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23 Using a new model of access to improve provision and uptake of postnatal and newborn 6-week checks (6WC) in general practice
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  1. Dhiviya Tharan
  1. Salford and Trafford GP Training Programme

Abstract

Introduction Future international health strategies are focussing on improving women’s health outcomes. Prior to the pandemic, it is estimated that 20–40% of women in England did not have a 6-week postnatal check recorded in primary care. To manage increasing primary healthcare demand, there has been widespread implementation of patient-initiated triage-based models of access which place an onus on the individual to organise their healthcare. Post-pandemic surveys have highlighted inadequate provision of healthcare that meets the needs of women’s postnatal physical and mental health. We had anecdotal evidence that women were compromising their postnatal care to ensure their baby’s appointments. Concerned that we were contributing to inequitable provision of care, we proposed to explore and evaluate an alternative model of care that prioritised the delivery of high quality postnatal care.

Aims and objectives of the research project or activity The project aim was for all women to undergo a postnatal check within 6–8 weeks after delivery as recommended by the National Institute for Health and Care Excellence (NICE) Guidelines on Postnatal Care [NG194]. To achieve this we sought to: perform a retrospective audit on current practice performance to understand barriers to attendance and develop a practice protocol to improve postnatal care provision without compromising postnatal baby checks. Our practice population is ~14,000 and the area is in the 5th most deprived decile. As women in more deprived areas are at risk of inequitable provision and uptake of postnatal checks, we wanted to ensure our intervention was: equitable by preventing unintentional exclusion, efficient by minimising wasted clinical time through unattended appointments and sustainable with existing workforce and software resources.

Method or approach The Six Sigma method of quality improvement was used for this project. The Six Sigma improvement process was used for its strengths in improving processes and reducing variability whilst allowing for rapid and frequent service evaluation and subsequent improvement. Baseline assessment included an audit of performance 12 months before the intervention using electronic health record data. Appointment data, length of time to check and clinical documentation were reviewed.

A practice protocol with a focus on protected appointments and proactive invitation of patients was developed. Patients were offered a 30-minute combined face-to-face baby and mother appointment delivered through a dedicated weekly clinical session. Following registration of a newborn baby at the practice, administrative staff contacted parents via SMS (Accurx) to inform them of the pre-booked appointment date and time. Parents had the opportunity to change their appointments if inconvenient. A single dedicated clinician was responsible for delivering the clinic.

Findings Prior to the intervention, audit results showed suboptimal provision of postnatal care compared to the newborn care. Of the patients who did not have a check, 4% were offered a pre-arranged appointment.

Within 6 months of the intervention being introduced in April 2023, uptake of maternal postnatal checks improved from 59% to 99% and appointments performed within 6–8 weeks improved from 59% to 71%. Uptake of baby checks improved from 88% to 100% and appointments performed within 6–8 weeks improved from 50% to 78%. Ongoing audit will provide 12 months of data by April 2024. Run charts are available for review.

Introduction and implementation of protected postnatal appointments with proactive invitation of patients via SMS demonstrated a sustainable improvement in practice service delivery and quality of care. The protocol required no additional resources, had a low administrative burden and used digital communication tools easily available to general practices nationwide.

Key messages Our practice, with average demographics and deprivation, was inadequately providing and performing postnatal checks for women in our local population. New models of access introduced following the pandemic risk vulnerable health groups losing access to health surveillance visits. Our intervention could be considered as a model for the provision of postnatal care in the community to reduce inequality and inequity in healthcare, counter digital exclusion, maintain patient safety and, promote women, child and public health interventions. The intervention was sustainable, efficient, equitable, timely and patient-centred. 99% of women invited attended their appointments suggesting strong patient desire to engage and that current system models and constraints risk limiting patient access to public health and preventative initiatives in general practice. The postnatal check provides an excellent opportunity to address multiple areas of preventative healthcare and its value is likely underestimated from the perspective of service commissioners.

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