GPs concerned over antenatal care

GPs have criticised plans to move them further away from antenatal care, after NICE developed a tick-box tool for midwives to replace clinical experience.

The antenatal assessment tool is meant to help midwives detect risks in pregnant women, say members of the guideline developing group (GDG) updating 2003 NICE antenatal guidelines.

But speaking at the Primary Care 2007 conference in Birmingham last week, chairwoman of the antenatal GDG Dr Rhona Hughes, a consultant obstetrician in Lothian, said: ‘Many patients aren’t seeing a GP, they’re seeing midwives and they don’t have the medical expertise.’

‘There is a worry that if midwives are doing the totality of care for pregnant women they may miss risks,’ said Dr Hughes.

‘As an obstetrician, it was easier talking to GPs about risks.

‘That’s the way the UK is and  women are seeing midwives.’

Last February, DoH national clinical director for children Dr Sheila Shribman published a report indicating that most maternity care should be done by midwives rather than GPs.

The first draft of the revised  NICE antenatal guideline is due to be published this autumn. It will include the antenatal assessment tool, which will consider maternal age, high parity, previous big baby, depression and any history of domestic abuse when calculating risk.

Dr Sarah Jarvis, RCGP spokeswoman on women’s health, has raised concerns that moving GPs away from maternity care threatened to de-skill the profession (GP, 16 February).

Wiltshire GP Dr Chris Barry, who is on the NICE guideline development group, said: ‘There’s been a swing of the pendulum and in some ways we have been squeezed out.’

Nevertheless, communication between GPs and midwives should be good and, if possible, antenatal clinics should be held by midwives in GP clinics.

Birmingham GP Dr Phillip Morgan, who has also been a registrar in obstetrics and gynaecology, said the concept of pregnancy assessment tools had been around for the past 25 years.

Once the protocol is written, midwives are likely to be able to use it as well as GPs, he said.

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