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Sharing the Caring: General Practitioner Antenatal Share Care

Central Coast Local Health District
Project Added:
9 December 2016
Last updated:
16 December 2016

Sharing the Caring: General Practitioner Antenatal Share Care

Summary

This project examined the causes of a substantial decline in general practitioner (GP) antenatal share care (ANSC) on the Central Coast over the last 15 years and implemented solutions to reinvigorate the model of care.

View a poster from the Centre for Healthcare Redesign graduation, December 2016.

Aims

  1. To increase the number of women receiving GP ANSC from 3% to 9%, and increase the number of GPs who provide ANSC from 71 to 81, by January 2018.  
  2. To ensure that all pregnant women in Central Coast Local Health District (CCLHD) are aware of GP ANSC as an option for their pregnancy care.  

Benefits

  • Increases patient satisfaction with antenatal care services.
  • Improves continuity of care for women during pregnancy and in the postnatal period.
  • Improves working relationships between antenatal clinics and GPs.
  • Provides women with antenatal care as close to home as possible.
  • Improves the use of healthcare resources in CCLHD.
  • Improves GP knowledge of ANSC.
  • Increases awareness of GP ANSC among pregnant women.
  • Increases the use of HealthPathways among GPs.

Background

GP ANSC is a model of antenatal care that is delivered through a combination of GP and hospital-based antenatal services. It aims to improve maternal and child wellbeing through integrated antenatal and postnatal care. Benefits include continuity of care, convenience for women and an improved use of healthcare resources.

An independent review of CCLHD Maternity Services in 2013-2014 found that 9% of pregnant women preferred to have their antenatal care delivered through the GP ANSC model. However, an audit conducted in 2015 found that only 3% of pregnant women received care in this way.

Quality improvement activities in 2009 and 2012 were unsuccessful in addressing the declining numbers of women participating in GP ANSC, which had reduced from approximately 50% to 3% over the last 15 years. A comparison with similar antenatal services indicated that the model was effective at providing care to greater numbers of women. As such, there was an opportunity to increase access to the model of care and encourage women to choose GP ANSC for their antenatal care.

Diagnostic activities with stakeholders including GPs, CCLHD maternity services staff and patients identified the following reasons for low participation rates in GP ANSC:

  • midwives, patients and GPs had gaps in their knowledge of the service
  • there was confusion about the requirements for GPs to deliver ANSC services, including registration
  • HealthPathways (an online portal providing GPs with information on how to assess and manage medical conditions) was not well used by GPs
  • there was poor communication between GPs and antenatal clinics, with no electronic communication or records system
  • not all women attending GP clinics and CCLHD facilities were offered GP ANSC
  • the perceived cost of visits to the GP influenced the decision of some pregnant women when choosing their antenatal care.

Implementation

  • A registered midwife was allocated as a dedicated central contact. They provided personalised GP visits, coordinated GP antenatal education evenings, developed online education for GPs and coordinated communication between GPs and antenatal services. This communication included regular newsletters and HealthPathways promotion.
  • Prior to the project, GPs were required to register on a list that would allow them to participate in ANSC and professional development activities related to antenatal and women’s health. There was no perceived benefit to this registration, as the list could not be shared and registration was not accredited or monitored. Many GPs were confused about the requirement, or found it onerous and unnecessary. To address this problem, the registered list of GPs providing ANSC was removed.
  • GPs were informed that cost is a deterrent for some women when choosing their antenatal model of care. They were encouraged to let women know that some GPs bulk-bill for antenatal care.
  • Midwifery-led antenatal education sessions for women participating in GP ANSC, will be undertaken in GP practices.
  • Investigation of a shared electronic record is underway, with technical issues identified and escalated.

Project status

Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.

Key dates

January 2016 – January 2018

Implementation sites

  • Central Coast Local Health District
  • GPs on the Central Coast

Partnerships

Evaluation

  • A final evaluation will be undertaken in January 2018 to measure the following outcomes:
    • number of GPs providing ANSC
    • number of feedback letters sent from antenatal services to GPs
    • GP satisfaction with communication of antenatal services, measured by a survey
    • number of GP practices requesting and receiving a personalised visit from the CCLHD registered midwife
    • number of views on the HealthPathways antenatal and ANSC pages.
  • Patient Experience Tracker (PET) surveys will be conducted every three months to measure:
    • the number of women aware of GP ANSC
    • the number of women who understand GP ANSC
    • the number of women offered access to the GP ANSC by their GP or registered midwife.

Results

  • A PET survey was conducted in July and September 2016. In that period, results showed that patient understanding of GP ANSC increased from 69% to 94% in the Wyong area and 67% to 75% in the Gosford area.
  • As of October 2016, there were 18 GPs offering ANSC who did not provide this service prior to the project.
  • There has been a sustained increase in the number of page views on the relevant HealthPathways pages since June 2016.

Lessons learnt

  • The project was implemented during an organisational restructure and redevelopment, which made it challenging due to change fatigue among staff.
  • Solutions that addressed longstanding communication and information technology issues between organisations required an extended timeframe to implement.

Further reading

  • Todd A, Porter M, Ampt A. Maternity Care in NSW: Having Your Say 2013-2014. A survey about women’s views of their maternity care. Sydney: The Kolling Institute, University of Sydney; 2016.  
  • Lucas C, Charlton K, Brown L et al. Review of patient satisfaction with services provided by general practitioners in an antenatal shared care program. Australian Family Physician 2015; 44(5): 317-321.
  • The Royal Hospital for Women and Central and Eastern Sydney Primary Health Network. Maternity Services – General Practitioners Services. Randwick: South Eastern Sydney Local Health District; 2016.

Contacts

Claire Neilson
GP Collaboration Unit Program Manager
Central Coast Local Health District
Phone: 02 4320 3046
Claire.Neilson@health.nsw.gov.au

Leanne Roberts
Midwifery Unit Manager Antenatal Services
Central Coast Local Health District
Phone: 02 4320 3863
Leanne.Roberts@health.nsw.gov.au

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