9: GP+ Working in Secure Environments with Dr Juli McCulloch

In this month’s episode we hear from Dr Juli McCulloch, a First5 GP working in secure environments and secondary care addiction services. Juli provides valuable insights into working in a high security prison, how her personal interest attracted her to the role and the benefits of pursuing this specialist interest. If you have any questions, please reach out to [email protected] and we are happy to put you in touch with Juli. Top tips

Research the different types of secure environments - There are a range of secure environments you can work in as a GP including open prisons, higher security units, immigration detention centres, and more. Juli works in a high security men's prison but she urges you to consider the type of secure environments near to you that interest you.

The job can be rewarding but emotionally demanding -Patients in these environments tend to have more complex needs and have experienced more trauma, often resulting in more mental health and substance use concerns. You need to consider how to care for yourself and your emotional resilience as well. Juli mixes prison shifts with a varied work week within a Portfolio career to protect herself from burnout.

Contacts are key - Juli highlighted that she secured an interview for her other role in substance misuse through her GP partner colleague, who had a contact in the local addiction services. Connect with GPs already working in secure environments to gain first-hand accounts of their experiences, join online forums, and seek out mentorship opportunities in this area. She found this route much easier and more informative than searching for job adverts and listed vacancies.

Preserve human dignity and provide empathy - It’s important to always approach individuals in secure environments with empathy and respect, recognizing their vulnerability. Juli states that a simple, human connection can make a significant difference in their experience and well-being.

Same but different - Juli highlights that she was not required to complete any additional qualifications to work in the prison environment. Although the structure and environment is different a lot of the day-to-day clinical work is exactly the same as that of your community GP clinics including chronic disease management, triaging patients, prescriptions for the pharmacists, and dealing with queries from the nurses. In Juli’s experience she also sees fewer patients per shift, allowing you to spend more time if the patient needs it.

Dr Juli McCulloch is a First5 GP working in Fife and Tayside. She divides her working week between a long-term locum GP post, a salaried post in secondary care addiction services, and a few shifts monthly at her local prison. Further reading

RCGP Secure Environments hub https://elearning.rcgp.org.uk/course/view.php?id=561 RCGP Secure Environments elearning course https://elearning.rcgp.org.uk/enrol/index.php?id=560

RCGP Secure Environments group https://www.rcgp.org.uk/about/communities-groups/secure-environments

RCGP Mentoring https://www.rcgp.org.uk/your-career/gp-mentoring BMA Forensic and secure environments committee https://www.bma.org.uk/what-we-do/committees/forensic-and-secure-environments-committee/forensic-and-secure-environments-committee-overview

BMA Forensic and secure environments ethics toolkit https://www.bma.org.uk/advice-and-support/ethics/working-in-detention-settings/forensic-and-secure-environments-ethics-toolkit RCGP Podcast Feedback Your feedback plays a crucial role in helping us improve the CPD products and services we offer. We would be grateful if you could please complete our short RCGP Podcast Survey, which will take no more than 5 minutes to complete.