How this fits in

Primary care services are delivered across many prisons every day in England but there is little previous research exploring the key organisational factors influencing quality of care and access in this setting. This qualitative interview study with people who had been in prison and prison healthcare staff found that understaffing—which then often led to a reactive and crisis-led service — was the core organisational issue that influenced quality and access. Understaffing is rife across many sectors of health care in England but it is particularly fraught within the prison estate where it collides with a higher disease burden and exacerbates health inequalities. Factors that influence the quality of and access to prison health care deserve to receive mainstream research and policy attention.