to better support victim-survivors of family and sexual violence

Asking a patient if they feel safe at home can be uncomfortable.

For Dr Jason Ratcliffe, a GP registrar at the Geeveston Medical Centre in southern Tasmania, recent training helped him reframe that discomfort as part of his duty of care to his patients. This included recognising when someone may be at risk and taking appropriate steps to support their safety.

“In med school, we are taught how to have conversations about suicide awareness, and in the training they likened it to these conversations,” Jason says. “Asking someone if they feel safe in their own home is a really uncomfortable thing to raise. It’s not just a matter of asking, it’s a matter of asking with real intent.”

Jason recently completed training delivered by the University of Melbourne’s Safer Families Centre as part of the Australian Government-funded Supporting the Primary Care Response to Family, Domestic and Sexual Violence Pilot, coordinated in Tasmania by Primary Health Tasmania. The pilot supports general practices and Aboriginal health services to better recognise and respond to family violence, sexual violence and child sexual abuse.

It has two components: a specialist support service delivered by Engender Equality and Laurel House, and education packages convened by the Safer Families Centre. The program aims to increase support for GPs and other primary care providers to assist with early identification and intervention, and to strengthen connections between the services helping people affected by violence.

It takes a whole-of-practice approach, supporting GPs and Aboriginal health services, including practice nurses, reception staff, practice managers and allied health professionals, to respond to disclosures, navigate referral pathways and connect victim-survivors with specialist support.

Family, domestic and sexual violence can affect people of any age and gender, although it disproportionately affects women, girls, and gender-diverse people. Statistics show at least 28 per cent of Tasmanian women have experienced sexual and/or intimate partner violence, while about the same proportion of all Tasmanians have experienced child sexual abuse. For many victim-survivors, general practice is one of the first places they seek help.

Primary Health Tasmania’s Susan Powell says GPs are a crucial entry point to support.

“Research shows GPs are the highest professional group disclosed to by current family violence survivors,” Susan says. “Of those who disclose, approximately one in three survivors who are currently experiencing violence, and one in four who have previously experienced partner violence, will seek help from GPs.

“At least one in 10 women attending general practice will have experienced family violence, which for a full-time GP translates to around five women per week. This is why GPs are uniquely placed to identify when family violence is occurring.”

The program provides education and upskilling, health system navigation, warm referral pathways and stronger integration between general practice and Tasmania’s specialist family and sexual violence services.

Engender Equality CEO Alina Thomas says each participating practice or Aboriginal health service has access to a designated support specialist.

“That support can include tailored presentations, secondary consultations, assistance with referral pathways, advice about documentation and mandatory reporting, and support for staff affected by difficult disclosures,” Alina says.

“We’re here to support clinics to be able to support their patients.”

Laurel House CEO Kathryn Fordyce says GPs play a key role in responding to sexual violence.

“General practice plays such an important role in early identification and support,” she says. “When primary care is safe, affirming and informed, and clinicians feel confident to ask, listen without assumptions and connect people to specialist support, it can make a profound difference for people affected by sexual violence and child sexual abuse.”

For Jason, the practical focus of the training was particularly valuable.

“As doctors, we’re very solutions-focused people,” he says. “We want to know, ‘what can I do?’.

“With my role in society, I can actually make the referrals to help people. So having a very practical conversation was really important. It was really great to understand the local resources and network. Now I’ve got numbers to call.”

He says the training also helped him think more carefully about the role of safety, choice and trust in the consultation room.

In one appointment after the training, Jason asked a patient experiencing family violence whether they felt comfortable continuing care with him, given the perpetrator was male and he is also a male GP. The patient chose to continue care with a female GP.

“It’s a vulnerable space,” Jason says. “You’re asking someone to bare their soul to you and you need to be the right person for them to feel safe to do that.

“I offered that question knowing that might be part of what was going on in the back of their head. I said, ‘I’ll look after you until we can get you in with a female GP’.”

Jason says the training helped him understand the importance of making options explicit, so patients did not feel awkward asking to see someone else.

“I probably wouldn’t have made that offer, ‘would you like to see a female doctor’, had I not had reason a couple of weeks earlier to really analyse the kind of care I was giving someone in that space,” he says.

The program also recognises the important role of non-clinical staff.

Jason says reception staff are often the first point of contact for people in distress, including people experiencing panic, suicidal thoughts or family violence.

“There’s a little bit of care that happens even before they sit down,” he says. “And it’s really valuable.”

Jason says the training helped reception staff feel more empowered in their role, while also prompting important conversations about how practices can support staff exposed to traumatic disclosures.

“So often reception staff in GP clinics are ignored in this space,” he says.“The value they can add by having more expertise and more comfort in understanding these things is really important.”

Safer Families Centre Director Professor Kelsey Hegarty says the education program is grounded in evidence and lived experience.

“Together, we’re working to build safer pathways for those experiencing family violence by equipping primary care with the tools and confidence to respond effectively,” Kelsey says. “By embedding trauma-informed approaches, we can help ensure victim-survivors receive timely, compassionate and effective care.”

Tasmanian Family and Sexual Violence Alliance CEO Bree Klerk says primary care is often the first—and sometimes the only—service people experiencing violence come into contact with.

“By building the skills of primary care workers to recognise and act on concerns early, we can reduce harm and improve health and wellbeing over the course of people’s lives,” Bree says.

For Jason, the message for other GPs is simple: the conversations may be uncomfortable, but they matter.

“It was really good just to give myself that little fire under the bum to make myself take that extra step and instead of tiptoeing around it to say, ‘Look, I just need to get better at this for the sake of patient wellbeing’,” he says.

“You can affect really powerful change on a person’s life as a doctor, which is wonderful in so many different ways.”

Jason says family and sexual violence training should be a part of mainstream medicine training.

“Because I think had we been taught to have this uncomfortable conversation, the same time I was taught how to ask someone if they’re suicidal, I would never have thought weirdly about it at all,” he says.

“But instead, I spent a few years probably dodging the question, to be frank, because I just didn’t know how to ask it.

“And as soon as someone provided me with a little bit of room to think about it, and a few examples of how to do it in a fluid and comfortable way, I’m like, ‘now I can do it’—and that’s all it took.

“I guess in my space, what I can do is just make sure I feel safe to the patient. I think that’s the most important thing.”

Learn more about Primary Health Tasmania’s role in supporting the primary care response to family and sexual violence here.

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This story features in Issue 22 of our Primary Health Matters magazine. Click here to read the rest of the issue.

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