Provision of Primary Care Services into Forensic Psychiatry

Department of Health Standards, which are now a contractual requirement, mandate that medium secure services must have a Primary Care Service provided by a specialist primary care provider in order to allow an equivalence of service to that available in the general population. The medium secure service at Newton Lodge has been designated as a medium secure provider on an interim basis pending the implementation of appropriate primary health care.The decision has been taken to expand the remit of the primary care service to provide equivalent input to the two low secure services on the Fieldhead Hospital site.There is a significant need for the long term care of this service user group, particularly given the lengths of stay for in-patients. There is a need for equity of access to primary care services with the general population and although in the past there has been a perception of this population consisting of mainly young and physically fit men, this is no longer the case. There are many factors increasing the risk factors for physical illness within this population group which include the presence of major mental illness, substance misuse and previous patterns of chaotic, dysfunctional and unhealthy lifestyles. There is also significant impact of psychotropic medication, particularly relating to atypical antipsychotics with all the related issues of weight gain and metabolic disorder. The population is increasing with age and all the associated increased morbidity factors seen in the general population will be reflected within the service. The Department of Health Standards for Medium Secure Units require primary care provision to be undertaken by local primary care services. The Trust has been operating with a local primary care service for the past five years but now needs to market test the contract ensuring that the service provided meets all its obligatory requirements, delivers a quality solution and offers best value for money. The Forensic Commissioners aim to reduce health inequalities within its local population. Health inequalities are the result of a complex and wide-ranging network of factors. People, who experience material disadvantage, poor housing, lower educational attainment, insecure employment or homelessness, are among those more likely to suffer poorer health and an earlier death, compared with the rest of the population. Health inequalities are particularly marked within the forensic secure service population. It is the responsibility of the Provider(s) to proactively reduce health inequalities in supplying this service. The nature of secure environments means that the practicalities of delivering healthcare and particularly equivalence can be challenging. For example, security considerations can restrict service user movements, the opportunity for self-care is more limited and there are some restrictions in the degree to which choice can be exercised. The commissioning organisation and the service provider will work in partnership to overcome barriers to health promotion, prevention of ill-health and delivering effective healthcare wherever possible.