Dr Jake Hard
GP with special interest in prison medicine, substance misuse and Expert Witness
The day after I qualified as a GP, I found myself in HMP Leicester working as a locum. Little did I know then how much this opportunity would shape my future career.
Some of the most interesting, challenging and complex medicine I have faced as a GP has been behind a five-meter-high wall. Focusing on the doctor-patient relationship is key. My motivation is to find a connection without being constrained by any pre-judgement of the person’s background. I am constantly striving to deliver medical care without compromising my own integrity or sacrificing my ethical principles in the way I practice. I aim to make a difference to their lives.
After 5 months at Leicester,I went on to spend the next five years at HMP Parc in Bridgend. It’s here that I successfully procured the contract for GP services and worked my way up to clinical lead. Don’t forget that the NHS only took over prison healthcare in England from April 2006, so it was all still relatively new and evolving. I’ve since worked in HMP Swansea, HMP Eastwood Park (Women’s prison) and HMP Leyhill (Category D open prison)
I work with a number of multi-disciplinary teams, including pharmacy, mental health and substance misuse along with custodial staff, to provide the best support for my patients. I’m often asked if the people I see are more violent or aggressive. I’ve never been physically assaulted in a prison and have felt safer there than in some community settings!
My working day is much the same as you’d expect for any GP, except it ends with reception clinics for new prisoners who are being admitted with acute clinical issues such as drug and alcohol withdrawal. The highest risk of suicide is within the first 28 days of coming into custody and the challenge is to identify and safeguard against these risks.
I enjoy a portfolio career which keeps me thinking and hopefully bringing about lasting improvements for healthcare in secure settings. I was a part of the development panel for new NICE guidelines on the physical health of people in prison. We are beginning to see greater coordination in the transfer of prisoners into the community to enhance continuity of care as the development of a variety of ‘through the gate’ initiatives support people in contact with the criminal justice system. There’s not a day goes by that I don’t continue to think about how we can continue to improve and develop the care for people in prison at a local and strategic level – The opportunity to chair the Royal College of GPs Secure Environments Group has allowed me to contribute directly to the development of policy and networks.
Being an Expert Witness in the Prison Environment
With many years’ experience, I’ve gained a wealth of knowledge.
I’m passionate about prison medicine and just as passionate about supporting both the clinicians and patients where expertise is required to guide the courts in civil claims. I have nearly seven years of experience as an expert in this setting and have built a portfolio of around 450 (clinical negligence) cases during this time, including numerous court appearances.
Being able to fully appreciate the unique context of prison healthcare is fundamental to being able to guide the court in these matters. On many occasions, Claims may appear straightforward. Close inspection of the medical records by a Prison GP, provides a more faithful perspective of the care being provided than when viewed by the untrained eye.
To give you an idea - a claim arises out of medication being stopped abruptly. In the community setting this could appear to be negligent. But in the prison setting, medication is often seen as a currency item for misuse and diversion. It means that many of these drugs can be sought from the prison GPs for these reasons. The consequences of this ‘diversion’ can range from addiction, overdose, and death to bullying and violence.
Another example is where the care provided to an inmate falls outside the boundaries of so-called “equivalent” care. Imagine an injured leg. Why was a scan not undertaken as it would have been had the patient been in a community GP surgery? The medical records in this case may reveal a rushed consultation, little in the way of history or examination is recorded. This is not defensible practice.
Expert Witness work cross-pollinates into other aspects of the highly inspected prison environment. So, being able to provide a critical clinical eye on Death in Custody reviews, for Coroner’s Inquests or advice for the Parliamentary and Health Service Ombudsman serve to provide these bodies with the expertise necessary to fully support their investigations with that ‘inside’ knowledge. Being able to decipher and read between the lines of the prison clinical system can yield a detailed view into the care being provided and this helps to give inspectors and commissioners a better understanding of areas that need improvement.
Some doctors know what they want, have clear objectives and develop a career plan. For me it was just serendipity and knowing this was something I wanted to do. I hope I’ve been able to give you another perspective to consider.
Post CCT qualifications and courses
- RCGP substance Misuse Parts 1 and 2 and Secure Environments modules
- RCGP Certificate in the Management of Hepatitis B and C Part 1 and 2
- Advanced Minor Surgery