The GP Communication Project - Improving Care and Reducing Cost

Dr Richard Kirk, Northern Ireland

The problem:

Over 4,000 men and women are committed to prison each year in Northern Ireland, often with numerous comorbidities and complex needs. Historically, information sharing between community healthcare providers and prison healthcare has been limited partially due to security and operational reasons. Therefore, when a patient arrived in primary care there was no medical record to follow.

This impacted community GPs as they were not aware their patient was in prison and at times continued to prescribe medication for them in their absence. This also impacted the prison healthcare team and the patient as we did not have any medical background for the patients in our care.

The prison healthcare team identified this communication between community providers and prison healthcare as essential and developed a communication pathway to reduce risk for our patients and to ensure continuity of care is 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, NI Prison Service and the South Eastern Trust a letter was composed to send to the GPs of all patients in Maghaberry on their entry into prison. This letter advised GPs:

  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 us a brief medical summary so we could update the patients' 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 also 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 was aimed at improving the quality of healthcare provided inside prison, improving the quality of communication with GPs and also reducing 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. The letter was written by Dr Kirk in collaboration with Practice Manager Mrs Trish Yates and administration time was allocated within the current budget to organise and run the daily working of the project.

The impact:

  • Patients: While appearing cost neutral for the Trust, improved healthcare records save time for clinicians in prison and also improve knowledge of patients’ health history while improving our relationship with community GPs, which in essence is priceless. Improved quality care and management of conditions for this cohort of patients.
  • Staff: Increased knowledge of our patients has improved proactive planning for our population making the job of our nurses and doctors easier as they have greater knowledge of the patient. Reduced wasted community GP and receptionist time through better GP coordination with familly and prison health about potential medication.
  • Practice: Reduced number of unnecessary community prescriptions. Reduce GP time to prescribe and pharmacy time to dispense with associated cost savings. Improved patient safety and collaborative working.

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