General practice in prisons in England. Views from the field

Abstract

The standard of health care in prisons should be equivalent to that provided in the community. Prison populations are multiply disadvantaged and primary health care practitioners in prisons routinely face organisational and ethical challenges which are rare in community-based general practice. This raises questions of whether doctors working in prisons consider they would benefit from additional clinical skills or training, the range of prison-specific competencies they consider important and what they would like to see included in induction programmes. Through a series of semi-structured, face to face interviews with doctors and health care managers working in prisons, this study sought to identify views on the training needs for doctors working in prisons. Practitioners demonstrated that induction processes were varied and fragmented and that delivering primary care in prisons raised additional clinical and organisational challenges. Relationships with prisoner patients were generally good. Few ethical issues were raised by this small sample, with the exception of confidentiality. However, aspirations towards equivalence were tempered by tensions between custodial needs and clinical requirements and more research should be directed to the ways practitioners negotiate this interface. Induction programmes should ensure that all practitioners receive practical and ethical guidance to help them address these tensions.