Criterion 1.1.3 Care outside normal opening hours
Our service ensures reasonable arrangements for healthcare for patients outside our normal opening hours
► A. There is evidence of one (or a combination) of the following for our patients (document review):
i. our staff provide care for patients outside normal opening hours of the service either individually or through a roster, or
ii. formal arrangements for care outside the normal opening hours of our service exist through a cooperative of one or more local health services, or
iii. formal arrangements exist with an accredited medical deputising service, or
iv. formal arrangements exist with an appropriately accredited local hospital or an after hours facility in circumstances where we do not use an accredited medical deputising service or cooperative or provide the services ourselves.
Where a health service is providing care as indicated by Aii, Aiii, or Aiv, the documentation of the arrangement must include:
- reference to the timely reporting of the care provided back to the health service, and
- a defined means of access for the deputising practitioner to patient health information and to our medical staff in exceptional circumstances, and
- assessment by our service that the care outside normal opening hours will be provided by appropriately qualified health professionals.
► B. Patient health records contain reports or notes of consultations that occur outside normal opening hours by or on behalf of our service (health records review).
► C. Our service has a written policy for the provision of healthcare outside normal opening hours (document review).
D. A notice in all living quarters of the prison provides multilingual information on how to obtain care from the health service both within and outside normal opening hours (document review).
Sometimes patients require healthcare outside the normal opening hours of the health service. Health services are required to make reasonable arrangements for access to primary medical care services for their patients outside their normal opening hours. Arrangements need to be in place so that patients can be triaged (as commonly done by telephone) and a decision made about their clinical care by a clinically trained professional. This may be done by a health service staff member (eg. a doctor or a nurse), another health professional on behalf of the service (eg. a medical deputising service) or through a documented agreement with another healthcare provider such as a hospital.
It is important that people are able to access appropriate primary and emergency care when the health service is not normally open. The nature of incarceration means that the ability of patients to contact and use mainstream primary health and emergency services is restricted. As such, it is important that health services in prisons make arrangements for the timely and appropriate provision of healthcare to all people incarcerated in the facility at all times.
It may be necessary for health services to consider the quality and sustainability of potential options and to make judgments about which will provide the highest quality of care while maintaining the safety of patients and staff. It may be that telephone triage in the first instance is an appropriate arrangement for care when the health service in the prison is closed.
Regardless of the arrangements used to provide care outside normal opening hours, there needs to be documentary evidence of the system the health service uses to provide such care. If the health service uses other doctors to provide care, such as a medical deputising service or medical cooperative, the health service needs to have evidence of how and when it receives information about any care provided to their patients outside normal opening hours, and also how external contractors providing care can contact the health service in an emergency or in the case of exceptional circumstances for clarification or help regarding background information relating to that patient.
Where medical care outside normal opening hours is provided by a GP, then the GP should be a recognised GP (either a Fellow of the RACGP or vocationally recognised). In some facilities it may not be possible to recruit recognised GPs. In such circumstances, doctors who provide general practice care outside normal opening hours, and who are not recognised GPs need to be appropriately trained and qualified to meet the needs of the patient population. Doctors performing general practice care who are not recognised GPs need to have been assessed for entry to general practice and be supervised, mentored and supported in their education to the national standards of the RACGP (as outlined in Criterion 3.2.1: Medical staff qualifications and training).
When the health service’s own medical or clinical staff cannot safely or reasonably deliver care outside normal opening hours, the health service must be able to clearly document the alternative system of care that is available for patients at those times. Assessment of this criterion needs to take into account the approach of health services in other prisons. The care should be appropriate to the needs of the patient, timely and reliable (ie. what is claimed to be available is provided). What is ‘safe and reasonable’ is not defined here as it is a decision that each health service needs to make in their local context (eg. with regard to location, and the patient population). What is safe and reasonable needs to be considered by the health service in light of what their peers would agree was safe and reasonable.
Arrangements for healthcare outside normal opening hours need to be communicated clearly to prisoners, prison staff and patients of the health service.