I work at various prisons in the Midlands and it is the same everywhere. I am being overwhelmed by emails and text messages from prisons and locum agencies with long lists of empty rota slots to fill. Rates of pay are increasing but even then I avoid certain prisons as it is just not worth the personal risks.
There is a national shortage of GPs available and willing to work in Offender Healthcare. It is demanding work, frequently stressful with significant risks of physical violence exacerbated by a depleted prison officer workforce. It requires GPs sufficiently skilled in managing mental health problems and those with severe personality disorders, substance misuse, musculoskeletal and traumatic injuries. Only resilient GPs with an open mind tend to stick at it; those who like the challenge, have a natural curiosity about people and extreme situations.
It can be very rewarding too, identifying years of untreated pathology and improving the psychiatric care of vulnerable prisoners. Each day can be so different. You can be presented with very unusual events where you must be medico-legally precise, triage patients and balance treatment delay risks with security risks taking account of staffing available to escort patients out to hospital.
Last year at a prison during one shift we had to send 12 ‘blue light’ ambulances out. Use of illicit drugs especially novel psychoactive substances and ‘trading’ of prescribed medication is rife in most prisons. I’ve been at two prisons when Tornado Teams have been sent to tackle prison riots, fire-setting and roof-top protests. There’s never a dull day.
Full reimbursement of medical indemnity costs would attract more GPs, since in the prison setting ‘systems and processes’ rather than individual clinical negligence failings are more likely. There also has to be a network of support for GPs which in some areas there isn’t much. I don’t work in prisons full-time as I vary my portfolio work to a level that suits my work-life balance.
Dr David Barrett is a portfolio GP in the Midlands with a special interest in offender healthcare and secure environments