James Graham
Action Taken
G4S Forensic & Medical Services has circulated and discussed GMC guidelines on delegation and referral as part of Continuing Professional Development. An investigation into the individual's professional practice has concluded with remedial action and learning requirements. Work is ongoing to standardise the structure of all referrals for consistent information transfer, and the organisation will ensure cascaded learning across all staff. (AI summary)
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Dear Sir
Inquest touching the death of James Bewick Graham Date of death: 2 November 2014 - HMP Frankland
I write in response to your report dated 17 December 2015 made under paragraph 7, Schedule S of the Coroners and Justice Act 2009 and regulations 28 and 29 of the Coroners (Investigations) Regulations 2013.
G4S Forensic & Medical Services (UK) Ltd took over responsibility for provision of healthcare services at HMP Frankland on 1 April 2015.
G4S Forensic & Medical Services (UK) Ltd is responsible for primary care and substance misuse care at HMP Frankland and employs a team made up of qualified registered general nurses, mental health nurses and healthcare support workers, together with separate administration staff, for this work.
An organisation called Spectrum Community Health CIC is contracted separately to provide GP and Pharmacy Services at HMP Frankland.
Mental health services at HMP Frankland are provided by Tees, Esk and Wear Valley NHS Trust. As part of its responsibilities, the mental health team is responsible for conducting mental health assessments.
Podiatry services at HMP Frankland are provided by Premier Physical Healthcare.
Following Mr Graham's death, my predecessor wrote to the Gables Medical Practice, which was until 1 April 2015 responsible for providing GP services at HMP Frankland, to ensure that all clinicians understood and used the appropriate referral process and to ensure that all urgent referrals to secondary services were recorded and monitored.
The computerised medical records system, SystmOne is used at HMP Frankland. SystmOne is a centrally hosted clinical computer system used by healthcare professionals in the UK predominantly in Primary Care. The system is one of the accredited systems in the government's programme of modernising IT in the NHS and is used across the entire Prison Estate to ensure consistency and full access for medical personnel regardless of which prison at which the prisoner is residing. It is important that the procedures in place regarding referrals are complied with consistently to ensure optimum treatment and to avoid any possibility of relevant matters being overlooked. As part of the procedures in operation, SystmOne incorporates an
1
electronic referral system to help ensure referrals are accurately and promptly made and appropriately. monitored.
The procedure in place for referrals to secondary care, both routine and urgent, involve the GP handwriting a referral or typing the contents of the referral onto an electronic task. If handwritten, the GP would hand the document to the administrator responsible for secondary care or if an electronic task, would send this to the administrator. The administrator types the referral up on to Systmone. The referral is then saved in the referrals section of the clinical tree.
The typed referral is printed by the administrator and returned to the GP for consideration and signature. The referral is then sent to the Central Appointments Bureau.
The method of communicating the referral by the GP would depend on each GP's preference and other factors such as workload.
For urgent referrals to secondary care, the GP should highlight the urgency of the referral to the administrator, to enable the process to be fast tracked or so the referral can be sent direct to a hospital department, to ensure it is prioritised.
All referrals into secondary care are reviewed by a senior nurse or above to ensure they are within the right pathway.
The following steps have been taken to address your concerns surrounding the manner in which referrals to secondary care are made and monitored:-
* An instruction was sent to the Medical Director of The Gables Medical Offender Health Ltd by the former Head of Healthcare at HMP Frankland to instruct GPs that all urgent referrals to secondary care are discussed with the senior administrator and senior nurse in order to ensure that patients are managed through the correct process which will ensure clear management plans when ensuring pathways are monitored both clinically and with regard to security issues by the Security Department.
* Following the commencement of the new contract arrangements relating to the provision of healthcare services at HMP Frankland on 1 April 2015, the former head of healthcare at HMP Frankland is now employed by Spectrum Community Health CIC and therefore the current provider of GP Services at HMP Frankland is aware and informed of the requirements relating to referrals to secondary care.
I trust my response addresses the nursing concerns outlined in your recent report.
Inquest touching the death of James Bewick Graham Date of death: 2 November 2014 - HMP Frankland
I write in response to your report dated 17 December 2015 made under paragraph 7, Schedule S of the Coroners and Justice Act 2009 and regulations 28 and 29 of the Coroners (Investigations) Regulations 2013.
G4S Forensic & Medical Services (UK) Ltd took over responsibility for provision of healthcare services at HMP Frankland on 1 April 2015.
G4S Forensic & Medical Services (UK) Ltd is responsible for primary care and substance misuse care at HMP Frankland and employs a team made up of qualified registered general nurses, mental health nurses and healthcare support workers, together with separate administration staff, for this work.
An organisation called Spectrum Community Health CIC is contracted separately to provide GP and Pharmacy Services at HMP Frankland.
Mental health services at HMP Frankland are provided by Tees, Esk and Wear Valley NHS Trust. As part of its responsibilities, the mental health team is responsible for conducting mental health assessments.
Podiatry services at HMP Frankland are provided by Premier Physical Healthcare.
Following Mr Graham's death, my predecessor wrote to the Gables Medical Practice, which was until 1 April 2015 responsible for providing GP services at HMP Frankland, to ensure that all clinicians understood and used the appropriate referral process and to ensure that all urgent referrals to secondary services were recorded and monitored.
The computerised medical records system, SystmOne is used at HMP Frankland. SystmOne is a centrally hosted clinical computer system used by healthcare professionals in the UK predominantly in Primary Care. The system is one of the accredited systems in the government's programme of modernising IT in the NHS and is used across the entire Prison Estate to ensure consistency and full access for medical personnel regardless of which prison at which the prisoner is residing. It is important that the procedures in place regarding referrals are complied with consistently to ensure optimum treatment and to avoid any possibility of relevant matters being overlooked. As part of the procedures in operation, SystmOne incorporates an
1
electronic referral system to help ensure referrals are accurately and promptly made and appropriately. monitored.
The procedure in place for referrals to secondary care, both routine and urgent, involve the GP handwriting a referral or typing the contents of the referral onto an electronic task. If handwritten, the GP would hand the document to the administrator responsible for secondary care or if an electronic task, would send this to the administrator. The administrator types the referral up on to Systmone. The referral is then saved in the referrals section of the clinical tree.
The typed referral is printed by the administrator and returned to the GP for consideration and signature. The referral is then sent to the Central Appointments Bureau.
The method of communicating the referral by the GP would depend on each GP's preference and other factors such as workload.
For urgent referrals to secondary care, the GP should highlight the urgency of the referral to the administrator, to enable the process to be fast tracked or so the referral can be sent direct to a hospital department, to ensure it is prioritised.
All referrals into secondary care are reviewed by a senior nurse or above to ensure they are within the right pathway.
The following steps have been taken to address your concerns surrounding the manner in which referrals to secondary care are made and monitored:-
* An instruction was sent to the Medical Director of The Gables Medical Offender Health Ltd by the former Head of Healthcare at HMP Frankland to instruct GPs that all urgent referrals to secondary care are discussed with the senior administrator and senior nurse in order to ensure that patients are managed through the correct process which will ensure clear management plans when ensuring pathways are monitored both clinically and with regard to security issues by the Security Department.
* Following the commencement of the new contract arrangements relating to the provision of healthcare services at HMP Frankland on 1 April 2015, the former head of healthcare at HMP Frankland is now employed by Spectrum Community Health CIC and therefore the current provider of GP Services at HMP Frankland is aware and informed of the requirements relating to referrals to secondary care.
I trust my response addresses the nursing concerns outlined in your recent report.