Experience of setting up a genitourinary medicine in-reach clinic in a male prison

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A fortnightly in-reach genitourinary (GU) medicine Service to a medium security male prison has been provided since April 2004. Patients are seen either by referrals from the prison general practitioner (GP), or at an individual's request. Problems have arisen due to a lack of space and time - the health adviser and doctor have to share a room. Since the prisoners have to leave Health Care by 1130 hours, if one inmate has complicated issues, it can result in these not being dealt with, or in patients not being seen as there is no flexibility. There has been an unexpectedly high DNA rate, which is multifactorial. Some prisoners have been moved to another prison since the request to be seen was made, some are on court attendances or have legal visits. Additionally some men choose not to come when sent for on the day. A few men who attend do so mistakenly, thinking that GUM is the dentist. This is particularly a problem where English is not the first language. The attendance of prisoners at the GU medicine service is noted in their prison health record, with relevant information, such as referral for management of hepatitis C. Of the 219 men seen in the first year, 55% had a GU medicine screen. The most common infections were chlamydia 10.5%, warts 12.1% and HCV 9%. The clinic has been well supported by patients and prison staff. High rates of infections are being detected and managed. The men have been happy to be screened, and despite initial concerns all are happy to provide urine specimens for chlamydia screening.