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Standards for health services in Australian prisons

Criterion 1.5.2 Continuity of the therapeutic relationship

Patients attending our health service are able to see an appropriate member of our clinical team.


Indicators

A. Our staff can describe how patients can request access to an appropriate member of the clinical team when making an appointment or attending our health service (interview).

B. A sample of patient health records indicates that where possible and practicable, patients see the same doctor or other member of the clinical team (health records review).

C. Members of our clinical team can identify the person who coordinates clinical care where this is required for a particular patient (interview).


Explanation

Relational continuity is a sustained relationship between a single practitioner and a patient (or sometimes more than one practitioner and a patient) that extends beyond individual consultations or episodes of illness. This can be described as a sense of affiliation between a patient and their doctor (‘my doctor’, ‘my health service’, ‘my psychologist’ or ‘my patient’). It is often viewed as the basis for continuity of care. Health services in prisons may need to consider the ways in which they can build trust and confidence with patients, particularly where patients may not have access to the practitioner of their choice due to the nature of the setting. Therapeutic continuity is particularly challenging to achieve where there is a high volume of patient movement to other locations (a feature of prisons) and where it is difficult to attract or fund permanent staff.

It is acknowledged that some health services do not have formal, written appointment schedules by which patients are booked to see a doctor or another member of the clinical team. However, health services need to be able to demonstrate that they have a system or rationale for determining how patients may see an appropriate health professional.

Many health services employ doctors, nurses and allied health professionals as part of the clinical team. In general, the RACGP Standards protect a patient’s right to see their preferred doctor or another member of the clinical team such as a nurse or allied health professional. However, the RACGP acknowledges this may not be feasible in the prison setting.

Where practicable, the health service needs to make reasonable efforts to enable patients to see a health professional of their own gender, where a patient has specifically requested this.

Coordination of care is a critical issue in providing safe, high quality care to patients in Australian prisons. Coordination is a particularly significant factor where several health professionals are providing episodic and isolated care. In this scenario, the health service needs to identify a particular person (GP or otherwise) who coordinates the clinical care for an individual patient.

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