An HMP Durham inspection has revealed a reduction of violence, however the prison was found to have significant shortfalls in health care.
Leaders at the men's category B prison brought down levels of violence by almost two-thirds since the previous inspection, said HM Inspectorate of Prisons.
But inspectors also found that more needed to be done to help a significant proportion of the population who required support for complex mental ill health and substance misuse.
Go here for the latest crime news and breaking North East police updates
Charlie Taylor, HM Chief Inspector of Prisons, said: "The quality of health care in every area, from GP appointments to mental health provision, was suffering from some serious staff shortages.
"Prisoners frequently complained to inspectors about the difficulties in getting treatment or medication."
The inspection, which took place on 15 and 22–26 November 2021, found that there were long delays for routine GP appointments.
264 prisoners were on the waiting list during the inspection, some of whom had been waiting more than eight weeks.
It also found that many new arrivals did not receive health care screening and deficiencies with the appointment booking system added to problems in accessing care.
Inspectors underlined the potentially illegitimate use of force and poor practice in some cases, despite an overall decline in physical intervention.
And urgent action was required to make sure staff received the training they needed and effective systems were in place so incidents could be reviewed.
Prisoners spent too long locked in their cells, particularly if they had just arrived at the prison and some could only spend half an hour in the open air every day and 45 minutes undertaking domestic tasks.
There was also found to be a lack of activities or work, and the education provider had been too slow to restore face-to-face educational and vocational training workshops.
A worrying 43% of men, including some high-risk prisoners, were released from the prison without suitable accommodation to go to.
The inspection did recognise the joint working between security, drug strategy and safety managers had led to the reduction of violence and disorder, which was found to be below the average for a local prison in England.
This was reflected in the Inspectorate's survey of prisoners, where fewer men than at the previous inspection said they had experienced verbal abuse, physical assault, threats or intimidation, or theft.
Mr Taylor said: "Much credit must go to the impressive governor and to what was a generally strong leadership team, who had worked together to reduce the supply of drugs into the prison.
"This had contributed to a more than 60% fall in violence since our last inspection, making the prison one of the safer category B locals in the country.
"Throughout the inspection the prison felt calm and generally well-ordered."
Mr Taylor added: " Durham prison has shown some impressive improvements since our last inspection and the governor and his team should be proud of the progress the jail has made, particularly considering the challenges caused by the pandemic.
"The inspection team left optimistic that if senior leaders remain in post and the issues raised in this report are addressed, the prison can continue to make good progress."
A spokesperson for the NHS in the North East and Yorkshire said: “We are working closely with the healthcare providers at HMP Durham to respond to the recommendations in the report. Progress has already been made in a number of key areas, with patients no longer experiencing delays for routine GP appointments.”
A spokesperson from the Ministry of Justice said: “We are pleased that inspectors have recognised the hard work of staff at HMP Durham whose efforts have reduced violence by two-thirds, while our actions during the pandemic have kept prisoners safe and restrictions have been eased in line with government guidance.
“Too many prisoners leave jail without stable accommodation and a dedicated team at HMP Durham provides extra support to find at-risk offenders a home.”
