HMP Bristol (Horfield), HMP Leyhill (Tortworth, South Gloucs) and HMP Ashfield (Pucklechurch, South Gloucestershire)
HMP Bristol is a Category B adult male prison for up to 450 people. There is a GP onsite Mondays to Friday 9am-9pm and Saturday afternoons 2pm-6pm to cover Saturday court arrivals . HMP Ashfield is a Category C adult male prison for up to 400 people. HMP Leyhill is a Category D adult male resettlement prison. On-site daytime GP healthcare is provided by DrPA (subcontracted by Oxleas NHS Foundation Trust).
From 28.11.22 SevernSide is commissioned to provide primary care support and advice to all three prisons. Full information about the prisons, their daytime healthcare provision and SevernSide's clinical assessment and management of people residing in prison is provided in the updated Prison Standard Operating Procedure. Prescribed medications will usually require an accompanying Oxleas Medication Authorisation Chart.
Briefly, prison healthcare professionals on site can call BrisDoc via the Professional Line, to provide brief clinical information, the patient’s observations and NEWS. The case will be added to the Advice queue for a call back to the HCP within 2 hours.
If there is no HCP on site, then the prison officer will call NHS111 to access the Severnside service.
Clinicians can speak with the prison HCP/ non-HCP and/ or the prisoner (this is not always possible due to staffing levels at the prison in the OOH period) to obtain a clinical history and agree a management plan. Please note that
- it is not possible to video consult or obtain photos from prisoners because mobile digital devices are not permitted inside prisons
- Prisons use Systmone, so background clinical information will not be visible on EMIS. Please use the summary care record within the CLEO record, although this will not be visible for some patients. The patient or prison HCP should be able to provide background clinical information if you cannot view this.
Clinical assessment and management should be equitable with that offered to all the patients we serve, inline with BrisDoc’s values
- Telephone consultations may be managed with self-care advice, reassurance, own GP (prison daytime healthcare service) follow up, electronic prescribing, or advice to attend hospital or call 999.
- If an out of hours face to face appointment is required, prisoners can be booked in the usual way to be seen at the IUC Treatment Centres. The prison team will ensure full risk assessment and management of the prisoner’s security. Severnside staff will always be accompanied by two or more prison officers
- Eligibility for a home/ prison visit aligns with the criteria described in the Severnside home visit policy, with the addition of security/ lack of prison escort making attending an appointment impossible. When entering the prison, clinicians must take photo ID with them. All possessions, including electronic devices, must be left at the prison reception. Clinicians will be accompanied by prison officer(s) at all times.
Prescribing for prison residents via EPS, dispensing from prison or Severnside stocks
When prescribing for patients in HMP Bristol and HMP Ashfield, an Oxleas Medication Authorisation Chart must be completed to enable administration of the medications. An authorisation chart is not required for HMP Leyhill.
- Electronic Prescribing
Please send electronic prescriptions to a mutually agreed community pharmacy for collection by prison staff. Please do not send EPS to Easton Day & Night pharmacy. Please complete and send the authorisation chart (the shift manager will email this).
- Prison stock medications
Each prison holds a stock of drugs (see SOP for details for each prison). If prescribing medication held in prison stock and there is a HCP on site to access it, please complete the authorisation chart and ensure your CLEO records provide clear dosing instructions.
- Dispensing from Severnside’s stock medications held in cars or Treatment Centres
Please follow usual Severnside guidance, and dispense from our stock only if community pharmacies are closed and the clinical need is such that treatment should be commenced before they reopen. Again, please log clear dosing instructions in theCLEO clinical record and complete the medication authorisation chart
None of the prisons should seek substitute prescribing (eg methadone, Subutex) from Severnside, and these medications should not be prescribed OOH for prison patients.
- Alcohol withdrawal in prisoners arriving straight from court at HMP Bristol (Horfield) ONLY
Occasionally we get calls late in the evening from HMP Bristol, regarding prisoners who have arrived straight from court and are withdrawing from alcohol, and there is no GP available at the prison to prescribe a detox regime. A nurse from the prison will be able to give you their CIWA-Ar Score and usually, a set of obs.
A CIWA-Ar score is a validated 10 item assessment tool which quantifies the severity of an individuals alcohol withdrawal symptoms. The CIWA-Ar provides guidance on monitoring and benzodiazepine dosage throughout withdrawal.
If the score is over 8, nurses are advised to contact a GP for advice, but are able to use PGD for diazepam if no GP available (which for most patients is the most suitable thing overnight). Less experienced nurses or those not able to use PGD may phone NHS111.
PLEASE NOTE THAT CHLORDIAZEPOXIDE PRESCRIBING IN THE COMMUNITY / OTHER SETTINGS OUTSIDE OF HMP BRISTOL, IS NOT SUPPORTED IN OUT OF HOURS.
If you are called overnight-- ask for the CIWA-Ar score:
If CIWA-Ar is between 10-14 a 20mg STAT chlordiazepoxide would be suitable and review by the onsite GP in the morning
If CIWA-Ar is between 15-20 then a 30mg STAT chlordiazepoxide is suitable and review by the onsite GP in the morning
If CIWA-Ar is over 20 then are entering the realms of more severe withdrawal and on-site assessment/A&E review is needed
If CIWA-Ar is over 35 call 999
Chlordiazepoxide is held on site at the prisons. If you are prescribing a stat dose, you need to complete an Oxleas Medication Authorisation Chart and arrange for it to be emailed to the prison. The full policy used for alcohol withdrawal at HMP Bristol is attached at the bottom of this page.
Guidance for consultations with prison residents (telephone and F2F)
- 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 prisoner
- Photo ID is required to enter the prison site (BrisDoc photo ID, NHS smartcard, photo driving license are all acceptable)
- Remove all items from pockets that could be used as a weapon
- Keep all medical equipment out of reach of the prisoner 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.
HMP Eastwood Park
50 Church Avenue, Falfield, Wotton-under-Edge, Gloucestershire GL12 8DB
IUC/ OOH provides a service to all adults and babies held at Eastwood Park.
SevernSide IUC provision for HMP Eastwood Park – Radar
Patients in short term police custody
These patients remain the responsibility of the Police and all health-care needs should be re-directed to the Police surgeon on-call. These cases are not managed by Severnside.