SCA practice case · Telephone consultation
“I got out yesterday and they stopped all my meds — I’ve got nothing”
Telephone consultation
Adult patient
Hard
Health disadvantage & vulnerabilitiesMental health & addictionUrgent & unscheduled care
The candidate brief
This is what you would read in the 3-minute window before the patient connects. Read it once, note two or three hypotheses and one thing you must not miss, then stop.
Patient
Lee Marwood · 41 years · male
Setting
Telephone — recently-released prisoner with no medication.
Past history
- New patient — GP2GP and prison records awaited
- Self-reported: psychotic illness, epilepsy, opioid dependence (on OST in custody)
Medication
- None held — reported antipsychotic, antiepileptic and methadone (unconfirmed)
Allergies
Not recorded
Recent notes
⚠ Released from prison yesterday. Registered today. No fixed address. No discharge summary or medication supply received.
Reason for contact
Telephone call requested: “Left with no medication.”
Practise this case
The full case is in the Hot Seat with the Gold plan. You get a 12-minute timer, a role-player script with facts released only when asked, examiner checkpoints by the three RCGP domains, a model consultation and the guidance behind it.
What this case tests
Show the learning points (spoiler: read after you have practised)
The first weeks after prison release are an extreme-risk window — markedly elevated drug-related overdose death (lost tolerance after enforced abstinence/reduction), suicide, relapse, mental-health crisis and seizure risk — so being left with "nothing" is a dangerous gap to close urgently, and continuity of medication plus rapid wrap-around support is potentially life-saving. Triage each medication: continue the ANTIEPILEPTIC (abrupt stopping risks seizures) and ANTIPSYCHOTIC (stopping risks relapse) safely and urgently after verifying prison records, and route OST/methadone via the drug service (verify, don’t prescribe blind — same rule as bridging, plus overdose risk from lost tolerance). Address the intertwined SOCIAL emergency (homelessness, finance, substance/mental-health service linkage) via prison-release/RECONNECT-type and homeless-health pathways, carry out a mental-health/risk assessment, and provide harm reduction (overdose/naloxone). The examinable hidden agenda is fear of relapse and "ending up back where I was", shame and low self-worth, and an expectation of being judged/turned away; meet him with respect and genuine urgency — his life matters — hold the OST boundary while conveying care, and deliver continuity-as-life-saving-care with close follow-up. He is effectively homeless, penniless and unsupported — a social emergency intertwined with the medical one. Housing, benefits/finance, and substance/mental-health service linkage are core. Many areas have specific prison-release/RECONNECT-type liaison and homeless-health pathways. Addressing the destitution is part of preventing the bad outcomes.
The guidance behind it
Similar SCA cases
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