National award for helping to reduce pain behind bars

Julie Phillips, pictured with other members of the prison chronic pain team

A healthcare team has won a national award for supporting prisoners who suffer with long-term pain.

The Chronic Pain Team, at Kent Community Health NHS Foundation Trust (KCHFT), was highly commended in the PrescQIPP CIC awards in the patient safety and overprescribing category. PrescQIPP is an NHS funded not-for-profit organisation, which supports the best prescribing for patients.

The award was for introducing a new way of working at Elmley and Swaleside prisons in Sheppey, which resulted in fewer gabapentinoids (a non-opiate pain killer) being prescribed, which prisoners have been known to misuse and trade with fellow inmates.

Due to its success, this system was more recently introduced at Rochester Prison too, where it has seen prescribing of these drugs drop from 5.5 per cent to 3.5 per cent, helping to keep prisoners safer, reduce their dependency and make things better for staff.

The new set up means inmates seeking help for chronic pain have to see a multi-disciplinary team (MDT) to get changes to their prescriptions, with a GP, a pharmacist and a pain practitioner all present. In addition, nurse-led self-help pain clinics are offered, with prisoners given tools and techniques to help, without the need for drugs.

Previously, clinicians had sometimes experienced challenging behaviour from prisoners when they would not prescribe the drugs the prisoner wanted and the system was open to abuse with prisoners seeking out other prescribers if their requests were not met and becoming aggressive if refused again, resulting in stress for staff.

KCHFT Prison Pain Practitioner Julie Phillips said: “Gabapentinoids can have a mood-altering effect and give a sense of euphoria. They can be high-risk if misused and used with other drugs.

“Introducing the MDT at Rochester Prison has had a marked impact. Prisoners soon realised this was the only way to have high-risk medications prescribed or modified so demand for these drugs has reduced. It’s a good example of joint working and prisoners are better supported due to the service we provide.”

Julie has found chronic pain to be widespread among prisoners, with the causes different to the general population. People are often suffering from a younger age and as a result of old injuries, which may not have been treated.

She said: “This is a very vulnerable group of patients. There can be a history of trauma or abuse. Some prisoners may have drifted in and out of substance abuse, they might have been homeless and had poor access to education and healthcare. Add on to this injuries they might have sustained before entering prison. Their ability to engage with post-operative care or rehabilitation might have been limited and they might even add to their injuries through various forms of self-harm.”

Julie previously worked as a health visitor and has been a nurse for almost 40 years. She said: “I love hearing about people’s stories and journeys. The patients in prison have had such a difficult time that I really want to do my best for them."

Dean Gardiner, Governor at Rochester Prison, has welcomed the new way of working. He said: “It has been pleasing to see healthcare and Her Majesty’s Prison and Probation Service working together to improve the service for patients, while at the same time ensuring the use of medication is appropriate to the person's needs.

“Patients are provided with alternative methods to control pain that do not always involve medication, which will help prepare them for release and help to reduce the risk of reoffending.

“This is a pioneering service at HMP Rochester and I am delighted that we have been able to make a difference to the lives of those in our care.”
The award was was collected by colleagues from KCHFT and Oxleas NHS Foundation Trust, which work together to provide the service.

*As well as this award, KCHFT has been shortlisted three times in the Academy of Fab NHS Stuff Awards, with winners to be announced in December. The trust was shortlisted for improving a patient bladder diary, developing virtual wards, where patients receive care at home rather than having to go into hospital and for work carried out by the Quality Improvement Team, to share innovation, new ideas and best practice.

Pictured left to right are: Lesley Wright, consultant nurse and clinical lead, Community Chronic Pain Service (KCHFT), Dr Jane Mbogoro, lead GP for Sheppey cluster (Oxleas), Dr Anamjeet Singh, lead GP for Kent cluster (Oxleas), Julie Phillips, prison pain practitioner (KCHFT), Kartik Dravid, lead pharmacist for Sheppey cluster (Oxleas).
Amrinder Singh, lead pharmacist for Kent cluster, was unable to attend (KCHFT) .