• General practice
  • Obstetrics

Location: MRI-UQ

Type of student: PhD or MPhil only

Type of work: Literature review

Prerequisite skills: Academic writing skills

Brief synopsis: This project examines the outcomes of various models of maternity share care have on birthing outcomes for women from a safety and quality perspective.

Australia’s Maternity Services Review highlighted ‘improved service integration, encouragement of community-based care and improved continuity of care’ as important priorities for enhancing the quality of maternity care nationally. Yet, despite the Review identifying 40% of women receiving care involving a General Practitioner (GP) component, the subsequent National Maternity Services Plan was silent on initiatives to support ongoing GP involvement in a critical facet of holistic care.

Two chart audits have been conducted on models of care and birth outcomes since 2008. We are looking for someone to write a paper examining these outcomes.

This project has developed a formal GP share-care program with Queensland’s largest maternity hospital, Mater Mothers’ Hospital (MMH), and its impact on maternal screening, first trimester care and birth outcome.

In line with national trends and a commitment to providing the highest quality of antenatal care to women, MMH, in partnership with Brisbane South Primary Health Network, provides the MMH/ GP Maternity Shared Care ‘Alignment Program’. This program recognises the increasing complexity of antenatal care provision and the need to proactively manage current risks to women, doctors and MMH.

Prior to the commencement of the Alignment Program MMH was providing regular educational updates for GPs, facilitated by a GP with support from specialist colleagues. Numbers were low, no-shows common and there was a core of 5-6 well-informed GPs who attended each update and who were well across the topics. It became clear that a more formal, structured program was needed and the decision was made to create a high quality, well-supported education, communication and relationship-building program. The program was commenced in November 2008 and in April 2011 it became compulsory for GPs who wished to provide maternity shared care with MMH. Along with recognised gaps in communication, a routine audit (July 2007) identified significant documented omissions to routine antenatal care e.g. screening for fetal abnormality, Glucose Challenge Test (GCT) and correct follow up of abnormal results, and Anti D not being given as part of routine care.

The ultimate driver for change was a combination of simultaneous events which included lower number of GPs agreeing to share maternity care and the perceived need for more GPs to do shared care. In 1998 1100 GPs were sharing maternity care with MMH, in 2007 there were 629 GPs.
This was against a backdrop of a changing health care workforce with declining numbers of GPs, midwives and obstetricians, the expansion of other models of care being offered by MMH including Midwifery Group Practice, and the medical indemnity crisis. There was also the issue of managing risk and concerns regarding the quality of care provided to women following some adverse outcomes for women and children and resultant litigation. Recognising that not all of the GPs providing shared care would elect to participate in a compulsory program, as some were close to retirement and others provided shared care infrequently, it was anticipated up to 450 GPs would chose to complete the program. Today the program has provided education to over 2000 GPs

Other info
The Alignment Program has evolved progressively since 2008. It commenced with a 0.5 FTE GP Liaison Midwife, written guideline and a 6-hour face-to-face RACGP Category 1, 40 point CPD education event. A post event evaluation includes a 10 Q&A multiple choice test with a required pass rate of 8/10. Re-alignment is undertaken every RACGP triennium and can be either face-to-face or on-line. The program has grown to include a number of resources, most of which can be viewed online at Critical to the program has been the leadership and engagement of midwifery, nursing, allied health, medical and research staff, which are integral to the planning and running of the events and present as well as serving as the clinical experts for various case studies.

Time frame: Currently second chart audit is being analysed


Caroline Nicholson

Caroline Nicholson

Centre for Integrated Care & Innovation
PhD student