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Leading commissioner says maternity services must change to reduce costs

GPs should use their commissioning clout to prevent unnecessary hospital births, caesarians and epidurals, a leading commissioning spokesman has said.


Commenting on a controversial new report from the Royal College of Obstetricians and Gynaecologists, which called for midwifery-led services to be the default option for pregnant women,  Dr Charles Alessi, interim chair of NHS clinical commissioners said: ‘Current financial imperatives and flatlining budgets mean we simply have to do things differently.


'If midwife-led services offer the same outcome in terms of safety and patient satisfaction as well as saving money, then commissioners will back them, quite rightly,' he told Practical Commissioning.


The RCOG´s advice to CCGs was produced in collaboration with the Royal College of Midwives and parenting charity, the NCT and encourages CCGs and GPs to work to advise women to have a ‘normal' childbirth to reduce the costs of maternity services.


The report, which found preventing each caesarian section that could be a normal birth would save the NHS £1,200 in tariff price alone, said GPs have a pivotal role to play because they were often the first point of contact for patients.


It added: ‘Women must receive consistent, positive information and advice from their health professionals if they are to have confidence in a normal birth. The first messages they receive will often be from their GP and these will powerfully influence their approach to their pregnancy.'

The national caesarean section rate in England is 24.5%. The NHS Institute for Innovation and Improvement has concluded that a 20% rate would be ‘achievable and sustainable'.

The RCOG guidance has been criticised by women´s groups and some obstetricians who said putting pressure on women to give birth at home could lead to birth trauma and medical complications. 

Dr Alessi said: ‘The role of GPs and CCGs should be synonymous. Clearly, if it is the case that unnecessary procedures are being done in hospital, it is the role of CCGs to find better ways of doing things.


'In the new world of clinical commissioning we should be looking towards population health and greater integration with secondary care and we´re not going to succeed unless we share our aims and values with secondary care.


'We can have everything including raising quality and decreasing cost just by changing the way we deliver stuff.'


Making sense of commissioning Maternity Services in England – some issues for Clinical Commissioning Groups to consider. Royal College of Obstetricans and Gynaecologists. 2012