Introduction

Prisoners often have complex health and social care needs including living with physical and mental health conditions, enduring periods of homelessness and unemployment, and experiencing addiction to drugs and alcohol [1]. In addition, the world prison population is ageing [2], with older prisoners having more chronic conditions, comorbidity, mental ill health and mobility issues than younger prisoners [3]. The United Nations (Nelson Mandela Rules) specifies that prisoners should receive the same standards of health care that are available to the general population [4]. These standards include access to necessary health care without discrimination (Rule 24), and that the organisation of appropriate health services should ensure continuity of care and treatment between prison and the community (Rule 25) [4]. The organisation and staffing of health care in prison settings differ between countries [5]. In prison settings, the frequent changing or turnover of staff and the transfer of prisoners may lead to continuity of care issues [6].

The National Health Service (NHS) includes general practice, community pharmacy, and dental and optometry services within primary care [7]. The King’s Fund defines two types of continuity of care in general practice: (i) relationship continuity and (ii) management continuity [8]. The first type of continuity refers to a continuous therapeutic relationship between a GP and patient and management continuity encompasses care planning and co-ordination of care including the provision and sharing of information [8]. The transition from prison to community is a vulnerable time period among former prisoners, and there is a need for health and social care organisations to be responsive in terms of providing continuity of care between prison and the community setting, particularly for hard to reach or vulnerable prisoners, who may have had their specific health needs addressed in prison, and, post-release, require referral to appropriate health services [5]. For example, prisoners who do not tend to seek help or access services when they are living in the community may engage in treatment for substance use when they are in prison [9]. The health care needs of this population such as chronic illness, mental ill-health, substance use disorder and injury require dedicated attention during this time of transition [10].

Despite receiving continuous care and treatment during incarceration, often, the health of a prisoner may deteriorate after release and the overall effect of prison on health may be negative [11]. Among a cohort of men released from prison (with histories of injecting drug use), a prospective study reported high levels of unemployment, homelessness, physical and mental health morbidities, and illicit substance use during the two year follow up period [12]. Following the release from prison, individuals are at a higher risk of morbidity and mortality [13–16]. A recent scoping review (2011–2021) found that former prisoners have an increased risk of drug-related death during the first year after release from prison, with this risk particularly elevated in the first two weeks post-release [16]. Increasingly, research findings are pointing to an increased risk of hospitalisation after prison release. A retrospective study of emergency department visits among a cohort of former prisoners found that recently released prisoners were more likely to attend hospital than the general population for mental health disorders, substance use disorders and ambulatory care sensitive conditions (for example, asthma, hypertension, and diabetes) [17].

Research has shown that in the United Kingdom, approximately half of prisoners do not have a general practitioner before entering custody [1]. Primary care in most health systems tend to have an encompassing remit and aim to meet the health needs of people in their local communities, from health promotion and disease prevention through to treatment, rehabilitation and palliative care [18]. Individuals who are released from prison may experience discrimination and/or other barriers to accessing health care. For example, a study of scripted telephone calls to primary care physicians (n = 250 universal health care providers) in British Columbia, Canada, to request an initial appointment for four patient scenarios; male former prisoner, male control, female former prisoner and female control, reported significantly fewer appointments offered to scenarios for patients recently released from prison compared to control individuals [19]. In this study, scenarios involving control individuals were 1.98 [95%CI 1.59–2.46] times more likely to be offered an initial family physician appointment compared with scenarios involving former prisoners [19]. A recent study identified diverse and complex health needs following release from prison and difficulties accessing health care as well as housing, employment, and social services [20]. A NAO report (2023) in England pointed to the lack of support and service planning, overall, for prison leavers [21]. For example, key prison-to-community staff handover meetings did not take place for around half of the prison leaver population even among prisoners who were released on a scheduled date and for whom there was adequate time to plan handover and community resettlement services [21]. The NAO report (2023) also pointed to a barrier to effective service access and receipt by prison leavers related to inefficient information sharing between health care providers and criminal justice professionals [21].

A systematic review of measured continuity of care to all patient groups by doctors in any setting (search 1996–2017), found that higher continuity of care was associated with reduced mortality [22]. There is limited evidence in terms of interventions to improve health services contact and outcomes in the transition from the prison to community setting. A systematic review of prisoners with mental health conditions found that interventions during the transition from prison to community improved contact with mental health care and other health services after release [23]. However, there was some evidence to suggest that interventions during this transition period may be associated with an increase in the number of individuals returning to prison (for example, as a result of increased monitoring) [23]. The interventions included in the review focused on different stages of release from prison and had differing content, therefore further studies are warranted in this area [23]. A recent scoping review of all study designs investigating the continuity of opioid substitution treatment between prison and community settings in Indonesia, Malaysian and Vietnam (search 2011–2021) was limited by a low number of studies and a lack of generalisability [24]. However, the review found three emergent themes: (i) facilitators of post-release continuity of care included guidelines, staff training and family support, (ii) barriers of post-release continuity of care included lack of trained staff and a high turnover of staff, lack of coordination between prison, community health centres and government departments, lack of data management between prison and community, limited availability/challenges accessing care and side-effects or concerns about treatment, and (iii) therapeutic considerations supported post-release continuity of care [24].

Methods

This scoping review will follow the framework by Arksey and O’Malley (5 stages) and guidance developed by the Joanna Briggs Institute (JBI) [26, 27]. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and guidance has been used to inform this protocol (S1 Checklist) and will be used to report this review [28]. The completed PRISMA checklist will be available as an appendix with the full review.

Discussion

It is hoped that by synthesising the evidence about individuals’ contacts with primary care after prison release, this review may provide an opportunity to increase and improve continuity of care for those most at-risk following prison release, by helping to inform future research in this area. This review will focus on observational studies that have investigated this topic using linked data. A separate review of trials and quasi-experimental research is warranted. The search strategy will focus on ’former’ incarceration and its variants in order to increase specificity. The use of such terms may pose a possible limitation as potentially some publications may be missed due to reduced sensitivity. However, the focus of the review will be primary care contact after release from prison and therefore authors feel this decision is justified. The review will not include a grey literature search and due to resources for translation, the search strategy will be limited to publications available in English which may limit the interpretation of the findings. Given the exploratory nature and breadth of a scoping review it may mean that changes to the protocol could be required as new information becomes available throughout the review process. Any changes in the full review will be documented and the rationale for these changes will be provided. Ethical approval is not required as this work will summarise publicly available sources of research. The full review will be disseminated as academic research and will be published in a peer-reviewed journal and presented at relevant conferences.

Supporting information

Acknowledgments

Thanks to Richard Fallis, Subject Librarian, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, for reviewing the search strategy and for providing guidance in the use of reference management software.