HSSIB investigation. Healthcare provision in prisons: data sharing and IT (24 July 2025)

Summary

This Health Services Safety Investigation Board (HSSIB) report explored how information is shared between prison operational IT systems and prison healthcare IT systems, and the current process of General Medical Services (GMS) registration. 

It found that prison security and prison healthcare teams use different IT systems that cannot automatically share data. This means vital information is not always available to clinicans treating them. It also requires prison healthcare departments to duplicate appointment information across both systems, increasing risk of errors.

The investigation highlights how GMS registration process may disrupt continuity of care, particularly for people on remand who are detained for short periods. Registering with a prison GP often leads to de-registration from a person’s community GP. Patients are asked to consent to GMS registration during the prison reception process, but it was found due to a number of factors, patients are not always able to make fully informed decisions about their care.

Content

Findings

• Prison operational IT systems (the Prison National Offender Management Information System and the Digital Prison Service) and the prison healthcare IT system (SystmOne) are not able to automatically share information between each other.
• Important patient information, such as risks they pose to themselves or others, is not readily available to healthcare staff when seeing patients.
• Prison healthcare department admin staff have to duplicate medical appointments onto both the healthcare and the prison IT systems. This can amount to thousands of appointments per month, expending time and resource, while also creating multiple opportunities for user input error.
• The prison healthcare IT system has been adapted in readiness to receive and exchange information with the prison IT systems. The prison IT systems have not been adapted and there is currently no plan to adapt them.
• Patients who are detained on remand for short periods of time may have their continuity of care in the community negatively impacted by being GMS registered with the prison GP, and therefore de-registered from their community GP.
• Patients are given information about GMS registration during the prison reception process, when they are asked to consent to the sharing of their medical records. There is limited time for patients to consider the information or ask any questions and understand what they are consenting to, during what HM Prison and Probation Service describes as a ‘stressful experience’.
• There is variability across prisons in the understanding prison healthcare staff have about the GMS consent and registration process, resulting in different processes. This causes difficulties in maintaining continuity of care for some patients.
• Prisons housing remand prisoners experienced much lower GMS registration rates due to remand patients expressing concern about the impact on them of registration if they are released from remand.
• Each prison healthcare department is viewed by the NHS as an independent GP practice; however, for the purposes of GMS registration, all prison healthcare departments are viewed as surgeries under a single prison GP practice. This has led to confusion at all levels in healthcare, from national leaders to provider staff, about the consent process for the transfer of medical records.
• Some patients are being asked to re-consent to GMS registration when they move to a new prison. This is creating inconsistencies in the way consent is sought and gaps in patients’ medical records, making continuity of care difficult as patients move between prisons and to the community.
• Patients who do not consent to GMS registration do not automatically appear on national screening programmes, such as the breast screening and bowel screening programmes.

HSSIB makes the following safety recommendations

Safety recommendation R/2025/067:

• HSSIB recommends that NHS England/Department of Health and Social Care ensures that the General Medical Services registration process, for patients in prison, is designed using informed consent principles, providing patients sufficient time, advice and support to understand what registration means for them. This is to ensure patients are making informed decisions about their healthcare provision, therefore improving patient safety.

Safety recommendation R/2025/068:

• HSSIB recommends that NHS England/Department of Health and Social Care, working with healthcare service providers and their healthcare teams at prisons which hold remand prisoners, reviews and amends the process for GMS registration of patients on remand. This is to ensure a consistent approach to GMS registration across the prison estate, which acknowledges the potential negative impact short-term changes in care provision may have on the continuity of care for patients who have been remanded in custody.

Safety recommendation R/2025/069:

• HSSIB recommends that HM Prison and Probation Service ensures that the development of the Digital Prison Services system includes interoperability with healthcare IT systems. This will ensure that information which does not impinge on the confidentiality requirements of either system, relevant to the safety and wellbeing of staff, patients and other prisoners, is available at the point of need.

Safety recommendation R/2025/070:

• HSSIB recommends that NHS England/Department of Health and Social Care includes within its healthcare IT procurement system specification the need to support interoperability between the operational prison IT systems and any future prison healthcare IT system. This will ensure that information which does not impinge on the confidentiality requirements of either system, relevant to the safety and wellbeing of staff, patients and other prisoners, is available at the point of need.

Local-level learning

HSSIB has identified local-level learning for prison healthcare providers and teams, who can improve patient safety by:

• aligning local policies, in relation to consent for GMS registration, with NHS England guidance on informed consent principles
• assisting staff to adapt their approach to consent discussions with patients in recognition of the stressful reception environment.

HSSIB has identified local-level learning for prison healthcare providers and teams, who can improve patient safety by adopting processes to avoid patients who are GMS registered within the prison system being automatically asked to re-consent when transferring to a different prison.

HSSIB has identified local-level learning for prison healthcare providers and teams, who can improve patient safety by supporting patients to pre-register with community GPs as part of release planning.

HSSIB has identified local-level learning for prisons who can improve patient safety by adopting a mechanism for healthcare providers and teams to highlight patients who may not be medically suitable for release on temporary licence (ROTL) and, where appropriate, being involved in the decision process.