Intended for healthcare professionals

Rapid response to:

Letters Knife crime as a public health matter

Those most at risk of involvement in knife crime are the least likely to have any interactions with a GP

BMJ 2019; 367 doi: (Published 01 October 2019) Cite this as: BMJ 2019;367:l5791

Rapid Response:

Re: Those most at risk of involvement in knife crime are the least likely to have any interactions with a GP

I read the news item: “BMA calls for knife crime to be tackled as a public health concern” (5) and the letter, “Those most at risk of involvement in knife crime are the least likely to have any interactions with a GP “(7) with great interest.

Knife crime is a significant and preventable public health issue that needs urgent and sustained action (1, 2,3,4). It is heartening that this continues to be acknowledged across the country, including by the British Medical Association (5). Healthcare professionals have a vital role in violence reduction (1).

I agree with Dr Pound’s assertion that the emphasis should not be placed solely on general practice primary prevention interventions (7) or indeed on interventions based in health care settings alone. Population-level violence prevention approaches should encompass primary, secondary and tertiary prevention (3,6). A violence reduction unit can coordinate and support this (3). However, I believe that everyone has their role to play and that general practice has a particularly important role in reaching families at risk, guiding them to the support they need, wherever that support is ultimately provided.

A wide variety of risk factors have been identified as associated with violence at individual, family and community levels (4). Examples include mental ill health, alcohol and drug problems and adverse childhood experiences, including domestic violence or parental incarceration (1,4,8). These issues can present to general practice and may arise many years before involvement in violence (1, 8, 9,10,11). Secondary and tertiary prevention are also important (1,6,12) and general practice may also have a role in this. Whilst we can establish population trends and estimates of likelihood, there will always be exceptions to the rules. We also know that knife crime is not always associated with injury (13). How will we know the circumstances of an individual, or their family members, unless we ask?

Nevertheless, as acknowledged, there are also other settings where we need to try and make a difference (5,7) and it is important not to lose sight of this. What is clear, is that in Scotland and Cardiff, where there have already been reductions in violence, they have been committed to working together over many years as a multi-agency, multi-component approach in addressing this highly challenging and emotive issue (2,3).

1. Bellis, M., Hughes, K., Perkins, C., & Bennett, A. (2012, October). Protecting people Promoting health A public health approach to violence prevention for England. Retrieved January 2019, from
2. Florence, C., Shepherd, J., Brennan, I., & Simon, T. (2011). Effectiveness of anonymised information sharing and use in health service, police, and local government partnership for preventing violence related injury: experimental study and time series analysis. BMJ, d3313.
3. Scottish Violence Reduction Unit. (n.d.). Scottish Violence Reduction Unit. 10 Year Strategic Plan. Retrieved March 20, 2019, from
4. World Health Organization. (2010). European report on preventing violence and knife crime among young people. Retrieved October 3, 2019, from
5. 5. Hurley, R. (2019). BMA calls for knife crime to be tackled as a public health concern . BMJ, 365:l4424 .
6. David-Ferdon, C., Vivolo-Kantor, A. M., Dahlberg, L. L., Marshall, K. J., Rainford, N., & Hall, J. E. (2016). A Comprehensive Technical Package for the Prevention of Youth Violence. Retrieved March 27, 2019, from National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.:
7. Pound, N. (2019). Those most at risk of involvement in knife crime are the least likely to have any interactions with a GP. BMJ, 367:l5791. 7
8. Public Health Wales. (2015). Welsh Adverse Childhood Experiences Study. Adverse Childhood Experiences and their impact on health harming behaviours in the Welsh adult population. Retrieved March 21, 2019, from$FILE/ACE%20Report%20FINAL%20(E).pdf 8
9. England, E. (2014, June). The extraordinary potential of primary care to improve mental health. Retrieved October 10, 2019, from
10. Barbosa, E., Verhoef, T., Morris, S., Solmi, F., Johnson, M., Sohal, A. E.-S., . . . Feder, G. (2018). Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world: updated modelling based on an MRC phase IV observational pragmatic implementation study. BMJ Open.
11. RCGP. (n.d.). The RCGP curriculum. The curriculum topic guide. Retrieved October 4, 2019, from
12. World Health Organization. (2015). Preventing youth violence: an overview of the evidence. Retrieved July 2019, from
13. Allen, G., Audikas, L., Loft, P., & Bellis, A. (2019, September 30). Knife crime in England and Wales. Briefing paper. Retrieved October 4, 2019, from House of Commons LIbrary:

Competing interests: No competing interests

04 October 2019
Susan R. Roberts
Public Health Specialty Registrar
West Midlands