Quality standard

Quality statement 1: Services – access to antenatal care

Quality statement

Pregnant women are supported to access antenatal care, ideally by 10 weeks 0 days.

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.

Structure

a) Evidence of local services that ensure antenatal care is readily and easily accessible.

Data source: Local data collection. The baseline assessment tool for NICE's guideline on pregnancy and complex social factors can be used to assess current activity related to recording information for women presenting to antenatal care with complex social needs to inform mapping of the local population and to guide service provision.

b) Evidence of local arrangements to encourage pregnant women to access and maintain contact with antenatal care services.

Data source: Local data collection. The baseline assessment tool for NICE's guideline on pregnancy and complex social factors can be used to assess current activity related to recording information for women presenting to antenatal care with complex social needs to inform mapping of the local population and to guide service provision.

Process

Proportion of pregnant women missing a scheduled antenatal appointment who are followed up within locally defined timescales.

Numerator – the number in the denominator followed up within locally defined timescales.

Denominator – the number of pregnant women missing a scheduled antenatal appointment.

Data source: Local data collection.

Outcome

a) Pregnant women accessing antenatal care who are seen for booking by 10 weeks 0 days.

Data source: The NHS Digital Maternity Services Data Set collects data on booking appointment dates and estimated dates of delivery. The Care Quality Commission Maternity Services Survey asks the question 'Roughly how many weeks pregnant were you when you had your 'booking' appointment (the appointment where you were given access to your pregnancy notes)?'.

b) Pregnant women accessing antenatal care who are seen for booking by 12 weeks 6 days.

Data source: The NHS Digital Maternity Services Data Set collects data on booking appointment dates and estimated dates of delivery. The Care Quality Commission Maternity Services Survey asks the question 'Roughly how many weeks pregnant were you when you had your 'booking' appointment (the appointment where you were given access to your pregnancy notes)?'.

c) Pregnant women accessing antenatal care who are seen for booking by 20 weeks 0 days.

Data source: The NHS Digital Maternity Services Data Set collects data on booking appointment dates and estimated dates of delivery. The Care Quality Commission Maternity Services Survey asks the question 'Roughly how many weeks pregnant were you when you had your 'booking' appointment (the appointment where you were given access to your pregnancy notes)?'.

d) Median gestation at booking.

Data source: The NHS Digital Maternity Services Data Set collects data on booking appointment dates and estimated dates of delivery. The Care Quality Commission Maternity Services Survey asks the question 'Roughly how many weeks pregnant were you when you had your 'booking' appointment (the appointment where you were given access to your pregnancy notes)?'.

e) Pregnant women accessing antenatal care attend at least the recommended number of antenatal appointments.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that systems are in place to support pregnant women to access antenatal care, ideally by 10 weeks 0 days.

Health and social care professionals support pregnant women to access antenatal care, ideally by 10 weeks 0 days. This includes following up women who have missed a scheduled antenatal appointment.

Commissioners ensure that they commission services that are readily and easily accessible and that support pregnant women to access antenatal care, ideally by 10 weeks 0 days.

Pregnant women are encouraged to see a healthcare professional about their pregnancy as early as possible and have regular check-ups from their midwife or doctor throughout their pregnancy (antenatal care). This may include being contacted by their midwife or doctor if they miss a check-up.

Source guidance

Definitions of terms used in this quality statement

Support to access antenatal care

Commissioners and providers should ensure that antenatal care can be started in a variety of straightforward ways, depending on women's needs and circumstances, for example, by self-referral, referral by a GP, midwife or another healthcare professional or through a school nurse, community centre or refugee hostel.

At the first antenatal (booking) appointment, discuss antenatal care with the woman (and her partner) and provide her schedule of antenatal appointments (plan 10 routine antenatal appointments with a midwife or doctor for nulliparous women and 7 for parous women).

At the first antenatal (booking) appointment (and later if appropriate), discuss and give information on:

  • what antenatal care involves and why it is important

  • the planned number of antenatal appointments

  • where antenatal appointments will take place

  • which healthcare professionals will be involved in antenatal appointments

  • how to contact the midwifery team for non-urgent advice

  • how to contact the maternity service about urgent concerns, such as pain and bleeding.

[NICE's guideline on antenatal care, recommendations 1.1.1, 1.1.7, 1.1.8, 1.3.7 and 1.3.8]

Follow-up after a missed appointment may be undertaken by the maternity service or other community-based service the woman is in contact with, such as a children's centre, addiction service or GP. Follow-up should be via a method of contact that is appropriate to the woman, which may include:

  • text message

  • letter

  • telephone

  • community or home visit.

[NICE's guideline on pregnancy and complex social factors, recommendation 1.2.8 and expert opinion]

Equality and diversity considerations

Pregnant women include women with complex social needs who may be less likely to access or maintain contact with antenatal care services. Examples of women with complex social needs include, but are not limited to, women who:

  • have a history of substance misuse (alcohol and/or drugs)

  • have recently arrived as a migrant, asylum seeker or refugee

  • have difficulty speaking or understanding English

  • are aged under 20

  • have experienced domestic abuse

  • are living in poverty

  • are homeless.

It is therefore appropriate that localities give special consideration to these groups of women within the measures. NICE's guideline on pregnancy and complex social factors has recommendations about how to make antenatal care accessible to pregnant women with complex social needs and how to encourage women to maintain ongoing contact with maternity services.