The government is preparing to perform a U-turn on its decision to plan and fund maternity nationally and instead hand responsibility to GPs, HSJ’s sister title Nursing Times has learned.
The change has been attacked by midwives and childbirth charities who said it was “dangerous” and raised questions about ministers’ commitment to improving choice and safety in maternity.
Maternity is such an important part of local healthcare - how can you separate it from children or pre-conception care?
The government announced in July it would hand the vast majority of NHS commissioning to groups of GPs but said maternity was an exception and would be planned by a new national commissioning board, which is likely to have regional offices.
The consultation on the white paper proposals said it would “be less appropriate for [GP] consortia to commission” maternity.
But senior Department of Health sources confirmed to Nursing Times the government, which is refining plans before bringing legislation to Parliament next month, has changed its mind and now intends maternity to be part of local GP commissioning.
The change represents a second significant U-turn from the government affecting NHS care. The first was abolishing primary care trusts and strategic health authorities, after promising to “stop the top-down reorganisations” in the coalition agreement between the Conservatives and Liberal Democrats published in May.
The fresh U-turn follows pressure from GP leaders who have described the decision to keep maternity out of their hands as “outrageous” and “stupid”.
A senior DH source said its view was now that maternity commissioning “has to be done locally”. Another said the DH consultation was “doing what it says on the tin” by allowing plans to change.
Royal College of Midwives general secretary Cathy Warwick told Nursing Times the college would be reiterating to the health secretary its opposition to GPs taking on commissioning. She said: “If this happens it would make us fundamentally very concerned about other commitments the government has made about maternity services, like the commitment to choice and to equality of standards.”
Professor Warwick said GPs were not usually experts in maternity care and in the past had wrongly advised women against choosing home births, which are often a better option.
She said: “Commissioning on that basis would be very bad. GPs absolutely need to be involved in maternity care but that doesn’t mean they need to be commissioning, and they are not the people with the greatest knowledge.
“They don’t all maintain competence and knowledge [about maternity] and they won’t all have experts coming in to advise them.” Professor Warwick said offering greater choice to mothers to improve care and their experience required plans being made for a larger population than consortia are likely to cover, ideally at regional level.
She said: “If the government is serious about ensuring women have a full choice of service and really ensuring standards we believe you would have to be commissioning over a much larger area.” She added it was unclear how the proposals would tally with “maternity networks”, which the government has previously proposed would link groups of maternity providers.
National Childbirth Trust chief executive Belinda Phipps said: “Our very strong view is GPs are not the right people to commission maternity services. It would be extremely dangerous. There is good evidence women prefer to deal with midwives.”
A spokeswoman for neonatal charity Bliss said it was very concerned about the U-turn because it was likely to fragment specialist neonatal services, which will be commissioned by the national board, from standard neonatal care which would be likely to now come under
GPs. She said: “We want to see them all commissioned together. The pathway for babies needs to be paramount. This is one of the worst things that could happen.”
The government has previously said maternity should not come under GP commissioning because it does not fit with services for illness and GPs are often not involved.
However, Royal College of GPs chair Steve Field, one of the leading advocates of GP commissioning, said: “Maternity is such an important part of local healthcare - how can you separate it from care of young children or pre-conception care? Maternity commissioning should be based with GP consortia but we should only really be commissioning with strong patient input and input from specialists.”
The DH said in a statement: “We are still in the process of considering the responses to the white paper consultation. We had a number of varied responses and there were clearly a range of views about commissioning maternity services. We will announce the outcome of the consultation in due course.”
Responding to news of the U-turn, the RCM, the Royal College of Obstetricians and Gynaecologists and Royal College of Paediatrics and Child Health issued a joint statement opposing the move.
RCOG president Anthony Falconer said, “local commissioning by GP consortia seriously risks creating a poorer quality service and a postcode lottery with the more efficiently-run consortia providing a range of services while others in less affluent areas or those with other pressing medical needs struggle”.
RCPCH president Terence Stephenson said: “The white paper indicated that government was aware of the need for a joined-up approach to maternity and newborn services, requiring providers to ‘work together as networks to improve quality of services’ and ‘ensure every woman and her baby has access to the right level of care, with the right resources and staff with the right skills’.
“The RCPCH cannot understand why the coalition government would now wish to place these aims in grave jeopardy by fragmenting commissioning for mothers and babies.”
White paper plans for maternity
- Services commissioned by the national commissioning board, accountable to the health secretary.
- Providers “will work together as networks to improve quality of services while extending the range of choices available to women and their families”.
- Providers “will ensure every woman and her baby has access to the right level of care, with the right resources and staff with the right skills”.
- “Extend maternity choice and help make safe, informed choices throughout pregnancy and in childbirth a reality - recognising that not all choices will be appropriate or safe for all women.”
- Greater choice and information in pre-conception care, antenatal care, in labour and birth, and postnatal care.