SevernSide IUC provision for HMP Eastwood Park

Introduction

This document sets out the agreed framework for Out of Hours (OOH) primary health care provision at HMP Eastwood Park by Severnside Integrated Urgent Care Service (IUCS). Severnside is a BrisDoc service, and commissioned by BNSSG Integrated Care Board (ICB).

The service provided by Severnside IUC supports the urgent primary care needs of people in prison and babies at HMP Eastwood Park Monday-Friday 18:30-08:00am, and 24-hour cover on weekends and bank holidays.

Objective of the procedure

The framework provided within this document aims to:

Ensure that people in prison and babies have equitable access to OOH primary care healthcare provision. The service will be primarily telephone-based, with face-to-face by exception.
Support the secure settings in minimising the number of unnecessary admissions/ conveyances to hospital and/ or other urgent care centres.
Ensure that clinical staff at the site have timely access to additional clinical support during the OOH timeframes
Facilitate safe and appropriate face to face appointments at a Severnside Treatment Centre when this is required
Ensure that Severnside IUC clinicians can gain safe and timely access to persons requiring further clinical assessment
Ensure that the Severnside IUC service conforms to safety regulations within the prison establishment
Ensure an effective pathway for communication exists between Practice Plus Group (PPG) and Severnside IUC, specifically in relation to OOH interactions and actions being effectively and promptly communicated to PPG
Overcome challenges and barriers associated with the differing clinical IT systems used within secure healthcare settings to support effective and prompt sharing of clinical records and safe clinical care
Ensure that learning as a result of interactions between these services is captured and fed back to support continued shared learning and improvement
Ensure this vulnerable cohort of people have safeguarding processes clarified between Brisdoc, Eastwood Park and PPG.

Background

Practice Plus Group

Practice Plus Group is commissioned by NHS England to provide the primary healthcare in hours service to HMP Eastwood Park, and is subcontracted by BrisDoc to provide NHS 111 to PPG.

HMP Eastwood Park is in Wooton-under-Edge in Gloucestershire and for women aged 18 and over. There are 370 people in the prison.
It is a closed Category C prison
HMP Eastwood Park has a mother and Baby unit which accommodates 10 mothers and 11 babies (children under 18months). HMP Eastwood Park Healthcare Professionals are responsible for the health of people in prisons only. Healthcare for babies in-hours is via own GP practice and out of hours is via NHS 111.
There is an Induction wing called Kinnon for screening of patients and identifying detoxing needs, where people spend the first 14 days being monitored before being moved to the general prison
Nexus wing is for the prison population with emotional personality disorders and who require intensive support
Cherry Blossom unit is for individuals who are having an acute mental health crisis who require increased support
The general prison population are separated into substance misuse and non-substance issues
Residential Unit (Res) 7 is for enhanced prisoners who work every day
Residential Unit (Res) 1,2,3,5 and 6 are for the general prison population

There are no prescribers on overnight. In these instances, medication is dispensed on a Patient Group Direction (PGD). A healthcare team of GP, Clinical Practitioner, Nurse, Midwife and Pharmacist are available as follows:

HMP Eastwood Park	Monday-Friday	Saturday	Sunday & Bank Holidays
Doctor (GP) & non-medical prescribers	09.00 – 21.00	14.00-18.00	none
Nursing staff (no prescribers)	24 hours	24 hours	24 hours
Pharmacist / Pharmacy Technician	07.00 – 19.30	07.00 – 19.30	07.00 – 19.30
Midwife	08.00 – 18.00 By phone	08.00 – 18.00 By phone	08.00 – 18.00 By phone
Crisis Team	Mornings in person but available by phone 08.00-18.00	Mornings in person but available by phone 08.00-18.00	Mornings in person but available by phone 08.00-18.00

BrisDoc Healthcare Services and Severnside

BrisDoc provides the “Severnside Integrated Urgent Care Service (IUCS) across BNSSG. This combines NHS111 (subcontracted to Practice Plus Group) and GP Out of Hours (OOH). The GP out of hours service runs from 18:30 until 08:00 Monday to Friday, and 24/7 across weekends and bank holidays.

Severnside IUC Primary Care clinicians can assess and manage patients via telephone/ video consultations and face to face (appointments and visits) when required. Clinicians electronically prescribe using the “Electronic prescription Service” (EPS). Severnside’s clinical IT system is Adastra.

Severnside provides a ‘Healthcare Professional Line’ telephone service to registered healthcare professionals for clinical decision-making support (0117 244 9283). This access route negates the need for a healthcare professional to access GP OOHs through NHS 111. Where non-Healthcare professionals are making a health enquiry, then the caller should contact NHS 111 and not the Healthcare Professional Line.

The onsite GP in hours service at is provided by PPG.

The Standard Operating Procedure

Risk Management Procedures

The His Majesty’s (HM) Prison Service is obliged to carry out a risk assessment of the person in prison, the environment in which the person in prison is to be treated and (where applicable) the level of staffing/security required.
Most people in prison attending hospital/healthcare settings will be escorted by a minimum of two officers. All staff covering the escort will be in uniform. It is HM Prison Service’s intention that security requirements should interfere as little as possible with medical assessment/ treatment. However, people in prison will usually be restrained always using handcuffs or an escort chain to a member of staff, unless this is inappropriate on medical grounds.

Security measures: and guidance for staff

Other than your name and job role, do not divulge personal information about yourself or other members of staff in the presence and/or hearing of the person in prison
Remove all items from pockets that could be used as a weapon
Keep all medical equipment out of reach of the person in prison when not in use
Check with escorting prison staff before you hand anything to the prisoner
Never tell the prisoner of any future healthcare appointment or speak about it to escorting officers in the presence of the prisoner.

Severnside contact procedure

Registered healthcare professionals (HCP) calling for a person in prison on site should contact Severnside via the Healthcare Professional line 0117 244 9283 during the out of hours period. Access for health advice for Babies should be via NHS111.

Initial Priority Assessment During Out of Hours Period by HCP

It is the responsibility of on-site healthcare staff to decide whether there is an acute clinical need and access the service most appropriate, emergency response (999) or if the condition is suitable for referral to Severnside IUC.

A set of clinical observations and NEWS2 score will normally be required where a call is from an HCP to enable and support clinical decision-making. If this is not possible (when an HCP is present) then it is likely that 999 responses may be required.

Procedure for contacting Severnside IUC by HCP

The prison HCP telephones Severnside IUC professional line on 0117 244 9283
A Severnside call handler (non-clinically trained staff) will take the patient details including the reasons for referral and clinical observations/ NEWS2. The case will then be transferred to the Severnside clinical advice queue from where a clinician will pick up the case and call back, usually within two hours of the referral being made.
To ensure timely call back, the referring HCP must confirm: their name, radio call sign [usually HOTEL 1] and prison wing, along with the telephone number of the prison control room. The usual number is 01454 382100
The Severnside clinician will phone the prison control room and ask to speak to the HCP to obtain further information about the patient and agree the outcome. Photos can be sent via NHS e-mail directly to Severnside at consultation@nhs.net.
Video is possible for people in prison at Eastwood Park using equipment in their consultation room. Severnside clinicians will need to send the video link to the specified email address.

Access to prison medical records

SystmOne is the medical records system used in Eastwood Park prison. Severnside clinicians do not have access to SystmOne. The HCP onsite will support access to the medical records and be able to share key information such as medical history, medications and allergies.

Severnside clinicians will be reliant on information available via the Summary Care Record (SCR), which is visible on Adastra. Because this is an opt in service there will be some individual people in prison who have not registered and information will not be available on the SCR.

HMP Eastwood – ODS – Y03193

Potential outcomes following contact with Severnside

Case closed with advice and reassurance (self-care)

Case closed following clinical assessment (and /or photo or video) with prescribing advice.

Advice to prison staff/ or patient to call 999 for emergency ambulance

Recommendation to attend Emergency Department (ED) to prison staff

Recommendation for direct admission/ referral to hospital specialty. The Severnside clinician will make the clinical referral, and prison staff will facilitate the hospital attendance

Patient needs a face-to-face appointment at a Severnside OOH Treatment Centre (not a hospital attendance). The appointment time and location will be arranged via a callback from the Severnside operational team and a follow up text message will be sent to the escorting officer mobile number provided. Officers will need to call the Severnside Treatment Centre Host (receptionist) on arrival and wait in their vehicle until the patient is called in for the appointment. The patient will then go directly into the Severnside consulting room alongside appropriate prison security arrangements. If the patient needs to go into hospital, the hospital will need to be advised that the patient will be coming with appropriate prison escort.

When a patient needs a face-to-face assessment but cannot attend a Severnside Treatment Centre (for ill-health, disability, security reasons) then a Severnside visiting clinician can attend the site to see the patient. Eligibility for a home visit aligns with the requirements outlined in the Severnside Home Visiting policy, with the addition of security reasons/ lack of escort availability to support a Treatment Centre attendance. If escort availability is the main issue, then consideration should be given to delaying the appointment until such time as an escort is available.

When the consultation is completed and closed by Brisdoc an electronic post event message (PEM) will be emailed to the corresponding prison healthcare admin team to advise of actions and any recommended follow up.

HMP Eastwood Park mailbox – ep-yoi.admin@nhs.net

Attending HMP Eastwood Park

Prison addresses

HMP Eastwood Park: Eastwood Park, Falfield, Wotton-under-Edge, Gloucestershire, GL12 8DB

The Severnside clinician or driver will contact the prison control room when on route with estimated time of arrival

HMP Eastwood Park telephone: 01454 382100

Proof of Identity

The Severnside clinician must have an acceptable form of photographic identification when visiting any of the prison establishments. Failure to present this on arrival will result in being refused entry. A driving license, passport, BrisDoc/ Severnside Photo ID or NHS smartcard are the preferred forms of identification.

Parking

There is a designated parking in Eastwood Park. The driver should remain in the Severnside attending vehicle.

Checking in

Upon arrival, approach the entrance and report to the main prison gate where the clinician will need to provide their name and show the ID to be issued with a Visitor Pass. This must be worn at all times during the visit. Mobile phones/computers are not allowed in the prison, please see appendix 5 for further information on prohibited items.

Home Visit

The Severnside clinician will be met and escorted by a minimum of one prison officer to the location of the patient and HCP. During the OOHs period it is likely that the patient will be in their The Severnside Clinician will be accompanied at all times.
Prison cells are predominantly double The expectation is that the prison will facilitate the patient being seen in a nearby confidential space
The Severnside visiting clinician will carry with them a diagnostic bag, the content list is available at appendix

Outcome following home visit to the prison

Patient requires hospital assessment/treatment. Admit via 999 emergency ambulance or through hospital clinical site manager/operational hub in accordance with standard practice to refer to specialty
Care plan agreed including medication, further monitoring, follow up and action to take if deteriorates. (See section: Medicine Management and Prescriptions)
Severnside clinical records are logged on the Adastra clinical system. Notes are then available to healthcare staff within 5 minutes on Connecting Care (within “Integrated urgent care” tab). When the consultation is completed and closed by BrisDoc an electronic post event message (PEM) will be emailed to the corresponding prison healthcare admin team to advise of actions and any recommended follow up.

HMP Eastwood Park mailbox – ep-yoi.admin@nhs.net

Medicine Management and Prescriptions

The BrisDoc professional will not manage methadone/other opiate substitute prescribing. Persons in prison can hold their individual medicines in their own possession. This is determined by the in-possession (IP) risk assessment and the IP policy (see appendix 5).

Some individuals may not be able to hold any medicines in their own possession due to level of risk such as previous overdose with medicines and will need to be supervised taking their medicines. In contrast, some individuals are deemed low risk to hold their medicines in weekly or monthly supply intervals.

Some medicines can be given in possession regardless of in possession status and these are what are referred to as ‘green meds’ such as antibiotics, these medications do not require an authorisation chart. However, analgesia, for example, may be limited in line with the IP status and policy.

Therefore, documentation (PEMS) is required for the prison healthcare team to determine this and supply the medicines accordingly.

Medications prescribed/ advised by the Severnside clinician may be obtained via

Medication issued from prison stock
Electronic Prescription Service (EPS) then collection from a local community pharmacy
Medication issued from Severnside stock.

Issuing Medication from prison stock following Severnside consultation

Medications held in prison healthcare stock are listed in Appendix 2. Notes will be available on Connecting Care within 5 minutes of the consultation and/or the PEM will be emailed to the prison healthcare team. This will provide evidence of prescribing advice.

All PEMS will be emailed to HMP Bristol Healthcare Team – HMP

ep-yoi.admin@nhs.net

Obtaining medications not held in prison stock, or when no Healthcare Professional is on site to access prison stock (EPS or Severnside stock)

If Severnside is issuing a prescription for a drug that is not kept in the prison stock, or prison stock cannot be accessed, Severnside will either use Electronic Prescribing Service (EPS) and send the prescription electronically to an agreed local pharmacy, or medications may be issued from Severnside stock held at either Treatment Centres or in the visiting cars.

To EPS a prescription, the Severnside clinician must agree with the prison duty staff which local pharmacy. The prescription should state the prison address as the patient’s address to ensure no prescription charge is levied. It is the responsibility of the prison to collect the medication from the agreed pharmacy.

Severnside also holds a stock of medications in the visiting cars and at the Treatment Centre. If pharmacies are closed and the patient’s clinical need requires medication to start before they reopen, the visiting clinician can issue from the car stock, and a Treatment Centre clinician can issue from the Treatment Centre stock in line with usual Severnside process.

Safeguarding

Severnside works in partnership with PPG to ensure safeguarding Policies and Local Operating Procedures are in place to ensure statutory duties and BrisDoc’s core values are upheld within our service provision to the Prison community.

Safeguarding Patients if you have a Concern

If Severnside clinicians have a safeguarding concern following a consultation (F2F, telephone or home visit) then please follow the Brisdoc Safeguarding Policy.

Safeguarding Policy – Radar (radar-brisdoc.co.uk)

Eastwood Park does not make referrals directly to local authorities within BNSSG and instead have their own reporting process listed below under Referring and Sharing Information.

Initially, please share any safeguarding concerns with the Prison Staff involved in the care of the patient. The prison staff will report their concerns using internal prison safeguarding reporting processes.

Severnside clinicians should record details of the safeguarding concern(s) on Adastra and tick the safeguarding concern button at the end of a consultation.

Referring and Sharing Information

All Severnside staff with any concerns may complete a Learning Event available on Brisdoc Weblinks.

Severnside Staff consider speaking to your Line Manager or / and the Safeguarding Lead for Severnside IUC, or Head of Safeguarding for Brisdoc (listed in the Brisdoc Safeguarding Policy).

You may wish to consider a referral direct to the Prisons or contacting the Safeguarding Lead within Eastwood Park Prison the case of a serious/ urgent concern.

When sending an email please state ‘Safeguarding concern’ as subject to ensure that it is directed to the Safeguarding section to ensure it is sent to the appropriate person.

The safeguarding lead for Eastwood Park can be contacted via the prison control room Monday-Friday 09:00-17:00, outside of these hours please request to be put through to the Duty Governor.

HMP Eastwood Park telephone: 01454 382100

HMP Eastwood Park e-mail: ep-yoi.admin@nhs.net

HMP Eastwood Park

All Prison staff will have a process to raise concerns.

Any enquiries/ incidents/ learning events/ complaints regarding Severnside service should be emailed to Severnside using severnside.governance@nhs.net

Monitoring

Consultations will be monitored in accordance with Severnside’s Audit Framework.

Any learning events/ incidents will be reported in accordance with the Severnside Incident Management Policy and reported to the Governance Team for inclusion into the incident reporting system for review and management.

Appendices

Appendix 1 – Master List of Equipment in Severnside Diagnostic Bag

Appendix 2 –Stock Medication HMP Eastwood Park

Item description	Pack Size

Antibiotics
Amoxicillin 500mg capsules	21
Clarithromycin 500mg tablets	14
Clindamycin 300mg capsules	28
Co-amoxiclav 500/125mg tablets	21
Doxycycline 100mg capsules	8
Flucloxacillin 500mg capsules	28
Levofloxacin 500mg tablets	10
Metronidazole 400mg tablets	21
Nitrofurantoin MR 100mg capsules	6
Nitrofurantoin MR 100mg capsules	14
Phenoxymethylpenicillin 250mg tablets	28
Trimethoprim 200mg tablets	6
Trimethoprim 200mg tablets	14

Analgesia
Co-codamol 30/500mg tablets	30
Naproxen 500mg tablets	14
Paracetamol 500mg tablets	16

Respiratory
Prednisolone 5mg tablets	28
Salbutamol inhaler 100mcg	1

Antiemetic
Metoclopramide 10mg tablets	14
Metoclopramide injection 10mg/2ml	10

ENT/ Eyes
Chloramphenicol 1% eye ointment	4g
Gentisone HC ear drops	10ml
GTN spray	1
Minims Fluorescein 1%	Each
Minims Tetracaine 1%	Each
Otomize spray	1


Miscellaneous
Aspirin 300mg disp tablets	16
Ceftriaxone 1g vial	1
Chlorphenamine 4mg tablets	28
Hydrocortisone 1% cream	15g
Lidocaine 1% injection 5ml	10
Methylprednisolone 40mg/1ml	Vial
Methylprednisolone 40mg/1ml plus Lidocaine	Vial
Rivaroxaban 15mg tablets	7
Rivaroxaban 20mg tablets	7

Appendix 3 – HMP Eastwood Park Minor Ailments Stock

No prescription is required for these medications as there are Nursing Staff on shift for 24 hours of the day and can dispense as required.

Medication	Form	Strength	Pack Size
Anusol	Cream		23g
Asprin (IP)	Soluble tablet	300mg	16
Asprin (NIP)	Non Soluble tablet	300mg	300mg
Beclometasone	Nasal Spray		1
Clotrimazole	Cream	1%	20g
Hayfever eye drops	Drops		1
Ibuprofen	Gel	5%	50g
Ibuprofen (IP)	Tablets	200mg	16
Lactulose Solution (NIP)	Solution		300ml
Loperamide (IP)	Capsule	2mg	6
Loratadine (IP)	Tablets	10mg	14
Paracetamol (IP)	Tablets	500mg	16

Appendix 4 – Prohibited Items

The full list of prohibited items is made available in the gate area of the prison you are visiting. If you have any of the listed items on your person at that time, you must notify the prison staff in the gate area. You will either be directed to return such items to your vehicle or to secure such items in a locker provided by the prison. If you use a locker, you will be issued the key to keep on your person during your visit and to allow you to retrieve the items when you leave the prison.

It is a criminal offence to take prohibited items beyond the gate area and into the main prison, unless you have written authorisation from the prison’s security department.

The below is a list of prohibited items that must not be taken into the prison:

 Explosives, weapons or ammunition of any description (including imitation)

 Tools of any description, including scissors, pen knives

 Manicure sets, including nail files, tweezers, clippers, nail polish, polish remover

 Mobile phones, chargers

 Computer equipment

 Cameras, video recorders, audio recorders

 Smart watches, fitbits, wearable tech

 SIM cards, memory sticks, any other data transfer device

 Unauthorised drugs

 Alcohol

 Cigarettes, tobacco, lighters, matches

 Metal cutlery

 Glass containers

 Mirrors, including makeup compacts with mirrors built in

 Aerosols

 Chewing gum

 Blue tack (or similar)

 Tin foil

 Wire

 Clothing with offensive logos

 Umbrellas

 Chemicals or cleaning equipment

 Large amounts of cash (anything over £20)

This list is not exhaustive.

Change Register

Date	Version	Author	Changes
September 2024	Draft	Renuka Suriyaarachchi / Lucy Grinnell/ Kelly Smith	New policy