Quality statement 5: Medicines on transfer or discharge

Quality statement

People being transferred or discharged from prison are given a minimum of 7 days' prescribed medicines or an FP10 prescription.

Rationale

Continuation of medication is important to maximise benefits and reduce the risk of harm. Transferring people between prisons with a minimum of 7 days' prescribed medicines (excluding opioid substitution therapy, which is available from stock at all prisons) ensures that they have an adequate supply of medicines until they can get more at the prison they are transferred to. Discharging people from prison with a minimum of 7 days' prescribed medicines or an FP10 prescription to obtain medicines from a community pharmacy ensures that they have an adequate supply of medicines until they can get the next prescription after their release.

Quality measures

Structure

a) Evidence of local arrangements to ensure that a minimum of 7 days' prescribed medicines is transferred with the property of people moving to another prison.

Data source: Local data collection including medication protocols and working agreements with other prisons.

b) Evidence of local arrangements to ensure that, based on a risk assessment, a minimum of 7 days' prescribed medicines or an FP10 prescription is provided to people leaving prison.

Data source: Local data collection including medication protocols and risk assessments.

Process

a) Proportion of transfers between prison settings where a minimum of 7 days' prescribed medicines is provided.

Numerator – the number in the denominator where a minimum of 7 days' prescribed medicines is provided.

Denominator – the number of transfers between prison settings where the person is currently receiving prescribed medicines.

Data source: Local data collection including healthcare records and audits. The NHS England health and justice indicators of performance include data on the number of people transferred who are received into prison with 7 days' medication.

b) Proportion of prison discharges where a minimum of 7 days' prescribed medicines or an FP10 prescription are provided.

Numerator – the number in the denominator who receive a minimum of 7 days' prescribed medicines or an FP10 prescription.

Denominator – the number of discharges from prison where the person is receiving prescribed medicines.

Data source: Local data collection including healthcare records and audits. The NHS England health and justice indicators of performance include data on the number of people discharged from prison who are supplied with 7 days' medication or an FP10 prescription.

Outcome

a) Rates of medication continuity when people are transferred between prisons.

Data source: Local data collection including healthcare records.

b) Rates of medication continuity when people are discharged from prison.

Data source: Local data collection including healthcare records.

What the quality statement means for different audiences

Service providers (providers of healthcare in prisons) ensure that systems are in place, including risk assessment, for people to receive a minimum of 7 days' prescribed medicines or an FP10 prescription when they are transferred or discharged from prison. This should include ensuring that there is a process for people to receive a supply of their medicines or an FP10 prescription if they are transferred or discharged from prison at short notice.

Healthcare professionals (GPs, nurses, lead care coordinators and pharmacists in prisons) ensure that when people are being discharged or transferred from prison they are given a minimum of 7 days' prescribed medicines or an FP10 prescription. A risk assessment should be carried out to establish whether medicines or an FP10 prescription should be provided, or if neither should be provided because there is a risk of harm if medicines are supplied before a clinical assessment has been done.

Commissioners (NHS England) ensure that they commission prison healthcare services that discharge or transfer people from prison with a minimum of 7 days' prescribed medicines or an FP10 prescription, based on a risk assessment. This can be monitored through contract management.

People who are leaving prison or moving to a new prison are given a 7-day supply of any prescribed medicines they are taking, or, if leaving the prison, a prescription so that they can collect a temporary supply from a community pharmacy free of charge. After this they will be able to get their medicines by seeing a doctor, either in the new prison or in the community if they have left prison.

Source guidance

Physical health of people in prison (2016) NICE guideline NG57, recommendation 1.7.14

Definitions of terms used in this quality statement

FP10 prescription

A prescription form. People who are released from prison unexpectedly can take an FP10 to a community pharmacy to receive their medicines free of charge until they can arrange to see their GP or register with a new GP.

[NICE's guideline on physical health of people in prison]

Equality and diversity considerations

People should be provided with information that they can easily read and understand themselves, or with support, so they can communicate effectively with health services. Information should be in a format that suits their needs and preferences. It should accessible to people who do not speak or read English, and it should be culturally appropriate. People should have access to an interpreter or advocate if needed.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's accessible information standard.

If people are being released from prison into homelessness or temporary accommodation, or they are likely to have difficulty getting their medicines, for example if they are part of a traveller community, their lead care coordinator, if applicable, and the multidisciplinary team should work together to ensure continued access to medication.

If people need specialist medicines or critical medications, for example antiretrovirals, mental health medications or hormone treatment, or if they have substance misuse problems, their lead care coordinator and the multidisciplinary team should work together to ensure continued access to medication.