Healthcare in secure environments – making a break for it

Prison courtyard image

Dr Jake Hard FRCGP, Chair of RCGP Secure Environments Group

The RCGP Secure Environments Group (SEG) is committed to delivering healthcare of the highest possible standards to prisoners and detainees in the health and justice system. 

The Group held its first meeting in September 2004. Nearly 15 years on, we have seen massive changes in the quality of healthcare provided in secure settings. This has been supported and led by GPs who have adapted to provide care in these settings and have strived to meet the needs of their often complex and vulnerable patients.

The SEG recently held its two-day sixth Annual Health and Justice Summit in Liverpool. We heard from the diverse range of clinicians, practitioners, managers, pharmacists, nurses, researchers, Governors, service-users and many other partners interested in improving the quality and consistency of care in secure settings, often in adverse circumstances. What was most noticeable this year was how the work is gaining attention from our fellow community colleagues who share our aims – welcome!

One of the most basic principles of delivering healthcare in secure environments is that of ‘equivalence’ of care – not that it should be ‘the same’. From a legal perspective, it is well recognised at international, regional (European) and local (UK) levels that health care provision in secure environments should be of an ‘equivalent’ standard to that provided in the wider community. We recognise the benefit to our patient group by striving for ‘equivalent’ care and furthermore recognise the benefits this provides to our society. We published our position statement on ‘Equivalence’ on July 18 2018 – Nelson Mandela Day. 

SEG also recently published its work: Safer Prescribing in Prisons – 2nd Edition. The authors, Dr Marcus Bicknell, Dr Caroline Watson and Denise Farmer updated the guidelines to provide an in-depth and comprehensive resource outlining the important considerations for the clinicians who prescribe and treat within secure settings. It is becoming recognised that our work is of direct relevance to the community prescribing. The RCGP SEG was one of the first organisations to identify the widespread misuse of pregabalin because of the direct day-to-day experience of its members as prescribers in the health and justice system. 

Prisons remain in the public eye for all the wrong reasons – but we must not forget the healthcare teams who work hard to deliver care in these challenging settings. The College has sought to recognise this important area and the people behind this work by recruiting a Healthcare in Secure Environments Clinical Champion. This new leadership role will, working alongside the RCGP SEG, help to reduce clinical isolation, raise the profile of this important area of work and in doing so ensure that this challenging area of care is able to reduce health inequalities. 

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