01 February 2022
Dr Jake Hard a GP with special interest in Prison medicine tells us about this fascinating field of General Practice
Starting straight after qualification as a locum at HMP Leicester and moving to HMP Parc in Bridgend and becoming Clinical Lead, Dr Hard has followed a passion for Medicine in secure environments. This field is essentially an emerging specialism within General Practice in the UK requiring particular skills in substance misuse, management of blood borne-viruses and a knowledge of how the healthcare you are providing interacts with the establishment within which your patient is residing.
The very essence of being a GP is about advocacy and addressing an individual’s needs on a case by casebasis – no one case is exactly the same as another. Both in the community and in secure environments, As GPs, we work with some of society’s most vulnerable people and it requires being able to do so without judgement of any kind.
Being a compassionate and caring doctor very much sits at the heart of treating patients in secure environments. In many cases you are addressing the needs of some of the most vulnerable and under-served members of our society. Treatment needs to be non-judgemental and delivered to the highest possible level irrespective of the nature of offence, convicted or remand status. There is no one set of defining features for a GP working in secure setting. The skills required are many and varied and range from having knowledge of ‘the system’ and how it will impact on the your ability to deliver care; having the relevant consultation skills when addressing to drug-seeking behaviour; safer-prescribing in the secure setting, substance misuse treatment and addressing a high prevalence of mental health issues.
The high levels of health needs of patients who are detained are well-documented and range from significant levels of substance misuse, alcohol misuse, mental health issues and an increased prevalence of infectious diseases as well as unaddressed chronic disease and lifestyle management. Within the prison setting the healthcare services have been adapted to serve the increased needs of the patient group although detailed epidemiological data remains an area of need for further development. GPs working in prisons benefit from having an additional set of skills in order to properly address these needs, however at this time there is no requirement for additional training. The RCGP Certificates of the Management of Drug Misuse Parts I and II continue to be an important basic additional qualification.
Day to day work is much the same as you’d expect for any GP, except it ends with reception clinics for new prisoners who are being admitted with acute clinical issues such as drug and alcohol withdrawal. The highest risk of suicide is within the first 28 days of coming into custody and the challenge is to identify and safeguard against these risks.
I enjoy a portfolio career which keeps me thinking and hopefully bringing about lasting improvements for healthcare in secure settings. There’s not a day goes by that I don’t continue to think about how we can continue to improve and develop the care for people in prison at a local and strategic level.
For more info please follow the following links: