Patients, prisoners, or people? Women prisoners' experiences of primary care in prison: a qualitative study

Abstract

The development of primary care services within prisons has been central to improvements in the provision of health care in this setting over the past decade. Despite national imperatives to involve patients in the development of services and numerous policy initiatives, there has been no systematic evaluation of changes in the delivery of primary care and little published evidence of consultation with prisoners. AimTo explore women prisoners' experiences of primary healthcare provision in prison. Design of studyQualitative study using focus groups and interviews. SettingTwo women's prisons in southern England. MethodSix focus groups involving 37 women were conducted, as well as 12 semi-structured individual interviews. Focus groups and interviews were recorded, transcribed, and analysed thematically. ResultsWomen prisoners' perceptions of the quality of prison health care were mixed. There were accounts of goodquality care where practitioners were regarded as knowledgeable and respectful, but many perceived that the quality of care was poor. They complained about difficulties accessing care or medication, disrespectful treatment, and breaches of confidentiality by practitioners. They voiced the belief that staff were less qualified and competent than their counterparts in the community. ConclusionThe prison environment presents unique challenges to those providing health care, and much work has been done recently on modernising prison health care and improving professional standards of practice. However, the accounts of women prisoners in this study suggest that there is a gap between patient experience and policy aspirations. Keywordsprisoners; qualitative research; quality of health care; women. INTRODUCTIONThe development of primary care services within prisons has been central to improvements in the provision of health care in this setting.1 Since 1999 there have been a number of policies aimed at developing and improving the way in which health care is provided in prisons. Central to these developments has been the notion of 'equivalence' of care: that prisoners should have access to the same quality and range of health care as the general public receives from the NHS.2 Furthermore, a number of key initiatives have focused on the importance of primary care in delivering high-quality, effective health care to prisoners.Health professionals practising in prisons face a number of challenges; for example, professional isolation, a lack of understanding by other prison staff of the value of health care, 3 and working with a socially marginalised group of patients with considerable health needs, particularly relating to mental health and substance misuse. 4,5 Many of the issues facing these health professionals have been recognised, and there have been considerable changes to the way in which health care is delivered in prisons.Health care in prisons is now commissioned and E Plugge, MA, DPhil, MFPH, senior research scientist;

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