RCGP Bright Ideas: The prison GP communication project

The RCGP recently recognised GP, Dr Richard Kirk, from South Eastern Health and Social Care Trust, Northern Ireland with a Bright Ideas Award. Dr Kirk initiated and implemented a Bright Idea to improve communications between medical professionals caring for prisoners, improving healthcare and patient outcomes.

The Prison Health Care Department of South Eastern Health and Social Care Trust looks after over 4,000 men and women who are committed to prison each year in Northern Ireland, often with numerous co-morbidities and complex needs.

Historically, information sharing between community healthcare providers and prison healthcare has been limited partially because of security and operational reasons. Therefore, when a patient arrived in primary care in custody, there were no medical records for the work prison healthcare team to follow. This also impacted community GPs, unaware their patients were in prison and at times continuing to prescribe medication for them in their absence (which was often collected).

The prison healthcare team identified communication between community providers and prison healthcare as essential and developed a communication system to reduce risk to patients and to ensure continuity of care was maintained both on the way in and out of custody.

The Bright Idea

Following collaboration with the Health and Social Care Board, the Business Services Organisation, Northern Ireland Prison Service and the South Eastern Trust, a letter was sent to GPs in Maghaberry, County Antrim advising them: 

  1. Their patient was in prison
  2. To code in their record ‘13HQ in Prison’
  3. To de-authorise any repeat medication until they had received discharge notification
  4. To send a brief medical summary so the Prison Health care team could update the patient’s prison healthcare records
  5. Direct access contact details for the prison healthcare team for any queries

This project guaranteed both that Prison Healthcare had accurate information about patients’ historical health status and that community GPs were aware patients were in prison, reducing unnecessary prescriptions and the potential for diversion of medications in the community.

This proactive multi-agency approach improved the quality of healthcare in prison, improving the quality of communication with GPs and reduced the risk to the community from potentially diverted illicit medication. It is unique and the most comprehensive in any category A remand prison in the UK.

This project was initiated by the Prison Healthcare team, led by Dr Richard Kirk. Administration time was allocated within the budget to organise and run the daily working of the project.

The Impact

Staff

Due to the importance of information sharing and patient safety, dedicated administrative time was allocated. To date, 3,754 GP contacts have been made, with 1,091 patient summaries returned. The project demonstrated considerable actual and potential cost savings in a number of different areas. This initiative reduced wasted time for community GPs and receptionists through better GP coordination with family and prison health about potential medication.

Better knowledge of patients has improved proactive planning for the patients, making the job of nurses and doctors easier.

Patients

Outcomes have improved for patients in prison. Coding of active problems from healthcare records has enabled GPs and nurses to have a better knowledge of the patient when consulting. This has improved quality, enabling patients to be called for diabetic, asthma and COPD reviews to improve health in this vulnerable population. One result of this is diabetes management – a recent review showed that diabetes control was improved in 92% of patients with diabetes.

Practice

This communications project reduced time spent by GPs on prescribing, and time spent by pharmacies on dispensing, with associated cost savings. The project has become embedded in their system and is now custom and practice in prison healthcare. The team have moved on to the next stage – uploading discharge letters to ECR of all patients within 24 hours of release. The intention is to complete the knowledge cycle to ensure that prescribing and deprescribing within prison health is communicated to GPs. This makes the transfer of a patient from community to prison and back again relatively seamless.

Other

The project has reduced the number of unnecessary community prescriptions while appearing cost neutral for the trust. Improved healthcare records save time for clinicians in prison and improve knowledge of patients’ health history while improving our relationship with community GPs which in essence is invaluable.

RCGP Bright Ideas

The College recognises and celebrates GPs their teams, practices and patients who come up with ideas to improve efficiency and improve workload through the RCGP Bright Ideas Awards. They are part of the College’s Bright Ideas project – an online platform where people can share ideas for small changes that can have a big impact on general practice.

In early 2020, the RCGP will deliver webinar masterclass sessions with selected Bright Ideas winners. The sessions will explore the local challenges faced by the team or individual, how they developed and implemented their Bright Idea, the impact it had and how it might transfer or scale in different contexts. There will also be an opportunity for a question and answer session. The one hour long webinars can be accessed via your computer or tablet and are open to all (but particularly relevant for GPs and wider general practice teams). The first webinar, 'The Cancer Maps' will take place on 11 March 2020. Register here

You can submit your Bright Idea by emailing the Bright Ideas Project Team.

 

 

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