Core Revision
Revision aid, not clinical advice. This page is educational material written for exam preparation. It is not a substitute for the current guideline or for clinical judgement, and must not be relied on for the care of any individual. Always check up-to-date national guidance and verify independently before acting on anything here.
Chapter 9 of 11 · Ethics, Law & Safeguarding
Domestic abuse and coercive control
A statutory definition that is broader than most people expect, an offence that no longer requires living together, and a screening question the evidence does not support.
The statutory definition
Under the Domestic Abuse Act 2021 s1, behaviour is domestic abuse if both people are aged 16 or over, they are “personally connected”, and the behaviour is abusive. Abusive behaviour includes:
- physical or sexual abuse
- violent or threatening behaviour
- controlling or coercive behaviour
- economic abuse
- psychological, emotional or other abuse
It can be a single incident or a course of conduct. “Personally connected” is defined by s2, and covers current and former spouses, civil partners and intimate partners, people who have agreed to marry, people with a parental relationship to the same child, and relatives.
Two features people miss. It is not limited to partners — adult child to parent, and sibling to sibling, are domestic abuse. And under s3, a child under 18 who sees, hears or experiences the effects of the abuse, and is related to either party, is a victim in their own right — not a witness.
Controlling or coercive behaviour
The offence is in s76 of the Serious Crime Act 2015. Repeated or continuous controlling or coercive behaviour towards someone you are personally connected to, which has a serious effect on them — either they fear violence on two or more occasions, or it causes serious alarm or distress with a substantial adverse effect on their usual day-to-day activities. Maximum sentence 5 years.
The requirement that the parties be living together was removed by the Domestic Abuse Act 2021 s68, in force from 5 April 2023. Ex-partners and family members who do not cohabit are now covered. The change is not retrospective — conduct before that date between non-cohabiting ex-partners is not caught.
What coercive control actually looks like
- Monitoring and surveillance — phone checks, location tracking, demanding replies within minutes
- Isolation from family, friends and support
- Economic abuse — controlling money, running up debt in their name, sabotaging employment
- Reproductive coercion — sabotaging contraception, controlling decisions about pregnancy
- Withholding documents — passport, immigration papers, bank cards
- Restricting access to healthcare — including attending every appointment and answering for them
- Threats involving children or pets; weaponising child arrangements
“Section 76” is ambiguous and the exam knows it. Serious Crime Act 2015 s76 is the coercive control offence. Domestic Abuse Act 2021 s76 is about polygraph conditions. It was DAA 2021 s68 that removed the cohabitation requirement, and s77 that put Clare’s Law on a statutory footing.
Non-fatal strangulation
A separate offence since 7 June 2022 (Serious Crime Act 2015 s75A). No injury is required, consent is not a defence where serious harm results, and it is not confined to domestic settings. Maximum sentence 5 years.
Clinically this matters more than its sentence suggests: strangulation is one of the strongest single predictors of subsequent homicide in domestic abuse. Ask about it directly, examine for petechiae, subconjunctival haemorrhage, voice change and dysphagia, and treat a history of strangulation as a high-risk marker regardless of what you find.
Risk assessment and referral
| Route to MARAC | Threshold |
|---|---|
| Visible high risk | 14 or more “yes” answers on the SafeLives Dash checklist (24 questions) |
| Professional judgement | Your judgement alone is sufficient — a score below 14 does not preclude referral |
| Potential escalation | Usually 3 or more police callouts in 12 months |
High-risk victims go to MARAC (the multi-agency risk assessment conference) and to an IDVA (independent domestic violence adviser). A referral to MARAC can be made without consent where the risk of serious harm justifies it — but tell the person, unless doing so would increase danger.
A 34-year-old woman attends with a sore throat and hoarseness. On direct questioning she says her partner “grabbed her neck” during an argument three days ago. She has no visible injury. She scores 9 on the Dash checklist. She is frightened but does not want the police involved.
What do you do?
The Dash score is one of three routes to MARAC. Professional judgement alone is sufficient, and a history of strangulation is one of the strongest predictors of subsequent homicide. A score of 9 does not close the question.
Strangulation is a high-risk marker whatever the numerical score. Refer on professional judgement, refer to an IDVA, and document her words verbatim.
Clinically: examine for petechiae, subconjunctival haemorrhage, voice change and dysphagia, and consider imaging — serious internal injury can occur with no external mark, and delayed presentations are described.
Also: non-fatal strangulation is a criminal offence in its own right, no injury required. Explain that. And ask about children in the household — under s3 they are victims too, which may trigger a separate child safeguarding referral.
Her wishes matter and you should work with them as far as you safely can — but the risk of serious harm here justifies referral even without her agreement. Two weeks is a long time in an escalating situation.
Unless there is immediate danger, calling the police against her wishes can escalate risk and destroy trust. MARAC and an IDVA are the proportionate route; the police come in through that process, with a safety plan around her.
Pick an option to see the answer.
Clare’s Law and Sarah’s Law
| Scheme | What it is | Status |
|---|---|---|
| Clare’s Law (Domestic Violence Disclosure Scheme) | Right to Ask — a member of the public asks police whether a partner has an abusive history. Right to Know — police proactively disclose. | Statutory footing via DAA 2021 s77, commenced 5 April 2023. Initial checks within 24 hours; face-to-face within 10 days; 28 days maximum end to end. |
| Sarah’s Law (Child Sex Offender Disclosure Scheme) | Anyone can ask police whether a named person has a record of child sexual offences. Disclosure goes to the person best placed to protect the child. | Non-statutory police policy. |
Should you ask everyone?
This is where a lot of teaching is out of date, and it is worth being precise.
Screening for intimate partner violence is not part of any UK screening programme. The UK National Screening Committee opened a consultation on it in late 2025; no recommendation has been published, and the long-standing position is that there is no evidence screening reduces violence or improves health outcomes. Routine enquiry (asking everyone, regardless of indicators) is Department of Health policy in maternity and adult mental health services. General practice operates targeted case-finding: ask when indicators are present, in a trained way, with a referral pathway ready.
The distinction the AKT wants: screening (not recommended) is not the same as asking (essential when indicators are present). What the evidence supports in general practice is the IRIS model — whole-practice training, prompts in the clinical system, a named advocate educator and a direct referral pathway — validated in a cluster randomised trial.
Documenting safely
- Record her own words in quotation marks
- Describe injuries objectively; use body maps
- Record the risk tool used, the score, and your actions
- Record the justification for any disclosure made without consent
- Keep the detail out of records visible through proxy or online access — use your practice’s agreed protected coding
Forced marriage, honour-based abuse and FGM in adults
- Forced marriage is an offence (s121 Anti-social Behaviour, Crime and Policing Act 2014), maximum 7 years. Forced Marriage Protection Orders are available; breach is a criminal offence. The Forced Marriage Unit helpline is 020 7008 0151.
- Since 27 February 2023 the minimum age of marriage in England and Wales is 18, and arranging the marriage of anyone under 18 is an offence even without coercion — including non-legally-binding traditional ceremonies.
- Honour-based abuse has no standalone offence; it is prosecuted through existing offences with the context treated as an aggravating factor.
- FGM in adults is not covered by the mandatory reporting duty. Follow local safeguarding procedures, risk-assess girls in the family, explain that FGM is a criminal offence in the UK, and record on the FGM Enhanced Dataset.
Never use a family member as an interpreter where forced marriage or honour-based abuse is suspected, never attempt family mediation, and never let the person know you have contacted anyone if that would place them at risk. These are the standard errors, and in this context they can be fatal.
Self-testA man discloses that his wife controls his money, monitors his phone and has threatened to report him to immigration if he leaves. Does the law apply the same way?
Yes. The Domestic Abuse Act definition is gender-neutral, and everything described is recognised abusive behaviour: economic abuse, monitoring and surveillance, and threats exploiting immigration status — a well-documented form of coercive control.
Practically: male victims are substantially under-identified and face fewer refuge places. Ask the same questions, use the same risk assessment, and know your local male-victim services. The Men’s Advice Line exists for exactly this.
Self-testWhy does the removal of the cohabitation requirement in 2023 matter clinically?
Because the highest-risk period in an abusive relationship is often after separation. Before 5 April 2023 an ex-partner who had moved out and continued to control, monitor and threaten could not be prosecuted for coercive control — only for discrete offences such as harassment or stalking.
So a patient who says “we split up six months ago but he still checks my phone and turns up at my work” is describing a pattern that is now a chargeable offence, and one you should risk-assess as an escalating situation rather than a resolved one.
Written and checked by NHS GPs. Last reviewed 24 August 2026. UK law and guidance change — always follow current local policy and your defence organisation’s advice in a real case.
Practise the hard consultations too
Core Revision’s MSRA Professional Dilemmas bank has 500 scenarios on exactly these judgement calls, with timed mocks.
See the MSRA pack