HMP Durham

On this page

• 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 4 quality statements in this key question. The provider had safe systems and processes in place to support new patients entering the prison. The service had an improved staffing picture with stable GP cover and highly skilled primary care and pharmacy teams. Staff managed medicines appropriately. Incidents were managed effectively.

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

The provider had a clear incident reporting policy and framework. Staff used an electronic incident management system to report, manage and monitor incidents. All staff had access to the system and were expected to report incidents directly onto the system as soon as practicable after the incident.

Senior nurses reviewed incidents and determined if an investigation and/or any action was required. They had access to online training to support this role as well as the opportunity to book further face to face training.

The system generated action plans where required. There were several forums at which incidents and action plans were discussed. For example, the service held a weekly clinical assurance meeting at which they reviewed each incident and open action plans to determine next steps. Incidents were a standing item on the monthly team meeting agenda. There was provider-level oversight of incidents, for example, at daily ‘10 at 10’ meetings. In addition, the provider’s patient safety manager checked over all new incidents and liaised with the service on a case-by-case basis to request further information, seek clarification or give advice.

The prison had been receiving late arriving prisoners for some months. By the time they were processed by the prison, and handed over to healthcare, it was after 10pm. This presented challenges for healthcare staff in completing essential reception screening assessments as they were only permitted access to patients until 10pm. Staff reported these events as incidents, for example, staff did not have access to 9 patients on 10 June 2025 because it was after 10pm. Managers always shared these incidents with prison leaders the following day and also raised the issue at local delivery board meetings.

In these circumstances, staff sought out alternative ways to check up on new patients to mitigate the risks whenever they could. For example, they tried to speak to new patients through their cell windows; in cases of concern, they requested access to patients from prison officers and escalated their concerns if needed. They completed welfare checks, handing over to the night staff if needed. In anticipation of late receptions, staff checked incoming patients’ records for any immediate needs such as critical medicines and made appropriate arrangements. Outstanding reception screening assessments were completed as soon as practicable early the next day. This at times delayed staff with their other clinical activities scheduled for that day.

Healthcare leaders had worked closely with prison leaders to successfully change the latest access time to undertake initial health screening assessments to midnight. This had started during the week of our inspection and had resolved the issue. Staff now had access to patients until midnight to complete reception screening assessments.

Staff scheduled second health screening assessments and completed them promptly. Staff scheduled them on a daily ledger and shared the workload across the team to ensure they were completed.

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.

Following concerns about GP practice and supervision on another site, the provider had developed an organisational action plan that aimed to make improvements. At this inspection, we were keen to check if the recent learning and the actions taken were being applied at HMP Durham.

At this site, the service had previously experienced gaps in their GP cover and had to rely on temporary staff, which at times, had affected the stability of the service. The provider had improved their recruitment and selection processes and worked hard to recruit a stable team of dedicated GPs to provide daily cover during weekdays. At the time of our inspection, the service had a full team of GPs comprising 2 substantive GPs, 2 GPs who were bank staff but who had previously worked at the prison, and a lead GP to support new staff and undertake supervision and appraisals.

GPs had clear job plans. New staff received a corporate and local induction that included orientation, meeting with key staff and managers and shadowing GP clinics. They had access to a range of support from the lead GP and from wider healthcare staff such as pharmacists and advanced clinical practitioners (ACP). New staff were expected to complete a GP-specific mandatory training programme.

We spoke with 2 GPs during our inspection, and we were assured they had received an appropriate induction and had access to regular supervision (at least 3-monthly) and appraisals.

The primary care and pharmacy staff group included a wide range of staff roles and skills mix, for example, 4 ACPs, nurses and wing-based pharmacy technicians. However, the service had experienced some recent staffing challenges. In the 3 months prior to this inspection, staff sickness was just below 7% and turnover of staff was 15.5%. The service had several vacancies, however, recruitment had been successful and 12 new staff were progressing through the required recruitment processes. Only 2 posts remained unfilled.

The service had access to 2 regular agency nursing staff, which helped with maintaining a busy service. The provider had access to bank staff, most of whom were their own substantive staff. In addition, Spectrum had developed their bank service; from July 2025, this would mean staff from the wider health and justice network could work in different prisons.

Healthcare provided a 24-hour service, 7 days a week. The prison had an enhanced primary care unit (EPCU) for up to 6 patients, which was overseen by a dedicated lead nurse. This was only Monday to Friday and cover was mostly provided by a healthcare support worker outside of these times, who could access senior nurses on duty, if needed. However, we were not assured there was adequate managerial oversight and support for the EPCU. The demands on the lead nurse to develop and manage the service, as well as deliver care were challenging.

Most of the staff we spoke with gave positive feedback about the service, team and culture. They described a very busy service due to the prison’s remand function. They emphasised the need to work flexibly as a team and share the workload but some nursing staff told us they experienced a reluctance on the part of some staff to work as part of the wider healthcare team. Managers told us work was underway with the organisational development team to examine this.

Most staff said they felt supported by their managers and colleagues and had access to regular supervision. We reviewed the provider’s training compliance data, which showed that staff were up to date with mandatory training. Staff had access to further training and development opportunities, for example, prescribing. ACPs offered additional training such as suturing and taking blood pressure manually.

However, prior to this inspection we found that some of the providers standard operating procedures (SOP) required staff to complete additional training, such as pressure ulcer management, but this was not recorded in staff records. During this inspection, managers told us a quality improvement project was underway, commencing with a review of all clinical policies and SOPs, to determine what training requirements were identified.

Pharmacy technicians had received training in completing health checks and observations, including the NEWS2 tool, which is a national early warning scoring tool used to monitor a patient who is at risk of deterioration. This meant that wing-based pharmacy technicians who had better and timely access to patients could monitor them closely and effectively.

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

Medicines administration took place on wing-based medicines administration points (MAPs). Wing-based technicians administered medicines, undertook medicines’ risk assessments and reviews, spot checks on patient in-possession medicines, and held lead roles for specific areas such as controlled drugs and monitoring fridges.

The wing-based pharmacy technicians promptly checked up on patients who missed their daily medicines, and the pharmacy team routinely followed up patients who did not collect their in-possession medicines.

Staff experienced some challenges with the effective management of medicines’ queues (by prison officers); and wing unlocking times sometimes delayed medicines’ administration. However, staff felt they could raise these issues with the prison and identify workable solutions.

The service had no consistent on-call prescribing support after 9pm with staff directed to contact 111 or 999 if needed. However, there were Patient Group Directions in place to treat symptoms of alcohol and opiate withdrawal. Staff also had access to an emergency medicines cupboard.