Quality standard
Quality statement 6: GP postnatal check for women
Quality statement 6: GP postnatal check for women
Rationale
Carrying out an assessment of women's physical and psychological health and wellbeing 6 to 8 weeks after giving birth will prevent delays in diagnosing and treating any problems and improve health outcomes. There should be enough time allowed to focus on the woman's mental and physical health needs and respond to any concerns she may have. GPs will be able to refer women to other healthcare services including specialist services for ongoing investigation, management and support if needed.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Process
Proportion of women who had a GP assessment 6 to 8 weeks after giving birth.
Numerator – the number in the denominator who had a GP assessment 6 to 8 weeks after giving birth.
Denominator – the number of women who gave birth.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from electronic health records for postnatal check. This could be collected in a way that disaggregates the data for vulnerable groups to observe and react to potential inequalities.
Outcome
a) Proportion of women who had a GP assessment 6 to 8 weeks after giving birth who are satisfied that the GP spent enough time talking to them about their physical and mental health.
Numerator – the number in the denominator who are satisfied that the GP spent enough time talking to them about their physical and mental health.
Denominator – the number of women who had a GP assessment 6 to 8 weeks after giving birth.
Data source: Data could be collected from a local survey of women who gave birth. The Care Quality Commission maternity survey includes data on the proportion of women who had a postnatal check and said their GP 'definitely' spent enough time talking to them about their own physical and mental health.
b) Rates of unplanned hospital attendance for women within 3 months of giving birth.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records or from NHS Digital's Hospital Episode Statistics.
What the quality statement means for different audiences
Service providers (primary care) ensure that all women are offered an appointment for a GP assessment to take place 6 to 8 weeks after giving birth. Service providers ensure appointment times are long enough for a full assessment.
Healthcare professionals (GPs) ensure that they are aware of the requirements for, and carry out, assessments for women 6 to 8 weeks after giving birth.
Commissioners (NHS England) commission services that offer a GP assessment to all women 6 to 8 weeks after giving birth with appointment times that are long enough for a full assessment. Commissioners monitor GP postnatal assessments and work with providers to identify and address any inequalities in take up.
Women who have given birth are invited to have a postnatal check with a GP 6 to 8 weeks after giving birth. This will cover their physical and mental health. The GP will refer them for any help they may need.
Source guidance
Postnatal care. NICE guideline NG194 (2021), recommendation 1.2.7
Definitions of terms used in this quality statement
GP assessment
NHS England's update to the GP contract agreement 2020/21 to 2023/24 states that, in line with NICE guidance, the maternal check should focus on:
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a review of the mother's mental health and general wellbeing, using open questioning
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the return to physical health following childbirth, and early identification of pelvic health issues
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family planning and contraception issues
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any conditions that existed before or arise during pregnancy that require ongoing management, such as gestational diabetes.
NICE's guideline on postnatal care states that the assessment carried out by a GP should include the following areas, taking into account the time since the birth. The GP should respond to any concerns, which may include further investigation and referral to specialist services in either secondary care or other healthcare services such as physiotherapy:
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asking about their general health and whether there are any concerns and assessing their general wellbeing, which may include:
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symptoms and signs of potential postnatal mental health problems and how to seek help
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symptoms and signs of potential postnatal physical problems and how to seek help
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the importance of pelvic floor exercises, how to do them and when to seek help
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fatigue
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factors such as nutrition and diet, physical activity, smoking, alcohol consumption and recreational drug use
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contraception
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sexual intercourse
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safeguarding concerns, including domestic abuse
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assessing psychological and emotional wellbeing
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assessing physical health, including:
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for all women:
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symptoms and signs of infection
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pain
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vaginal discharge and bleeding
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bladder function
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bowel function
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nipple and breast discomfort and symptoms of inflammation
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symptoms and signs of thromboembolism
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symptoms and signs of anaemia
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symptoms and signs of pre-eclampsia
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for women who have had a vaginal birth:
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perineal healing
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for women who have had a caesarean section:
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wound healing
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symptoms of wound infection
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giving the woman the opportunity to talk about her birth experience, and providing information about relevant support and birth reflection services, if needed.
[NICE's guideline on postnatal care, recommendations 1.2.1 to 1.2.3 and 1.2.5]
Equality and diversity considerations
Healthcare professionals should be aware that the 2020 MBRRACE-UK reports on maternal and perinatal mortality showed that women and babies from some minority ethnic backgrounds and those who live in deprived areas have an increased risk of death and may need closer monitoring. GP practices should consider the best way to engage with women in these groups to encourage them to attend for a postnatal check. This could include joint working with health visitors or local groups.
Healthcare professionals should consider the best methods to invite women from vulnerable groups, including women known to social services, women in contact with the criminal justice system and women separated from their baby shortly after birth, to attend a GP assessment 6 to 8 weeks after they have given birth. It will be important to tailor the invitation to individual needs and preferences. In some cases, a phone call may be preferable to a letter or text message, and it may be necessary to arrange the appointment rather than expecting the woman to arrange it for themselves. The invitation should be accessible to people who do not speak or read English. Women who do not attend should receive a follow-up invitation.
Women should have access to an interpreter or advocate if needed. The interpreter or advocate should not be a member of the woman's family, her legal guardian or her partner, and they should communicate with the woman in her preferred language. For women with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.