23 Using a new model of access to improve provision and uptake of postnatal and newborn 6-week checks (6WC) in general practice (2024)

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.

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.