Escalation, specialist support and local pathways

Concerns about domestic abuse may require practice safeguarding advice, urgent clinical input, police involvement, adult or child safeguarding referrals, or contact with specialist domestic abuse services.

Use the right route for the level of concern

Some contacts need immediate emergency action. Others require same-day review by a clinician or safeguarding lead. Non-urgent contacts still matter when they contribute to a pattern. Local procedures should be clear so reception staff know how to escalate.

• Immediate danger: follow emergency procedures and seek urgent clinical or safeguarding support.
• Disclosure or safe-contact concern: escalate to the safeguarding lead or an appropriate clinician according to local policy.
• Child or adult safeguarding overlap: make the relevant safeguarding referral in addition to arranging domestic abuse support.
• Specialist domestic abuse support: follow approved local pathways and use safe signposting methods.
• Unclear concern: consult the safeguarding lead, duty clinician or manager rather than keeping the concern unaddressed.

Signposting is not always enough

Giving a helpline number can help in some situations, but it is inadequate where there is immediate danger, child risk, adult safeguarding concern, unsafe contact, severe coercive control or where the patient cannot safely act on the information.

Printed leaflets, texts or links can increase risk if the abuser checks bags, phones, browser history or messages. Follow local guidance on safe ways to provide information.

Ownership matters

After escalation, someone must take responsibility for the concern. Reception staff should know who has accepted the concern, what immediate action is expected, and who to contact if the usual lead is unavailable.

Specialist support

Signposting is not enough when there is immediate danger or a safeguarding concern that requires professional ownership.