Weak role of GPs is undermining maternity care

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GPs' lack of involvement in maternity care is undermining the care of pregnant women and their families, according to a report published for The King's Fund's Inquiry into the Quality of General Practice in England.[i]

GPs' role in maternity care has all but disappeared over the past 30 years, with recent policy and guidance omitting any reference to their role in caring for pregnant women.

Under the terms of the new GP contract introduced in 2004, GPs are no longer paid for each pregnant woman they look after. In addition, many GPs have opted out of providing out-of-hours care, resulting in sick pregnant women going to A&E with pregnancy-related problems – or simply not knowing what to do if they are ill. Women can also now self-refer to a midwife, though many still do see a GP hoping to confirm pregnancy. And, increasingly, midwives are now based at children's centres, further removing them from GP surgeries.

The role of GPs in maternity care – what does the future hold? suggests that GPs could take a more active role in delivering high quality maternity care by sharing responsibilities with midwives and obstetricians, particularly for women with ongoing medical conditions. GPs hold vital information on women's medical history and social context and may therefore be better placed to pick up on potential problems earlier. The report suggests shared care could result in better co-ordination of care for women with complicated medical histories.

However, the report also identifies the challenges of shared care, such as the current lack of training for GPs and confusion among pregnant women about who is in charge and who they should turn to if they feel unwell.

Despite this, the authors believe there are a number of activities that could help GPs overcome these challenges, for example, by participating in continuing professional development and education related to pre-conception care and the care of pregnant women and by establishing relationships with local maternity services to agree protocols for referral and sharing information about a woman’s social and medical history.

The report also identifies a real need for leadership to support GPs in delivering care and recommends a greater role for the Royal College of General Practitioners (RCGP) in ensuring that all GPs in training are equipped with the necessary skills and competencies and make available educational materials for GPs to maintain and update their skills.*

Anna Dixon, lead author and Director of Policy at The King's Fund, said:

'It is right that those with specialist skills, such as midwives and obstetricians, take the lead role in caring for pregnant women, but GPs have a vital role to play in pre-conception and shared ante-natal and post-natal care.

'So long as women turn to their GPs for care during pregnancy, GPs must ensure they have the necessary training and competencies to care or appropriately refer them.'

Notes to editors

[i] The King's Fund commissioned an 18-month Inquiry into the quality of general practice in England. Launched in April 2009, the Inquiry has sought to collect and examine evidence on the quality of care and services provided by GPs and other health professionals working in general practice. We have looked at a range of care dimensions that were selected by an independent panel and will publish a final report in November 2010. See www.kingsfund.org.uk/gpinquiry for more information.

* The Confidential Enquiry into Maternal and Child Health (CEMACH) made a series of recommendations to GPs, many of which point to what a GP needs to do as part of providing high quality care to women and their families and how they should communicate and work with others who are caring for women, especially midwives. These messages could be adopted and disseminated by the RCGP in developing educational material for GPs.

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The King’s Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, we help to shape policy, transform services and bring about behaviour change. Our work includes research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas.