Saving Mothers' Lives: - Public Health Agency for Northern Ireland

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17 Issues for General Practitioners
A young pregnant woman who could not speak English was seen just before a Bank Holiday with
bronchopneumonia and treated with antibiotics. Her GP thought he had “safety netted” by telling
her husband to take her to the ED over the weekend if her condition worsened. The husband
did not contact the OOH service and she was not seen again until four days later when she was
seriously ill and admitted to hospital. She died shortly afterwards of fulminating pulmonary TB.
In this case the GP care was substandard; her usual GP, who saw her before a Bank Holiday failed to
recognise how ill she was. He should have admitted her to hospital directly if early reassessment was
impossible or communicated his worries about the patient directly to the OOH services. It is inappropriate
to expect sick patients or their relatives to do this.
Box 17.11
GP learning points: out of hours (OOH) care
OOH services and usual GPs need to be able to communicate with each other rapidly and effectively,
preferably electronically or by fax.
OOH services and usual GPs need to maintain records of all contacts with patients both within and
between each service.
Conclusions
It is ironic that this Chapter, the fi rst to be written specifi cally for GPs, comes at a time when GPs are
no longer the main providers of antenatal care for women with low risk pregnancies. Nevertheless the
contributions that they can make are still very signifi cant: GPs are “experts” in managing uncertainty, the
early presentation of illness and in managing and minimising risk. There is a risk that changes in midwifery
care will lead to GPs becoming de-skilled, although they will still be the fi rst to be involved if the family or
midwife suspect something may be wrong. This role needs to be recognised and encouraged. They need
to maintain their skills and professional development to be able to provide excellent care for all pregnant or
recently delivered women, including those at higher risk or in emergency situations.
Even if they are no longer the lead carer, GPs still have a duty of care for pregnant women and should be
interested in their health and well-being as they will be caring for these women, and their families, for many
years to come. GPs should therefore not only make sure that the midwives or specialists caring for their
pregnant women are as fully informed as possible of any past or current medical, psychological or social
problems, but should also give them access to her complete case notes on request.
It is hoped that the learning points and recommendations in this Chapter will help to maintain and improve
the care that GPs can provide.