A confession... I didn’t always work within a prison environment. I was what some people would call a ‘normal’ GP working within a general practice with a personal list of patients I knew and who knew me, wanted me and only me. It would consist of a morning surgery, a few visits, a lull in the middle of the day to do my paperwork and an evening surgery. Manageable and enjoyable
I’m not looking back through rose tinted glasses. Yes, it was busy, yes, they moaned then too, and yes, I felt undervalued at times but I knew I was good at my job and was making a difference
However, it changed for me; I can’t put my finger on when, maybe 2 years or 4 years ago…
I hoped it might change but it didn’t and it wasn’t about to.
Purely by accident I visited a prison. I’ll admit I was worried when I came in at first. Since then I have left behind a good partnership, friends and a completely unmanageable, unsustainable workload and I realised I haven’t been as professionally happy for years.
My day now? Full of variety, oh yes. Challenging, at times, yes. Pathology, loads of it. General Practice like it used to be? Not quite. But not as different as you might think.
Prison medicine is embracing an expanded primary care team just like “on the out” with a strong emphasis on quality, safety, governance and a patient centred approach but in a secure environment.
Today was a Monday (what is Monday like at your practice I bet your thinking?)
First thing I came in to check on the patients in the Care and Separation Unit. It is what is says on the tin. 45 minutes checking on 20 patients separated from the main prison population for a variety of reasons and they all have access to a GP every 72 hours.
14 wanted nothing. One wanted his eczema cream, one wanted an orthopedic opinion on a 5th metacarpal injury, one wanted his anti-depressant restarted before release as he knew he’d find it tough asking a new GP for help and lastly one who broke down in tears worried that rectal bleeding was cancer - it was just piles; same patient worries you’d encounter in General Practice.
Next, 8 patients made up my morning surgery. All prisoners from the “vulnerable prisoner wing”. You would find that the majority of patients on this wing are older, and suffer from chronic disease management.
Middle of the day was protected time for admin. You know, letters, results, script queries, quality meeting. I was genuinely surprised by the focus on quality in prison medicine and the reflection on the service delivery. Significantly greater than in regular primary care in my opinion and my surgery was a high quality innovative training practice.
I answer queries from the on-site pharmacy, the ANPs, our own paramedics along with the integrated substance misuse and mental health teams.
Then at 1.30pm, it was afternoon surgery. In total I had 14 patients plus 1 extra with a real mix of issues from abnormal blood results, organising referrals, food refusal, depression, gender dysphoria and addressing drug seeking behavior. You can’t get away from the fact that some just want something to numb their physical or emotional pain. But you are a GP; you can help them through this.
I was finished by 16.25 and ready for home.
OK. Downsides?
You can’t wear a tie and it took me a while to get my head around Systm1, which is the prison computer system. There are some prison idiosyncrasies but I actually enjoyed learning new things and of course the admin systems lag behind a slick, well run practice and some things default to “the GP” (but there is a willingness to evolve and there is far less “treacle” to deal with if you are used to dealing with CCGs!).
Money/Pensions/Terms.
I chose to be salaried but if you would prefer they can look at Self-employed contracts too. Salaried is a bit less than partnership but it’s a very different environment and yes, they pay my indemnity too (if salaried)!
I enjoy it and yes I am proud to be a prison GP!