30 November 2018

AMA goes in to bat for GP obstetricians

AMA General Practice O&G

The AMA has penned a passionate defence of GP obstetricians in its submission on the proposed new National Maternity Services Strategy, saying support of these specialists should be a priority.

The submission comes shortly after GPs grabbed headlines for protesting at Western Australian hospitals which had begun curtailing their obstetric practice.

In Rockingham General Hospital, seven GP obstetricians were required to apply for roles working in the hospital alongside midwives, and only one secured a position.

“The gradual exclusion of experienced GP obstetricians from rural and regional public hospitals in certain states, only reduces the choice of women in these areas and fragments their care [emphasis theirs],” Dr Tony Bartone and his AMA colleagues wrote in their submission. “This is a short-sighted policy that is strongly opposed by the AMA.”

“It makes no sense for women not to be able to be cared for by the GP obstetrician who has delivered her previous babies, simply because the local hospital no longer ‘supports’ this model of care.”

That move also provoked a sharp response from the RACGP, who defended the benefits of GP obstetricians for continuity of care, especially among potentially vulnerable women such as Aboriginal and Torres Strait Islander women, refugees and women affected by domestic violence.

This new national strategy is an update to the Commonwealth’s previous 2010-15 plan.

While overall the AMA commended the Department of Health for updating the strategy, it identified several key concerns.

In particular, the Commonwealth’s emphasis on midwife-led continuity of care, which the AMA said was based on an out-of-context recommendation in a WHO paper aimed at low- and middle-income countries.

“Australian women are fortunate to have subsidised access to highly trained general practitioners [and other medical practitioners],” it wrote.

While midwives had a role to play, they largely came onto the scene around 20 weeks in this country and were not best suited for continuous care.

“GPs are best placed to take the lead in providing continuity of care and are accessible in nearly all parts of Australia,” Dr Bartone and his colleagues said.

“GPs are the key health practitioners, already providing care to women before, during and long after their pregnancies. GPs are especially crucial in the provision of whole of maternity care for rural and hard to access groups.”

The AMA said GPs had also been ignored the department’s efforts to improve care in the postnatal period.

“GPs already provide almost all postnatal care. GPs undertake the six-week check of mothers and their babies, provide immunisation, contraception, screening and interventions referral. As the average time in hospital after birth is decreasing, women are now seeking advice from GPs much earlier, with issues such as breastfeeding, sleeping and parenting.”