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Understanding the organisational influences on the quality of and access to primary care in English prisons: a qualitative interview study

BACKGROUND: Primary care for routine healthcare conditions is delivered to thousands of people in the English prison estate every day but the prison environment presents unique challenges to the provision of high-quality health care. Little research has focused on the organisational factors that aff...

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Autores principales: Sheard, Laura, Bellass, Sue, McLintock, Kate, Foy, Robbie, Canvin, Krysia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Royal College of General Practitioners 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10498379/
https://www.ncbi.nlm.nih.gov/pubmed/37666512
http://dx.doi.org/10.3399/BJGP.2023.0040
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author Sheard, Laura
Bellass, Sue
McLintock, Kate
Foy, Robbie
Canvin, Krysia
author_facet Sheard, Laura
Bellass, Sue
McLintock, Kate
Foy, Robbie
Canvin, Krysia
author_sort Sheard, Laura
collection PubMed
description BACKGROUND: Primary care for routine healthcare conditions is delivered to thousands of people in the English prison estate every day but the prison environment presents unique challenges to the provision of high-quality health care. Little research has focused on the organisational factors that affect quality of and access to prison health care. AIM: To understand key influences on the quality of primary care in prisons. DESIGN AND SETTING: This was a qualitative interview study across the North of England from 2019 to 2021. METHOD: Interviews were undertaken with 43 participants: 21 prison leavers and 22 prison healthcare professionals. Reflexive thematic analysis was undertaken. RESULTS: The overarching organisational issue influencing quality and access was that of chronic understaffing coupled with a workforce in flux and dependence on locum staff. This applied across different prisons, roles, and grades of staff, and was vocally discussed by both patient and staff participants. Intricately related to understaffing (and fuelled by it) was the propensity for a reactive and sometimes crisis-led service to develop that was characterised by continual firefighting. A persistent problem exacerbated by the above issues was unreliable communication about healthcare matters within some prisons, creating frustration. Positive commentary focused on the characteristics and actions of individual healthcare professionals. CONCLUSION: This study highlights understaffing and its consequences as the most significant threat to the quality of and access to prison primary care. Strategies to address health care affecting prison populations urgently need to consider staffing. This issue should receive high-profile and mainstream attention to address health inequalities.
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spelling pubmed-104983792023-09-14 Understanding the organisational influences on the quality of and access to primary care in English prisons: a qualitative interview study Sheard, Laura Bellass, Sue McLintock, Kate Foy, Robbie Canvin, Krysia Br J Gen Pract Research BACKGROUND: Primary care for routine healthcare conditions is delivered to thousands of people in the English prison estate every day but the prison environment presents unique challenges to the provision of high-quality health care. Little research has focused on the organisational factors that affect quality of and access to prison health care. AIM: To understand key influences on the quality of primary care in prisons. DESIGN AND SETTING: This was a qualitative interview study across the North of England from 2019 to 2021. METHOD: Interviews were undertaken with 43 participants: 21 prison leavers and 22 prison healthcare professionals. Reflexive thematic analysis was undertaken. RESULTS: The overarching organisational issue influencing quality and access was that of chronic understaffing coupled with a workforce in flux and dependence on locum staff. This applied across different prisons, roles, and grades of staff, and was vocally discussed by both patient and staff participants. Intricately related to understaffing (and fuelled by it) was the propensity for a reactive and sometimes crisis-led service to develop that was characterised by continual firefighting. A persistent problem exacerbated by the above issues was unreliable communication about healthcare matters within some prisons, creating frustration. Positive commentary focused on the characteristics and actions of individual healthcare professionals. CONCLUSION: This study highlights understaffing and its consequences as the most significant threat to the quality of and access to prison primary care. Strategies to address health care affecting prison populations urgently need to consider staffing. This issue should receive high-profile and mainstream attention to address health inequalities. Royal College of General Practitioners 2023-09-05 /pmc/articles/PMC10498379/ /pubmed/37666512 http://dx.doi.org/10.3399/BJGP.2023.0040 Text en © The Authors https://creativecommons.org/licenses/by/4.0/This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ).
spellingShingle Research
Sheard, Laura
Bellass, Sue
McLintock, Kate
Foy, Robbie
Canvin, Krysia
Understanding the organisational influences on the quality of and access to primary care in English prisons: a qualitative interview study
title Understanding the organisational influences on the quality of and access to primary care in English prisons: a qualitative interview study
title_full Understanding the organisational influences on the quality of and access to primary care in English prisons: a qualitative interview study
title_fullStr Understanding the organisational influences on the quality of and access to primary care in English prisons: a qualitative interview study
title_full_unstemmed Understanding the organisational influences on the quality of and access to primary care in English prisons: a qualitative interview study
title_short Understanding the organisational influences on the quality of and access to primary care in English prisons: a qualitative interview study
title_sort understanding the organisational influences on the quality of and access to primary care in english prisons: a qualitative interview study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10498379/
https://www.ncbi.nlm.nih.gov/pubmed/37666512
http://dx.doi.org/10.3399/BJGP.2023.0040
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