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A day in the life of a prison GP

I'm Caroline Allfrey, a newly qualified GP.

I knew early on, I wanted to do 'portfolio work'. I just didn't know what this would look like for me, or how to get the widest breadth of experience, whilst maintaining CPD, feeling rooted in an established community (I knew lots of locum work wasn't for me) and also keeping a roof over my head. 

Prison medicine, was not a career path I had in mind. I think it was a sense of unease about a lack of exposure to more complex mental health presentations, substance misuse and dual diagnosis, among some other areas, that led me to considering being a prison GP.

A relative lack of experience, and being newly qualified, has in some ways proved to be an advantage. I started this job with a desperation to feel more in control of my learning and develop my skill set, which in some ways numbed any trepidation I had about the environment; trepidation my family seemed to deal with by repeatedly asking me if I was 'quite sure' about taking the job. They've since learnt that they needn't have been so concerned.

HMP Wormwood Scrubs is a category B, male prison. As such, among a higher burden of the aforementioned problems, I see a wider variety of men's health issues. Now, instead of seeing a request for a patient to provide a urine sample as a golden opportunity to get the CKS guidelines up for prostatitis, I feel more enabled and relaxed, in managing the common men's health issues we as GPs see commonly but wish we could encourage men to present with earlier.

I've found the prison population varied, interesting and surprisingly willing to engage with you. I've found my communication skills pushed to the limit, but strengthened, and new areas for clinical experience I wasn't expecting.

The bread and butter of the job however, is entirely comparable to 'normal' GP work: clinics, duty doctor, paperwork, bloods. But we leave at 5.30 and get lunch! 

I work closely with nurses, HCAs, pharmacists, pharmacy technicians, counsellors and some third sector organisations - all under one roof providing huge opportunity for collaborative working.

For me, the sessions I do in prison augment my overall clinical practice. It's helped develop my confidence, clinical experience and sense of community orientation - something as hard as they try; VTS schemes often fall short on.

So, don't discount the idea because it's an under represented area of General Practice or necessarily allow the unfamiliarity to put you off. I'm pleased to say I've found it really rewarding! 

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