Serving as a Prison Doctor or Nurse in the Irish Prison Service
Are you a qualified GP who isn’t interested in the day-to-day operations of running a full-time practice? Perhaps you want an alternative career within healthcare?
You might consider working as a GP within the Irish Prison Service (IPS) healthcare service.
The IPS offers primary medical care for all prisoners regardless of the context of their imprisonment.
What Do GPs Do in the Irish Prison Service?
Being a GP in the IPS isn’t dissimilar from working in a community GP practice, at least in terms of the services you provide.
In general, the bulk of your work includes:
- Health and medical assessments of new arriving prisoners
- Providing ongoing general medical care
- Prescribing and monitoring treatments
- Making specialist referrals
- Working with other health professionals and other IPS staff
- Ensuring vaccination programmes go out as planned
- Screening prisoners for diseases
Just as in a GP practice, you don’t do much beyond recommend secondary care. If someone needs to go to the hospital, they go to one of the acute hospitals provided by HSE. Prisoners also go on public waiting lists for secondary services, just as anyone seeing a GP in the community might.
However, some secondary care does exist within the IPS. Patients can receive referrals to the prison’s psychiatrists, substance abuse specialists, and STI specialists.
Everything else occurs within the HSE.
It’s essential to keep in mind that while the type of care provided is similar to your current practice, the way you go about it differs significantly.
For example, you will have limited administrative support. In the past, colleagues and assessment bodies reported that there are no community practice trappings like medical secretaries.
Indeed, there is also a challenge in support from the patient perspective. Being in custody reduces prisoners’ opportunity to participate in self-care and make decisions for themselves as there is a specific hierarchy within the IPS.
How Many GPS Work for the IPS?
There are 14 prisons in the Republic of Ireland. These include both open centres and closed high-security prisons.
Every Irish prison has at least one full-time prison doctor who visits from Monday to Friday. Though, the times of attendance varies. The GPs also provide out-of-hours on-call services to their prisons.
For all else, there are nurses stationed in all closed prisons 24-hours per day.
Keep in mind that the HSE doesn’t manage the primary IPS healthcare (though, your registration as a GP is). There is the possibility of the HSE taking over, as the NHS has done in the UK. However, this has not yet happened.
What Are the Treatment Issues Facing Prisoners in Irish Prisons?
Generally speaking, prisoners are not only more preoccupied with their health than others. They also experience poorer physical and mental health compared to their general population peers.
In the UK, prisoners consult with their GPs three times as often as their peers in the community.
One of the issues noted by current GPs in the IPS is caring for patients who are growing older within the prison and who have more complex medical needs. Some of these needs start much earlier than in the general population.
For example, they are noticing issues with long-term respiratory conditions, arthritis, and cancer. Older prisoners who were injecting drug users also face hepatitis C complications; hepatitis C is another severe issue found among all Irish prisons.
Some of these issues are the consequences of the adverse living conditions they faced outside of prison. The problems also reflect the disparities in access to medical care and services they also experienced outside of prison.
Caring for Aging Prisoners
In an article in The Irish Times, Dr Des Crowley, a 20-year veteran of the IPS, said that some of the 50-year-old drug-using patients presented health outcomes more commonly seen in 70-year-old nondrug users in the population.
The result is the need to provide medical care for people who are getting older and whose old age is complicated by a complex medical history. Some of the tasks Dr Crowley foresees are the increase in staff to help older prisoners with personal care tasks as their health deteriorates and providing palliative care for terminally ill patients.
There could even be a specially adapted older prisoners’ unit developed to cope with these new needs. This would be particularly important in older prisoners where the infrastructure can date back as early as the pre-Victorian era, which limits mobility for disabled prisoners and isn’t conducive to providing modern medical care.
A New Emphasis on Prevention
Recommendations from studies and groups like the UN have included a renewed focus on prevention, as is the standard in the community. The shifting focus would help the IPS provide a ‘prison health service’ rather than a ‘prison medical service.” It would result in a focus on total health rather than responding to needs when they arise.
Health prevention and promotion would include advice on lifestyle choices like diet and exercise as well as health screenings for diabetes and heart disease.
This is a change recommended across the board. However, there is no documentation available from the IPS regarding its implementation.
Would You Be Up for the Challenge of Working in the IPS?
Irish Prison Service jobs require you to provide standard primary healthcare to prisoners. However, the role is so much more than this. The population you work with has more significant and more complex health needs. What is more, you must cater to them outside the confines of the familiar HSE space.
Are you interested in following the path of a locum GP either in the HSE or in another sector like the IPS? Get in touch today to learn more about current opportunities.