Guidance

Screening in detained settings

Updated 1 October 2024

This section describes the process for screening men who are long-term residents in secure organisations such as prisons and mental health units, and who may not be registered with a community-based GP practice.

People in detained settings who have less than a 3 month sentence should be actively supported to ensure they are registered with a GP on release into the community.

People in detained settings, regardless of the type of institution they are in, for longer than 3 months should be actively encouraged to register with prison providers.

1. Procedure for screening men in detained settings

The NHS Abdominal Aortic Aneurysm (AAA) Screening Programme’s Screening Management and Referrals Tracking (SMaRT) system attributes screening due dates for all men eligible for screening. Men in prison are not excluded from this but there are differences between men in prison and the general population as far as screening is concerned.

Men in secure settings are unlikely to have notified their GP of their detention address. As a result, any invitations to be screened may not reach them.

Access to screening by men in prison can only take place with the support of prison staff who are required to provide the local AAA screening service and the men in prison with information and support.

As men in prison can only access screening with the help of a third party, they have to give consent to their involvement and the sharing of demographic and clinical information.

1.1 Step 1

The local programme co-ordinator will identify a named member of the prison staff to liaise with (normally a member of the prison health centre) to provide demographic and other information to enable screening to take place.

1.2 Step 2

The local screening programme and the prison discuss:

• the screening pathway
• the process for selection for screening
• information requirements
• arrangements in the event of any men in prison requiring ongoing surveillance, ensuring rigorous processes are in place to prevent any man being ‘lost’ in the system
• issues of confidentiality and security
• consent issues
• practicalities for undertaking screening in the detained setting (such as rooms, couches and security of staff)

1.3 Step 3

The prison healthcare lead will identify men in prison in their 65th year and over (for self-referrals) and provide them with the appropriate screening information in the form of national screening information leaflets, available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/502433/AAA01_web_version_230216.pdf

Where the prisoner wishes to be screened, the prison will take their consent on the form provided and provide to the local screening programme the individual’s:

• NHS Number
• title, forename, surname
• date of birth
• correspondence address for the prisoner
• details of their GP practice or prison health service

Prisons can request NHS numbers via a ‘weblog’ account which NHS Digital’s (formerly known as HSCIC)’s National Service Desk maintain (http://systems.digital.nhs.uk/nhsnumber/contacts). The prison will log into their account and register their request for a number(s). The request is then sent directly to the National Back Office (NBO) by the Desk and the NBO will search for an NHS number. If a number is not found, they will allocate one. Each prison fills in the account application form, with as much detail as they are able and list all the staff they wish to be able to request this information. The National Service Desk also offers an over the phone training session for those newly registered with a weblog account to help them get started.

1.4 Step 4

The local AAA screening programme adds the consenting men to the SMaRT system. A dummy GP practice code may need to be assigned to the prison’s healthcare service if the men are not registered with a valid GP practice. This can be done by Northgate Public Services’ AAA Helpdesk.

Some subjects may already exist on SMaRT as they will have registered at their home address and GP practice. In these cases, the programme co-ordinator may need to ask the ’home’ local programme to transfer the men to their programme to enable them to be screened in the prison.

1.5 Step 5

The local programme arranges screening sessions for the men added in step 4. The screening clinics should be booked, and appointment letters and leaflets sent to the men at their current address (or via the contact at the prison).

1.6 Step 6

The men are screened at an appropriate location in the prison and given their results at the screening appointment as per normal screening procedures.

1.7 Step 7

Result letters are produced and sent to the individuals (only when an aneurysm has been detected), the prisoner’s GP (if known) and the prison health department.

1.8 Step 8

For men who require surveillance, it is important the man knows when he is next due for surveillance. He should be advised that if he moves prison or is released, he should contact the screening programme to enable his details to be updated.

Men in prison are often moved around the country, so it is important that any surveillance subjects are aware they must inform the programme if they move. For subjects on 3-month surveillance it may be possible for the prison to place the man in prison on ‘medical hold’ so they are not moved, however, this cannot be guaranteed.

It is essential that, as mentioned in step 2, rigorous processes are in place to prevent any man being ‘lost’ in the system, therefore it should be made clear that any man being transferred out, the prisons should inform the local screening programme of such change.

1.9 Step 9

Referrals will need to be made as soon as possible and should be with the co-operation of prison staff. Once the subject has been referred normal local procedures should be followed to enable the man to attend hospital for review. Again, it may be possible for the man in prison to be placed on ‘medical hold’ so that they are not moved, however, this cannot be guaranteed.

2. Transfers

SMaRT requires manual intervention by the local programme to confirm that the transfer in or out must go ahead. The system does not carry out any transfers automatically. When a record is flagged for transfer, the programme should note before transfer:

the professional contract within the record view would identify to the transfer programme that any particular man is prison

the clinic name and location of previous appointments within the appointment history screen

clinical location where screening sessions have taken place within the screening history screen

Any man appearing on the SMaRT alert screen under ‘transfer out’ should not automatically be actioned. In all instances, check that the transfer out is appropriate - contact the prison to confirm. If the accepting programme is in any doubt, contact should be made with the programme transferring out or the respective prison, if known. SMaRT will be updated with mandatory boxes to confirm appropriate checks have been undertaken.

It is important to note that until the National Offender Management Service (NOMS) is introduced in 2017, any care record that is updated by the community GP on the IT system, this will automatically create an SSPI and can revert to the man’s previous address or community GP thereby creating an inappropriate transfer out.

Prior to the new NOMS IT system being fully implemented next year, if anyone in prison registers with the healthcare provider there, their healthcare records will not automatically transfer over from the community. Currently, when a patient is detained their medical records continue to be held at the community GP practice they are registered with. Once they are detained, the prison healthcare opens a new medial record on their system (if they haven’t been detained before) and proceeds with that record.