Integrating primary care across the prison and community interface

INTRODUCTION

The prison population is commonly misconceived as static and distinct from patients served by community primary care.¹ In reality, given an annual throughput of over 250 000,² an average custodial sentence length of just under 20 months,³ and high rates of recidivism,⁴ the UK prison population is highly dynamic. Responsibility for the care of most patients, therefore, regularly passes between prison and community primary care practitioners.

Prison is a challenging environment in which to deliver high-quality primary care; one that has been further complicated by the current pandemic and concomitant reduction in face-to-face consultations. Even ordinarily, health care is severely affected by austerity measures,⁵ and occurs within a secure environment that imposes unique constraints on delivery. For example, clinics must be synchronised with internal regimes, and patient attendance can be adversely affected by incidents on prison wings. Prescribers need to exercise caution when prescribing analgesic medicines, which may be diverted from therapeutic use to be traded in the illicit prison economy.² Although international standards embody the ethical imperative to provide equivalent health care,⁶ community models of care provision cannot necessarily be applied to prison settings.²

Prison populations have complex and diverse needs. Social, economic, and environmental disadvantages confer a disproportionately high burden of illness on people in prison, with a significantly greater prevalence of blood-borne viruses, substance misuse, and mental health problems than in the general population.⁷ A prevailing focus on these conditions …