New (12 May 2023) research from NACRO finds too many people are being turned away from GP surgeries unable to register and access support because they have no proof of ID or address. Following reports from their frontline resettlement staff of an increase in the difficulties experienced by people leaving prison when trying to register with a GP, the charity undertook a mystery shopping exercise of more than 50 GP surgeries to ascertain whether this was an anomaly or a more widespread concern.
The key findings from this mystery shopper exercise were:
- 66% (37 out of 56) GP surgeries we contacted said they required proof of address and couldn’t register the prison leaver without it.
- 43% (24 out of 56) GP surgeries we contacted said they required ID in order to register the prison leaver.
- 41% (23 out of 56) GP surgeries we contacted said they required both proof of address and ID in order to register the prison leaver.
- Over half (21 out of 36) of the GP practices rated as ‘good’ said they required proof of address to register a prison leaver, and four out of the five rated as ‘outstanding’ required proof of address.
The health needs of prison leavers
As regular readers will no doubt be only too well aware, people in prison are more likely to experience a wide of health problems including higher prevalence of infectious diseases and (much) higher rates of substance misuse and mental health problems than the general population.
The period of transition from prison to community is a risky time due to the potential for gaps in continuity of treatment or care, and we know people who have been in contact with the criminal justice system continue to experience significant health inequalities post-release, compared with the rest of the population. Very sadly we know that at least 48 people a year die in their first two weeks out of prison.
The risk of reoffending
A lack of health support can lead to further offending. If people coming out of prison are unable to access the support and medication that they need, they are more likely to fall back into old patterns of behaviour: for example returning to depending on illegal substances and committing crimes to support those needs. We know that less than half the people who engage in prison drug treatment are able to access continued support in the community on release – although this figure varies significantly across the country.
Those who have left prison can often experience a diverse range of social, economic and environmental factors that disadvantage them further, such as persistent unemployment,
poverty and unmet accommodation needs – which are recognised as wider determinants of health. Access to a GP is a critical entry point to support, and given that many people in contact with the justice system come from disadvantaged communities, tackling their needs brings a ‘community dividend’ by having a positive impact on their wider peer group and social networks, as well as their broader communities.
Costs to the society
As well as the harm experienced by individuals, there are also financial costs to society and additional pressure on NHS resources. People who do not have access to a GP are much more likely to access the NHS through an emergency route (i.e. via the emergency services or direct attendance at an emergency department) which is much more dangerous to the person’s health, costly and
diverts resource away from other urgent need. For every GP appointment that saves an attendance at A&E, there is a saving of at least £37.77, and where treatment is required at a major A&E department this rises to £320 or more. You can see the current costs of different health service interventions from the infographic I have reproduced from the report below.
The NACRO report makes six recommendations designed to improve access to GP and primary healthcare services for people leaving prison. They include communication and training for GP receptionists and practice managers on the registration of patients from excluded groups and easy access to organisations who can provide free advocacy for those who are turned away.