WHEN I heard the clang as the gate was closed behind me for the first time, I have to admit that I was a bit nervous. Would there be serial killers walking around all over the place? Would there be fights left, right and centre and where was the pipe I could escape if I was mistakenly locked in a cell in true Andy Dufresne style from Shawshank!
That was 10 years ago and I’ve now worked in six different prisons and I have to say, I find it extremely rewarding. There’s no doubt that it can be a challenging environment to work in – the nature of the patients you are working with dictates that. Over 140,000 people pass through the prison estate each year, with many having very complicated home lives and with a mixture of social, emotional, physical and intellectual challenges. Much of the way pharmacy services are provided in secure environments is derived from the Department of Health Document A Pharmacy Service From Prisoners (2003). The document states that prisoners are entitled to the same healthcare provision as patients outside prisons and that patients should be “in possession” of their own medication by default and “not in possession” only in exceptional circumstances.
The best thing about working in prisons or secure hospitals though is working with the other members of the healthcare team – GPs, dentists, general and mental health nurses, physio’s, radiographers, pharmacists and pharmacy technicians. We all work together to deliver the best possible care to the patients, whatever they have done and however, they present. It’s a real contrast to working in a community setting which can seem like a far cry from multi-disciplinary working.
So what does a normal day in a prison pharmacy look like? That actually depends on the type of prison you are working in. When a person is arrested their first night in prison will be in a local prison. Each area/region will have a local prison to which people are remanded to and in these prisons, they have to deal with many acute health issues. These health issues could be physical, emotional or psychological in nature or in many cases, a combination of all three and add to that sprinkling of freshly ground substance misuse and you have the recipe for the sharp-end of prison healthcare.
The healthcare teams in local prisons have to support and stabilise these patients as quickly and professionally as they can. This job usually falls to the nurses who I think do a great job in what can be very challenging conditions. For the acutely unwell, GPs are available on-call during the night and at weekends and the healthcare teams have access to Out of Hours medication that’s supplied from the pharmacy to an Out of Hours location(s). The local prisons have a big turnaround of patients every week with patients transferring, being released or re-distributed around the prison estate. Working in a pharmacy in a local prison can feel a bit like working in a community pharmacy sometimes with nurses requesting medication ASAP as a patient is on the bus ready for transfer ‘now’ or just about to go to court or suddenly becoming acutely unwell.
In the maximum security estate and other non-local prisons, patients have usually been in the system for some time and their acute healthcare issues have already been met. However, as with any substantial population, there are always acute healthcare needs and long-term conditions to be managed. In some ways for prison healthcare, you can draw an analogy with a local acute healthcare trust – the A+E or AMU is akin to the local prison and the wards in that hospital analogous to the rest of the prison estate. In contrast to the community like nature of local prisons, the rest of the estate can feel more chilled as patients medication can be managed more easily in most cases.
So, from a professional and financial perspective, locum work in secure environments is really worth considering. We have probably placed upwards of 50 people in prisons and only one who decided prison pharmacy wasn’t for them.
Accessing locum sessions can be tricky, but if you are ready, willing and able to give it a go call an agency with experience working in secure environments and they can guide you through the essential compliance and security requirements.
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