Boundary spanners: Negotiating connections across primary care and domestic violence and abuse services

Improving access to support for people experiencing domestic violence and abuse requires better connections between healthcare services and specialist domestic violence and abuse (DVA) support agencies. We examined the work involved in restructuring the relationship between primary care and specialist DVA support services. This was part of a broader study of the implementation of a general practice DVA training and support programme (IRIS). We conducted an ethnography in two different UK areas where the IRIS programme was being delivered. We investigated the work done by specialist DVA workers (Advocate Educators) in the dual role of providing training to GPs and advocacy support to patients. Drawing on concepts of boundary actors and boundary objects, we examined how interactions between clinicians and patients changed after the introduction of the IRIS programme. The referral pathway emerged as a boundary object, meeting a shared ambition of general practitioners and patients to distribute responsibility for addressing DVA. However, maintaining this as a boundary object-in-use required significant, and often unseen, work on the part of the Advocate Educator as boundary spanner. Our study contributes to scholarship on boundary work by highlighting the role of marginal boundary actors in maintaining the use of boundary objects among disparate groups.