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Alongside discussion of the work carried out by the FPs, the interviews also discussed links with the pilot service. An initial settling in period was noted, by some interviewed, between the pilot staff and FPs, where boundaries and roles were established. The general feeling was that good relationships were developing between the pilot staff and FPs, one interviewee described it as ‘quite an easy relationship’, while another described it as ‘very good’. Another interviewee discussed how the two teams were able to liaise well, while pilot staff felt able to contact the FPs for advice and to check whether a call out was necessary. There was an awareness of the value of an FPs time from the pilot staff and they seemed to be conscious of ensuring they did not unnecessarily impact on this time. Additionally, there was a perception that FPs felt confident that they could ask pilot staff to assist with their work and that pilot staff could ask FPs for advice. The knowledge of the FPs and their expertise were noted as being of real benefit to the pilot team.

‘The work is different, interesting and interfaces between health and the law. Many of the detainees have challenging problems.’

‘… we liaise with the FPs a fair amount I find if they are out the other side of the county, you know, “Got this, what do you want me to do with it, what’s the priority?” And sometimes that might be saying, we liaise with A&E and then send people off if they need to. So yeah, I mean we, everybody has been pretty accommodating in that respect.’

One interviewee also thought that the pilot was a good way to support the role of the FPs, providing them with ‘backup’ and thought that having the moral support of another health worker was important. As such, the pilot was seen as a process of learning for all involved.

In addition to this, there is a shared language and knowledge developing between the pilot staff and FPs so that a telephone conversation about a detainee could provide more knowledge about that detainee’s health than if it had taken place between the police and an FP.

This positive relationship is also evident through the provision of training delivered by the FPs to the pilot staff.

‘And you can phone them for advice and they’ll say, “OK, you need to do this, this

and this,” and it’s quite reassuring for us…’

‘And I think they see, because if they’re busy in one side of the county, knowing we’re there and they can talk us through doing obs or monitoring this so that they can kind of feel that they’re doing both…’

‘I think for me it’s about them having the knowledge and expertise in things that I necessarily don’t have and being able to call on them for advice and guidance if I’m doing something I’m not very sure about.’

‘Some of them … up here really keen to have actually that backup because they can't always get anywhere as quickly as they would wish and I’m sure that’s quite frustrating for them and also … I think it was quite a relief to have somebody else there ‘cause however skilled you are actually being on your own is not very nice … So I think it’s probably been as enlightening for them in different ways as it has been for the police.’

‘I also understand there has been some feedback in relation to some training that the FMEs are prepared to give to the nurses to actually assist them in some of the roles that they’ve been doing.’

‘… they’ll have that conversation which is, has more information in it for them about making a decision because they’ve, you know, got the observations, they’ve assessed them and etc. so…’

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However, despite this developing working relationship, it was also noted that not all the forensic physicians were aware of the role of the pilot. Further to this, it was suggested, the relationship between pilot staff and forensic physicians could sometimes depend on which doctor was on call. The perception was that not all the FPs were fully supportive of the pilot. Initial tensions were also noted as the pilot was potentially seen as threatening to the role of the FPs, with thoughts that it would reduce their working hours and role. An additional complexity noted was that more than one FP could be called out to visit a patient during the course of a shift for the pilot staff. This was reported to be a difficult situation to manage as decisions on the patient’s condition could differ from physician to physician.

Some initial tensions may also have resulted from the mental health background of the pilot staff. It may have been expected initially that pilot staff would be physically health trained nurses, as is occurring in other regions in the country. Despite training to up skill staff in physical health issues, early expectations were that the pilot staff would be able to address a broader range of health issues.

In addition, one forensic physician shared concerns that service users’ health could be put at risk through the extended use of registered nurses to treat detainees. This individual expressed concern that problems can escalate quickly and without adequate cover from the forensic physician service, there could be a potentially negative impact on people’s health. This view was echoed by another forensic physician, who reported that ‘under qualified and poorly trained staff’ employed by external companies could have ‘disastrous consequences to patient health and the criminal justice system’.