Prisons are recognised as the most challenging working environments encountered by civilian GPs.
This is nonetheless part of the appeal of prison work to a cohort of GPs who have developed an interest and skills in treating socially disadvantaged patients in whom drug, alcohol and mental health problems are prevalent.
It is essential that such GPs are aware of their own need for support and supervision in undertaking this work.
Team working essential
You need to be certain of your responsibilities to your detained patients, and while understanding the implications of treating patients in a secure setting, undertake good medical practice.
Succeeding as a prison GP requires:
- An unprejudiced approach to treating offenders
- Team-based skills: you will be working with prison officers, governors and other clinicians.
Many GPs in the UK do some work in prisons. However, there is high employment turnover in prison general practice due to the working environment and medico-legal challenges, as well as to frequent changes in the delivery and organisation of prison healthcare by different providers.
This does however mean that GPs’ services are in demand. A few GPs are employed on full-time contracts, but the majority - including myself - do part-time prison work.
Dr Marcus Bicknell (Photo: JH Lancy)
There are several ways that prison GPs can work part-time:
- Some GPs include prison practice as part of a portfolio career.
- Many prisons obtain their GP cover from a local practice that extends its work into the local prison.
- A plethora of locum work is available that may be attractive to career locums, salaried GPs and GP partners.
In my case, I provide out-of-hours services to HM Prison Whatton for Nottingham Emergency Medical Services. I also undertake locum in-hours GP services to the Yorkshire cluster of prisons (and provide primary care services to a medium secure psychiatric hospital).
Locum prison work is often available through locum agencies and provides an opportunity for the GP to work in different types of prison in a variety of locations.
Most long-term prison GP work requires security clearance with the Ministry of Justice and includes a Criminal Records Bureau check.
A significant proportion of GPs provide out-of-hours cover to prisons. This may be through a private contract or through an out-of-hours provider. These GPs are not usually security-cleared.
CPD and revalidation
Both the BMA and RCGP strive to promote excellence in prison healthcare with high quality patient care in conjunction with optimal employment terms and conditions for the prison GP workforce.
Enlightened prison healthcare providers are well placed to employ GPs to work in their prisons and other secure environments on contracts that support CPD, appraisal and revalidation. They should offer regular sessions in traditional community settings to enable the GP to maintain a full general practice skill set if the GP wishes.
Commissioning of services
Commissioning and provision of prison healthcare services has seen enormous change in the last decade and is presently undergoing further reconfiguration.
Until recently, and since its inception, health provision in prisons was the responsibility of the Home Office. This was transferred to the DH in 2006 in England, and a similar change occurred in Scotland in 2012. Police health services to prisoners have moved from the Ministry of Justice to DH commissioning in recent months.
In England, the NHS reforms sanctioned by the Health and Social Care Act 2012 have had a huge impact upon the DH’s offender health remit. The Care Services Improvement Partnership used to serve as the DH’s regional delivery unit, but it has been abolished. Amalgamated NHS Commissioning Board Area Teams will be responsible for commissioning prison healthcare for the foreseeable future in the new NHS.
The wide range of prison healthcare providers includes NHS trusts, private sector companies (for example, Serco and Care UK) and community business enterprises. Each provider operates its own model of GP recruitment and employment for in-hours and out-of-hours primary care.
Pay for prison work
Prison GPs should earn a minimum £70 an hour and, by tradition, get their travelling expenses to and from the prison reimbursed.
It is hoped that enlightened prison primary care providers will offer contracts commensurate with average GP pay which is currently £103,00 for a 52-week year.
Contracts should include protected time for CPD and community surgeries.
Training and support
The University of Lincoln offers a master’s degree in healthcare in secure environments including a certificate and a diploma. This is an ideal vehicle for meeting prison GPs’ learning needs.
Training relating to section 12 of the Mental Health Act – detention of people diagnosed with a mental disorder (‘sectioning’) – is useful to prison GPs.
Expertise in treating drugs misusers and gaining the RCGP’s substance misuse certificates are also advantages.
The GPC and RCGP have defined structures in place to support prison GPs. The GPC has a prison GP representative seconded to it (me) who has full voting rights. The RCGP supports a regional network of secure environments groups that have been in place for a decade and host regional learning events.
There are regular national prison conferences and opportunities for doctors to extend their learning in offender healthcare.
Working in secure environments offers GPs unique professional opportunities.
Significant unmet health needs and extensive morbidity exist in offender populations. There is a wide range of secure environments that offer diversity. Specialties include working with women, young offenders, sex offenders, drug users, ethnic minority groups and the mentally ill.
There is a crossover in skills which provides opportunities for work in prisons, secure psychiatric hospitals, immigration and removal centres, police station detention facilities and secure children’s homes.
Research into the treatment of offenders, leading to improved clinical practice, offers major opportunities to clinicians and academics in a discipline historically under-researched.
Find out more
GPs interested in learning more about prison general practice should contact the RCGP for further information and arrange to liaise with their local RCGP representative.
The employment terms of prison GPs need be fair, firm and equivalent, mirroring the care that they should provide to patients. However, terms vary with the employer.
- Dr Bicknell is a GP partner in Nottingham, chairman of the RCGP secure environments group and represents prison GPs on the GPC.