APPENDIX
CLINICAL GOVERNANCE
FRAMEWORK FOR
GPS PROVIDING
INTRAPARTUM CARE
GPs providing intrapartum care should be required
to:
(a) develop and maintain a register of pregnant
patients, to whom they will be providing intrapartum care. This
will specify where care will be provided and at what level. Patients
could be (i) registered on the practice list and/or; (ii) on another
practice's list;
(b) state the level at which care will be
provided: level 1—support the woman and the midwife by providing
advice, support, continuity of carer, resuscitation (both neonatal
and maternal); level 2—provide a number of practical skills
in addition to neonatal and maternal resuscitation which may include
one or more of:
— Induction of labour for post-maturity
— Interpretation of cardiotocographs
— Augmentation of labour with Syntocinon
— Instrumental delivery (ventouse and/or
low forceps)
— Repair of episiotomy or perineum
tear;
(c) state where care will be provided: level
1—at hospital or at home; level 2—would usually only
be provided within a hospital setting;
(d) be appropriately trained: level 1—standard
vocational training; level 2—standard vocational training
plus six month obstetrics and/or obstetrics & gynaecology
post, plus holds the Diploma of RCOG;
(e) make and keep appropriate records of
care provided, either in writing or electronically, in the patients
hand held maternity record, the lifelong GP record, and in the
hospital record if delivery occurs in hospital;
(f) involve as appropriate and with maternal
consent the woman's midwife, family (or other lay carer), support
workers, and other clinicians. This will include regular communication
with these individuals;
(g) book woman for delivery, and provide
labour care (including monitoring of mother and foetus), in line
with locally agreed clinical guidelines based on national guidance
which is evidence based. Such guidelines will be endorsed by the
local maternity services liaison committee or similar representative
committee;
(h) provide in advance of, and during, labour
verbal and written information about the woman's choices, local
guidelines, and other relevant material, so that she be fully
informed of progress and of her choices as they occur both before
and during labour;
(i) undertake continued professional development
(CPD). For those providing level 1 care this would be consistent
with general professional CPD for GPs, including resuscitation
requirements. For those providing level 2 care the GP would need
to undertake regular updates such as the Advanced Life Support
in Obstetric courses offered in the UK.
(j) undertake an annual review and audit
of their care. They will compare their care and outcomes at least
annually with other carers both locally and nationally, providing
similar care whether at level 1 or level 2;
(k) contribute to local guideline development
and to the local MSLC or similar representative committee;
(l) be accredited by the Primary Care Trust
based on their previous training, ongoing CPD, adherence to local
guidelines and satisfactory audit;
(m) work with local midwives who would be
the principal carers at delivery and be funded to do so by the
local maternity provider in contract with the PCT. Any equipment
that the GP might need to provide level 2 care would be provided
by the local Trust as contracted with the PCT eg ventouse equipment
for delivery, appropriate CTG machines.
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