What is Steps to Safety, and how does it work?
It's a national NHS referral service for victims and survivors of domestic abuse and sexual violence, which the government first set out in December 2025. The NHS is often the first to see someone who's being abused, but it hasn't had enough ways to support them directly, so the service is built around the GP practice, in 3 parts:
- Practice staff are trained. Staff at GP practices in every region will be offered training to recognise abuse and know how to respond.
- A specialist support worker covers a group of practices. They support the staff at those practices.
- The patient is referred to specialist support. The practice connects them to specialist services in their own area.
It's meant to end what the government calls a postcode lottery, where the support someone gets depends on where they live. The announcements haven't yet said who will employ the support workers, how many practices each will cover or how a referral will be made.
What does it mean for GP practices?
In the year to March 2025, 2.2 million women aged 16 and over in England and Wales experienced domestic abuse. A referral route only helps if someone asks. When Healthwatch Surrey spoke to 64 survivors and 8 GP practices in Surrey, 89% of those who answered its survey said no one at their practice had referred them directly to specialist help. The barriers to telling anyone included having nowhere confidential to talk at the practice, worry about the digital trail and the fear of not being believed.
If the GP asked a series of questions in a way that would look behind the symptoms, such as 'Is everything at home, okay?', I think most people would want help if they needed it.
That question isn't far from what we're taught. At medical school, every history we take includes a social history: whether someone smokes, how much they drink, whether they use drugs and whether they're coping at home. Unfortunately, in general practice it can sometimes be harder to get to, when many appointments are still 10 minutes long and there's pressure from above to keep to time.
How do practices get it, and what should staff do until then?
Steps to Safety is run through ICBs, so practices will get it through their own ICB once it reaches their area. Until then, the National Institute for Health and Care Excellence's standard on domestic abuse still applies: anyone showing signs of possible abuse should be asked about it in a private discussion, and anyone experiencing abuse should be offered referral to specialist support. The National Domestic Abuse Helpline, run by Refuge, is free and open 24 hours a day on 0808 2000 247.
When will it happen?
The government's action plan on violence against women and girls had the service rolling out across ICBs from April 2026, with every area of England covered by 2029. The ICBs in the first phase weren't named in the announcement, which also doesn't say when the national clinical lead will be appointed.
Sources: DHSC: Support for families and babies rolled out to all family hubs (30 September 2026), DHSC and Home Office: Abuse victims to get specialist NHS support (16 December 2025), HM Government: Freedom from Violence and Abuse, Volume 2, Action Plan (December 2025), ONS: Domestic abuse in England and Wales overview (26 November 2025), Healthwatch Surrey: In safe hands? Domestic abuse survivors' experiences of general practice, in its insight bulletin (August 2025), Healthwatch England: What do survivors of domestic abuse tell us about their NHS care? (9 April 2026), NICE: Domestic violence and abuse, quality standard QS116 and National Domestic Abuse Helpline (Refuge)
