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Editor’s Notes #004: The repeated failures of maternity care

Nada Khan is an Exeter-based NIHR Academic Clinical Fellow in general practice and GPST4/registrar, and an Associate Editor at the BJGP. She is on Twitter: @nadafkhan

In the time since I wrote the Editor’s briefing for the Women’s Health themed April issue, Donna Ockenden published the Independent Review of Maternity Services at the Shrewsbury and Telford Hospitals NHS Trust. The report makes for chilling reading, detailing repeated failures of care which led to the loss of lives of babies and their mothers.

…the report also highlights how GPs must be involved with safe and individualised antenatal care as well as clinical follow-up in the postnatal period.

Although most of the learning and action points from the Ockenden report are specific to obstetric and midwifery services, the report also highlights how GPs must be involved with safe and individualised antenatal care as well as clinical follow-up in the postnatal period. The two editorials by MacGregor and Schoenaker in the April issue seem timely; providing specific guidance about the important role GPs have to play in optimising the health of women before and during pregnancy in order to reduce maternal morbidity and mortality.

…only 1% of maternity services in England are rated as ‘outstanding’ in terms of providing safe care.

The findings of the Ockenden report have repeatedly been referred to as a ‘scandal’; indeed, the report has caused widespread public outrage and sorrow.  MP Tanmanjeet Singh Dhesi, however, reminds us that it is not long since women and babies suffered the ‘scandal’ of failings at the Morecombe Bay maternity unit.  Morecombe Bay and Shrewsbury may be described as ‘outliers’, but as pointed out on Woman’s Hour, only 1% of maternity services in England are rated as ‘outstanding’ in terms of providing safe care.  I can only hope that the messages from the Ockenden report, along with the other reports before it, are taken into account and implemented before we hear of another tragic mishandling of maternity care in the NHS.

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1 year ago

Nada Khan is an Exeter-based NIHR Academic Clinical Fellow in general practice and GPST4/registrar, and an Associate Editor at the BJGP. She is on Twitter: @nadafkhan
Failings in women’s health have sadly been the focus of several recent scandals in the NHS, including but not limited to the Ockenden review of maternity services in Shrewsbury, maternity services in Morecombe Bay,and injuries from pelvic mesh surgery. This July, the Secretary of State for Health and Social Care published the ‘Women’s Health Strategy for England’, a wide-ranging report that aims to ‘right the wrongs’ of a patriarchal health care system that has historically ignored the voices of women.1 This health strategy aims to take a life-course approach to boost health outcomes for women and to develop a healthcare system that listens to women and girls. Reflecting on the Women’s Health Strategies published in the UK, Sharon Dixon and colleagues recently wrote in the BJGP about the need for primary care to the ‘at the heart of any strategy to support and enhance women’s health’.2 As they point out, GPs are ideally placed to support a life course approach, as we’re already there ‘for the journey’.
There are a lot of goals in the Women’s Health Strategy; the 10 year ambitions are certainly ambitious. There are three specific areas in which general practice is mentioned.

There are a lot of goals in the Women’s Health Strategy; the 10 year ambitions are certainly ambitious.

Firstly, in terms of access to NHS services, the strategy mentions the investment of £1.5 billion to create an additional 50 million general practice appointments by 2024. These appointments, the report explains, will be achieved through hiring a diverse workforce of 26,000 additional primary care professionals to deliver appointments and support GPs. I can only assume this relates to the 26,000 new roles funded through the Additional Roles Reimbursement Scheme (ARRS), which I wrote about recently in BJGP Life. Whether the new multidisciplinary teams under ARRS can actually deliver such a dramatic increase in appointment numbers or make a real impact on women’s health outcomes is uncertain.
Secondly, the report calls for curricula for GP specialist training to include teaching and assessment on women’s health. Some of this seems like political bluster; gynaecology, sexual health and a ‘woman-centred life course approach’ are already key components of the RCGP curriculum. As Sharon Dixon and colleagues note, ‘it’s a missed opportunity if the conclusion and outcome of these [Women’s Health Strategy] consultations defaulted to an explanation of ignorance and to pillorying GPs to simply know more.’2 Nevertheless, the strategy highlights the RCGP Women’s Health Toolkit and the Primary Care women’s Health Forum as important resources for maintaining professional development on reproductive health, menstrual wellbeing and menopause for practicing GPs.

More generally, the strategy has identified deep-seated problems that will need time, money and ambition to tackle.

Thirdly, the strategy is supportive of the expansion of women’s health hubs and ‘strongly encourages local commissioners and providers to consider adopting these models of care’. The vision is to have these hubs hosted in GP surgeries to provide a ‘one stop shop’ for contraception services, cervical screening, psychosexual services and management of for common issues including the menopause and heavy menstrual bleeding. For instance, the Primary Care Women’s Health Forum Health Hub Toolkit gives an example of how a women’s health hub might be able to streamline the patient pathway for heavy menstrual bleeding by reducing contacts and offering tests, examinations and management within one or two appointments. Sounds great for patients, if (big IF) there is capacity within the workforce to offer this service. The NIHR has commissioned research to evaluate existing women’s health hubs and provide information on performance, outcomes and costs to guide future development and policy in this area.
Gender inequalities in healthcare are entrenched in what we learn, how we practice, and what tools we have available to us. The Women’s Health Strategy has highlighted appointment access, education and delays in women’s health treatment as areas for general practice improvements. More generally, the strategy has identified deep-seated problems that will need time, money and ambition to tackle. As Dr Anne Connolly, Chair of the Primary Care Women’s Health Forum writes, ‘It will be difficult to realise the vision [in the Women’s Health Strategy] without extra financial support or a clear plan for workforce development at a time when health services are already at capacity.’3 We needed, and got, a women’s health strategy with clear performance goals. However, we need the resources and transparency to hold these ambitious ideals to account and ensure that they happen.
References

Women’s Health Strategy for England. Department of Health and Social Care; 2022.
Dixon S, McNiven A, Connolly A, Hinton L. Women’s health and primary care: time to get it right for the life course. Br J Gen Pract. 2021;71(713):536-7.
Women’s Health Strategy for England published: Primary Care Women’s Health Forum; 2022 Available from: https://pcwhf.co.uk/news/womens-health-strategy-for-england-published/.

Featured image by Ugur Akdemir on Unsplash

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