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* 1. Practice Name

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* 2. Does your practice have an up to date Domestic Abuse Policy in line with NICE guidelines?

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* 3. Are you aware of the website for Worcestershire County Council with regards to help, advise and support for families?

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* 4. Are practitioners confident when dealing with a disclosure of domestic abuse?

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* 5. Do all GP’s, ANP’s and PN’s have the skills and knowledge to recognise controlling and coercive behaviour?

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* 6. Do all GP’s, ANP’s and PN’s feel confident in asking a patient about domestic abuse?

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* 7. Do All GP’s, ANP’s and PN’s have knowledge of services locally for male victims of domestic abuse?

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* 8. Does the practice have helpline information on the practice walls and in the toilets?

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* 9. Are all practitioners trained in Domestic Abuse to level 3 standard?

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* 10. Any further comments?

Survey on behalf of NHS Redditch and Bromsgrove, NHS South Worcestershire and NHS Wyre Forest CCGs

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