Working as a prison doctor

Doctors at HMP Wandsworth need good 'jail craft', writes resident GP Dr Emmanuel Baikie.

HMP Wandsworth in south-west London is the largest prison in the UK, with more than 1,200 inmates.

Former occupants include Oscar Wilde, Ronnie Kray and Great Train Robber Ronnie Biggs, the only man ever to have escaped.

Biggs thoughtfully sent prison authorities a picture of himself sunbathing in Brazil, which is still on display in the prison.

More recent luminaries include musician Pete Doherty, Wikileaks founder Julian Assange and former energy secretary Chris Huhne.

All three left the prison, but not all prisoners have been so lucky. Before the death sentence was abolished, executed prisoners were buried in the prison cemetery, now beneath the inner perimeter road.

The former gallows are located in what is now one of the medical consulting rooms, giving it a unique, if somewhat macabre, setting.

Affluent neighbourhood

The prison was built in 1851 in what would have been a largely rural area, but is now home to one of London's most affluent neighbourhoods. Houses within a stone's throw of its 25-foot high perimeter walls now fetch close to £1m.

However, life inside this world within a world is very different and provides a challenging working environment for GPs like myself who divide their time between surgeries inside and outside the prison.

The average GP surgery has its share of awkward patients, so imagine a consulting room that includes murderers, thieves and armed robbers.

I have spent 11 years working in the prison and am one of two GPs working at HMP Wandsworth, along with a number of supporting locums and nurses.

The service is run by St George's Healthcare NHS Trust, which took over from an ailing private sector company in 2012 and has ambitious plans to showcase the site as a centre of excellence for prison healthcare.

This includes the capacity to treat more patients in-house, especially in emergencies, because hospital visits require a two-person escort and secure transport for inmates.

More than 80 healthcare staff work at the prison, including GPs - who divide their time between practice inside and outside Wandsworth's walls - nurses, healthcare assistants and pharmacists.

My working day is divided between surgery, where I may see up to 25 patients, and being the duty doctor dealing with emergencies on the prison wings, rewriting prescriptions and visiting the psychiatric unit.

The radial layout of the prison, including its network of stairways, innumerable doors to be unlocked and locked, and restricted space, presents a very challenging working environment.

This is particularly true when carrying a heavy medical backpack, including resuscitation equipment for emergencies which have included MIs, seizures and an attempted suicide by hanging.

It may surprise some colleagues to know that we also have a high number of 'did not attends' in surgery, because healthcare is always secondary to security in prison.

This presents a continuing challenge, with prisoners not turning up because they have been transferred to another facility, sent to court or placed in lockdown, where prisoners are confined to their cells following an incident.

We have to accommodate prison rules, but are lucky enough to have a progressive governor, who sees the value of healthcare inside the facility.

Keeping safe

Prison, contrary to popular belief, is safer than you think. Civilians are less likely to be a target of aggression than prison officers, although there can be verbal abuse from inmates who have alcohol and drug-related problems. However, it does require an intimate knowledge of 'jail craft.'

You have to be aware that some prisoners can be manipulative and demanding. Unwary GPs or generous prescribers of opiate-based medication can quickly find themselves inundated with prisoners who sense a soft mark and try to take advantage of the situation.

Medication open to abuse includes antipsychotics and sedative antidepressants, benzodiazepines, codeine, tramadol, buprenorphine (valued more highly than methadone) and nutritional supplements.

The issue of an F35 form can be a bone of contention, as it gives the GP the power to permit single cell occupancy, a special diet and other conditions that prisoners see as perks.

A prison GP needs to be firm and most inmates appreciate my help, although I see my fair share of hypochondriacs, probably because they have so much time on their hands to just sit and stew.

It is important to treat patients with respect and not be judgmental. Many come from broken homes, have been brought up in care or suffered at the hands of abusive parents.This does not excuse their behaviour, but it is deeply troubling to see a father and son serving time in the same prison together.

Self-harm

The conditions I treat are typical of those outside prison, but low-level mental health conditions, such as anxiety, depression and stress, affect a disproportionate number of inmates.

There is a higher incidence of self-harm, although the wounds are usually superficial, and a high proportion of patients with alcohol and drug-related problems.

These patients are identified during their first night in custody and monitored by the substance misuse nursing team before going through a detailed screening process the next day, with continuing reviews.

Some people see a stigma attached to prison work, but it is a decision I have never regretted. My advice to any GP curious about prison sessions is to arrange a visit through their CCG. You may find a career behind bars is the challenge you are seeking.

  • Dr Baikie is resident GP at HMP Wandsworth, London.

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