Article too sanguine on prisoners' health

EDITOR If Keavney's article on primary care in prisons is aimed at describing the generalist nature of prison healthcare delivery, and the inherent dangers of overspecialising, then it is equivocal on a number of points. The total number of prisoners incarcerated is around 65,000, not 6,000. Prisoners are not physically “more healthy than people of a comparable age in the community.” Across all age ranges, including young offenders, it is well documented that prisoners' health is poor when compared with the general population. Unpublished studies have shown that up to half of prisoners have seen a general practitioner in the six months before entering prison. It is worth mentioning that in some prisons up to 10% of the population is over 60 years old. In many prisons, the general practitioner shares delivery of primary health care with full time prison doctors and nurses. In others the local community GP is the only medical input. Dr Keavney is correct when he describes prison medicine as “primary care in a special setting” but with the added dimension of the vulnerability that a spell in prison brings. The successful delivery of appropriate primary care services to prisoners depends on good communication between prison healthcare teams and their colleagues in local primary care, with the sharing of accurate, timely, and appropriate information about the health needs of the community who happen to be in prison at the present time.

Jan Cassidy Prison/NHS Healthcare Liaison Lifespan Healthcare NHS Trust, Ida Darwin, Fulbourn, Cambridge CB1 5EE