The report, the third in a series focusing on prison healthcare, explored how information is shared between prison operational IT systems and prison healthcare IT systems, and how the current process of General Medical Services (GMS) registration for people in prison affects the safe delivery of care.
Limited information sharing
We found that prison security and prison healthcare teams use different IT systems that cannot automatically share data. This means important patient information—such as whether a person poses a risk to themselves or others—is not always available to the clinicians treating them.
Staff in prison healthcare departments are also required to duplicate appointment information across both systems. In some prisons, this amounts to thousands of entries per month, significantly increasing administrative workload and the potential for errors. The report notes that while the prison healthcare IT system has been adapted to allow future interoperability, the prison operational IT systems have not and there are currently no plans to update them.
Informed consent and continuity of care
The investigation also highlights how the GMS registration process may disrupt continuity of care, particularly for people on remand who are detained for short periods. Registering with a prison GP often leads to de-registration from a person’s community GP, potentially impacting their care both during and after custody.
While patients are asked to consent to GMS registration during the prison reception process, we found that limited time, high stress, and varying staff understanding of the process mean that patients are not always able to make fully informed decisions about their care. Patients who do not consent to registration are also not automatically included in national screening programmes, such as those for breast and bowel cancer.
In addition, the investigation found that patients are sometimes asked to re-consent to registration each time they move between prisons. This can result in gaps in medical records and further disrupt continuity of care.
Supporting improvements in prison healthcare delivery
We have made four recommendations aimed at supporting improvements. This includes ensuring better support for informed consent, reducing disruption to ongoing care relating to the registration process for patients on remand, focus on system interoperability and future system design. The report also contains local level learning that prison healthcare providers and prison staff can now take to improve patient safety.
Investigator's view
David Fassam, Senior Safety Investigator says: “Our investigation found that there are significant gaps in digital systems, affecting the care of people in prisons. The lack of interoperability between the prison operational IT system and the prison healthcare IT system is an urgent issue that needs to be addressed because vital information is being lost – the prison workforce told us doubling up on entries creates a significant burden, meaning errors are more likely to occur.
“The report also emphasises that people in prison must be given the time and space to understand what the transfer of registration from their community GP to the prison GP means. Patients in prison that were spoken to during the investigation reinforced that the process could be confusing and rushed. Overall, our findings and subsequent recommendations are aimed at tackling all these key issues related to prison healthcare data sharing.
"By improving process and streamlining digital systems, there is opportunity to reduce duplication and inefficiency, ensure smoother transitions for people in prison back to the community on release and most importantly ensure better care for patients in prison, whether they need an urgent appointment or are monitoring a long term chronic condition.”
Related articles
Electronic patient record systems: recurring themes arising from safety investigations
Read article
