Leading questions: Venn PCN’s inclusion health officer, Claire Garrett, on early release prisoners

In September, primary care was told to prepare to register an influx of prisoners who were being released through the government early release scheme SDS40, designed to help tackle prison capacity issues. Senior reporter Beth Gault spoke to Claire Garrett, inclusion health officer at Venn PCN, Hull, on how they managed to do this and how local collaboration was pivotal to making it work.

Beth Gault (BG): NHS England has asked practices and PCNs to support these prisoners coming out early, to make sure they are registered and have access to healthcare. How is that working on the ground?

Claire Garrett (CG): One of our practices, The Quays, was originally set up as a specialist service. It was a social inclusion practice set up for asylum seekers and refugees to access primary care. But it then expanded to help sex workers and those within the criminal justice system.

Although it stopped being a specialist service in 2017, it never really lost that speciality. So, there was always going to be released prisoners coming to the practice.

When I heard about SDS40 I was a little bit concerned because I didn’t want everyone registering at The Quays if they didn’t need to be – we just couldn’t take that influx. So, I was asked by the ICB if I could do a pilot so that when the prisoners came out of prison, instead of all going to one place, could we spread them out geographically across Hull.

With the cohort released in September, everybody was released with a bed – which was amazing given the housing crisis. There’s a care after custody service called Reconnect which runs in the prison and assessed every patient to find out who had a GP and who didn’t, and those who didn’t liaised with me and I liaised with the GP surgeries in Hull.

So, out of all the prisoners that were released, 14 were already known by The Quays and were registered there, and 10 were registered elsewhere – so 24 prisoners in total.

BG: And were you placing the patients just across your PCN, or wider?

CG: No, not just Venn PCN, it was geographically across Hull. If a patient said I used to be registered at Morrill Street practice, we’d go to them, and they’d take them.

I tried to share them across the city, so practices got one patient each, but it was also the patient’s choice about where they wanted to be registered.

BG: How did the process work?

CG: I worked really closely with Vicky Jackson from Reconnect, she was amazing and fed me the information from the prisons and who was coming out.

I then spent a day at probation, we closed off a whole bit to have all the SDS40s attend. Vicky’s team would go and assess a patient, make sure they were happy to speak to me and then I went and spoke to them and registered them with the practice.

For the patients registering with The Quays or another one of my practices, we also sorted out medications on the day. For example, if they were going into a hostel, but they got a 28-day supply of medication, then because I didn’t want them to lose that medication or for it to be stolen, I asked if they wanted it weekly or daily instead.

A lot of our patients accepted that, and then my practices sorted that out. We also asked about mental health, if they need anything, any referrals, or to see a doctor. We had a few say yes to that. We saw them at probation on the Wednesday and they had an appointment by the Thursday or Friday. So, there was a quick turnaround to try and ensure a smooth transition back to the community.

For those patients who weren’t with Venn PCN practices, I still asked about their medication, but then I sent an email or had a phone call with the practice saying you need to register this patient but look at the notes.

BG: Was it a clinic-style day at probation?

CG: They were all given appointment times to attend probation throughout the day, so from a 9am release to a 4pm release, and they just trickled through.

We also had lots of other services, I was there for primary care, but we also had Reconnect, probation workers, ReNew drug and alcohol service, and then other services as well.

It was a great blueprint for services working together. And it was great to be able to speak to them face-to-face.

A lot of our prisoners can fall of the radar a little bit once they’ve been discharged and released from prison. And they can be quite vulnerable. A lot of our patients don’t want to be released because they’re quite safe in prison, they get three meals a day and potentially some of them thought they might be homeless. But it was a day where they were reassured that they had a bed, and colleagues worked really hard to ensure the patients felt they mattered.   

Going forward, I hope this blueprint sticks because services working together is so much better than working in silo and sending out emails that can take days to go through.

BG: Do you think it built trust with the patient, being in the same room?

CG: Yes, absolutely. And it helped to see what we’re doing for that patient holistically – being able to have ReNew and Reconnect in the room.

BG: What were some of the challenges you faced?

CG: Some of the surgeries didn’t want to take the prisoners. I’m extremely lucky because The Quays has never been a ‘no’ practice – if patients have no address, no ID, nowhere to store medicines, no problem. I didn’t realise that other surgeries don’t work that way, so it was a bit of a battle.

I think it was just apprehension of ‘What does this mean if we register this patient?’. The media didn’t help either. But they were asking ‘can I say no?’ I said, ‘No practice should be saying no because we’re doing this fairly’. But it worked out in the end.

BG: Are you going to do the same thing again, or will you change anything for the next release date in October?

CG: We’ll do the same thing. We thought we might have something to learn from the first release, but actually it went really well and there’s nothing that we need to change.

BG: If any PCNs are considering a similar model but aren’t sure, what would you say to them? And where should they start?

CG: Contact your ICB lead and they’ll put you in touch with somebody, or you can contact me.

I’d say working in silo only makes it harder for yourself, but working together as a team is so much more beneficial. To get a patient to listen and to carry out what they need for their healthcare, for the best for them, you might need help from a support worker or drug and alcohol services. For that, communication and collaboration is key.