HMP Altcourse

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked at 2 quality statements in this key question. The provider had made a significant improvement in the management of medicines. The service had an improved staffing picture with stable GP cover although it was still heavily reliant on temporary staffing.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

The judgement for Learning culture is based on the latest evidence we assessed for the Safe key question.

The judgement for Safe systems, pathways and transitions is based on the latest evidence we assessed for the Safe key question.

The judgement for Safeguarding is based on the latest evidence we assessed for the Safe key question.

The judgement for Involving people to manage risks is based on the latest evidence we assessed for the Safe key question.

The judgement for Safe environments is based on the latest evidence we assessed for the Safe key question.

At our last inspection, we found the provider failed to ensure there was sufficient resource in the primary care team to safely and effectively support the needs of the prison population. The provider had responded quickly increasing staffing levels across primary care. At this inspection, we found an improved staffing picture, which positively affected the level and quality of the primary care service.

At the time of our inspection, the provider had recruited 11 new staff who were ‘onboarding’ and were recruiting to a further 13 vacancies across primary care (including bank staff). The service still relied heavily on temporary staff (agency and bank), but these were regular staff who knew the prison well and helped make up a stable team and service.

At our last inspection, the provider failed to ensure there was adequate GP provision to meet the needs of the population with 175 patients waiting to see a GP for up to 5 weeks and 2 days. There had been ongoing issues with GP provision, which had been recorded on the provider’s risk register for over 2 years.

At this inspection, we found significant improvements. PPG had commissioned an experienced GP to support the team 4 days per week, and they had provided a high standard of leadership and guidance to the primary care team. Staff spoke positively about the implementation of local procedures, such as the early days in custody meeting that took place daily to discuss all new arrivals from the previous day. This multi-disciplinary approach ensured new patients had their needs identified proactively rather than the team needing to react to concerns as they arose in future.

With the GP leadership being only an interim arrangement, the provider had worked with a group of locum GPs to secure regular GP cover up to the end of January 2026. Managers had commitment from the locum group to continue offering provision on a long-term basis to provide stability and consistency. In the background, managers were working to recruit new substantive GPs. They had already recruited 1 GP who was in the process of onboarding. This covered 36 of the 64 contracted hours; recruitment was ongoing to fill the remaining hours.

GP waiting lists had reduced from over 5 weeks to only 1 week. We reviewed patients who had seen a GP in the 2 weeks prior to the inspection, and all had been seen within a week of requesting an appointment. Leaders had worked with the mental health team to ensure that patients with primary mental health needs identified on reception were not routinely added to the GP waiting list. According to the provider, at the last inspection these patients accounted for around half of the waiting list and upon review, did not all need to be seen by a GP.

At the last inspection, we found a lack of supervision and GP oversight for the Advanced Nurse Practitioner (ANP) role, which was unsafe. The ANP had since left the service and this role remained vacant. However, with the increased GP provision on site, this had not had a detrimental impact on the service to patients. Managers recognised that GP retention had been challenging in the past but felt that with new working practices in place and reduced waiting lists, the GP role would now be more attractive to potential candidates. The interim lead GP had supported the interview panel to manage expectations for potential new recruits.

At our previous inspection, we found the provider had failed to ensure there were sufficient staff to cover night duties. At this inspection, we found the provider had taken immediate action after the inspection to address this shortfall by increasing the night staff cover from 1 qualified nurse to 2 qualified nurses. As before, a healthcare assistant was also available at night. We spoke with several staff who regularly worked night shifts. They told us while it was still busy, the workload was much more manageable and felt less risky. The manager told us that it was now easier to staff night shifts, and staff agreed they were now more likely to pick up these shifts as it felt safer.

Improved arrangements between healthcare and the prison had also had a positive impact on the workload at night. For example, there was now a safer protocol for completing overnight clinical observations on patients experiencing substance withdrawal, and clarity on the admission criteria for the inpatient unit (IPU).

At our previous inspection, we found there were insufficient health resources to support patients residing on the IPU. Since then, the provider had made several improvements to the IPU. The provider had liaised with the prison, the mental health provider and commissioners to clarify the purpose of the unit and agree admission criteria.

At this inspection, we found the staffing resource allocated to the IPU reflected the number of patients on the unit and their needs. The unit had 5 patients, 2 of whom had mental health needs and one with personal care needs. The mental health team attended the IPU to complete welfare checks on their patients (IPU rounds) 4 times a week. Healthcare assistants supported the patient with personal care needs daily.

Staff held weekly multidisciplinary meetings at which they discussed referrals, identified patients’ needs and risks, and estimated their length of stay. We reviewed patients’ records and found they all had appropriate admission documentation that included personalised care plans clearly setting out their needs. In addition, staff kept detailed journal entries covering daily observations, risks, interventions and actions.

Patients on the IPU had access to a range of recreational activities set out in a weekly timetable. These included access to the gym and library as well as involvement in the in-house radio show. In addition, patients could access to a range of resources such as television and films, books, board games and a pool table. Prison orderlies were available to support activities, and they led a reading group. The mental health team visited their patients on IPU to complete welfare checks as well as any planned interventions such as 1-1 counselling. Patients continued to have their key worker meetings with officers.

The judgement for Infection prevention and control is based on the latest evidence we assessed for the Safe key question.

At our previous inspection, we found the provider had failed to ensure robust clinical governance arrangements for the management of medicines. At this inspection, we found the provider had improved systems and processes to help ensure medicines were managed safely and effectively. Staff we spoke with felt positive about the changes made and agreed that practice was safer.

At our previous inspection, we found the administration of controlled drugs (CD) was not being carried out in line with the provider’s policy and good practice guidelines. During our inspection, we observed medicines administration practice and checked CD records and found improved practice and robust processes. The provider had introduced manual and electronic second checking and signing as standard practice across the administration of all controlled drugs. Staff allocations included the second signatory role for all 10 medicines administration points. Additional staff had been trained and their competencies assessed for supporting the new process.

Pharmacy leads had introduced weekly audits to check the quality of controlled drugs’ records. These identified any gaps and errors and managers took action to address them. This included informing the staff of their errors and encouraging them to reflect and improve their practice. Managers also raised recurring issues at daily huddles and team meetings, provided reminders and brief guides, and offered training sessions.

At our previous inspection, we found the safe storage of medicines was at risk of being compromised due to high room temperatures. During our inspection, we visited clinic rooms, looked at medicines and equipment storage, and checked a range of records. We found clean and tidy rooms, safe storage and up-to-date documentation. The provider had made the monitoring and recording system of room and fridge temperatures more robust, and staff took action to address variances. Staff also reported room temperatures at daily huddles.

Managers had introduced a new comprehensive daily wing checklist that showed all the checks and tasks staff needed to complete in their treatment rooms. These included checks on room and fridge temperatures, clinical cleaning tasks, and checks on supplies, emergency equipment and bags. Managers completed weekly audits to check these had been completed. Managers had also developed a medicines management audit that they completed monthly. They used the findings of these audits to identify gaps and improve the service.

At our previous inspection, we found that local management meetings had ceased. At this inspection, we found there was now good oversight of medicines management. The provider had scheduled and restarted monthly meetings. Meetings were multidisciplinary across healthcare and had a comprehensive agenda covering items such as critical alerts, prescribing data, security measures, and system issues. They included a review of incidents, identifying common themes and actions to address them.

We reviewed the incidents log from August to October 2025 and found that staff keenly reported medicines-related incidents, which helped improve practice. Pharmacy leads told us they had noticed a decrease in the number of incidents reported as practice improved.

At our previous inspection, we found there were no prescribing reviews of tradeable medicines, and no structured medicines reviews. At this inspection, we found that safer prescribing reviews had recently started supported by a safer prescribing strategy to improve prescribing in prisons. Clinics had been set up on the electronic system ledger and patients who met the criteria could be added to it. Pharmacy staff had commenced reviews of frequently prescribed medicines to check if they were suitable for the patient’s condition. The provider had also commissioned remote structured medicines reviews. However, while these had commenced, it was not always easy for patients to attend the telephone appointments due to the prison regime. After the inspection, managers told us they had started to incorporate these reviews into their regular GP schedule.

The health care service benefited from other changes such as the installation of new CD cabinets in some treatment rooms. They had also rolled out a programme on all wings to place automated machines that dispensed an opioid substitution treatment medicine. This meant that patients no longer needed to attend the health care unit for their treatment, which helped both health care and prison staff. The provider had engaged an external pharmacy to dispense post-dated prescriptions, which was working well, and reduced the workload of the stretched pharmacy team.