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GPs warn of ‘unsafe’ removal of midwives from practices

A hospital trust´s decision to remove first antenatal appointments from GP surgeries is putting pregnant womens´ lives  at risk, GPs have warned.

Midwives were relocated from surgeries in the Liverpool, Sefton and Kirkby areas to community clinics in December as part of an Early Access to Maternity Services scheme introduced by Liverpool Women´s NHS Foundation Trust.

Under the scheme, women with no underlying medical problems are given a first antenatal appointment in a clinic in a children's centre in their local community instead of in their GP surgery.

They are seen by the midwife that will provide the care throughout the remainder of the pregnancy and in the postnatal period.

But GPs have raised concerns that the change is ‘clinically unsafe', with midwives now unable to routinely enter details into practice computer systems, leaving GPs in the dark about patients' medical histories.

Dr Andrew Mimnagh, chair of Sefton LMC, said: ‘It´s an accident waiting to happen. In many young women, a change in blood pressure from 80 to 110 would be highly clinically significant as a possible sign of pre-eclampsia. But because 110 is well within the normal range it could be missed by a GP who didn´t know it was to do with pregnancy.'

'GPs were able to confirm results and check midwife urine sample results for treatment needs. Previously the data would be on the system. When we see women in pregnancy with headache and do not know BP history or trend, how do we detect toxaemia?'

'Women previously choosing to attend GP surgery for booking for convenience are being denied choice and clinical care is compromised.'

The change had been introduced by the trust at "intolerably short notice", he added.

'We´re making representation about this at the highest level. We´ve also done a "mystery shopper" investigation that suggests women can´t always go to the clinic nearest to them.'

In a statement the hospital trust said. ‘This new service gives women the choice to either visit their GP or contact Liverpool's Women's Hospital direct where an appointment with a midwife will be arranged. If women do attend their GP they will be advised to telephone our early access line. This single point of contact facilitates equality and consistency in how women access maternity services.'

'Previously a number of women did not meet their community midwife until they were 16 or sometimes 25 weeks pregnant and were being seen initially in a hospital environment by staff that were not aware of the services in the community available to pregnant women. ‘

'Women will continue to have their follow up visits provided from their GP surgery where the midwives work as part of the multidisciplinary team.'

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