Improving maternal postnatal check uptake in general practice using an opt-out equitable model of access: results of a 12-month quality improvement project

BACKGROUNDIt is assumed that there is universal provision of the maternal postnatal 6-8 week check (6WC) in primary care following the introduction of additional funding provided through the General Medical Services contract in 2020/21. Prior to the pandemic, it is estimated that 20-40% of women in England did not have a postpartum maternal check recorded in primary care. Concerned that changes in local appointment access were contributing to an inequitable provision of postnatal care, we explored a model of access that improved the delivery of maternal postnatal care in general practice AIMTo design a primary care model of access to improve the uptake of the maternal postnatal check that prioritised equitable access to care. DESIGN AND SETTINGCohort study and quality improvement project; women who had delivered a baby or stillborn delivery over 24 weeks gestation METHODA retrospective pre-intervention clinical audit between April 2022 and March 2023 evaluated the service delivery performance of maternal postnatal 6WC. Implementation of a model of access with protected postnatal appointments and proactive invitation via SMS was introduced in April 2024. Post-intervention audit evaluated the interventions performance after 12 months. RESULTSPre-intervention audit showed 58% (70/121) of eligible women had a maternal 6WC and 60% (42/70) were performed within 6-8 weeks after delivery. Following the introduction of the intervention, 98% (112/114) of eligible women were offered a postnatal check appointment. After 12 months, the uptake of maternal postnatal checks improved from 58% to 89% (101/114) and appointments performed within 6-8 weeks improving from 60% to 76% (77/101). The uptake of newborn checks improving from 86% to 91% (106/116) and appointments performed within 6-8 weeks improving from 46% to 75% (80/106). CONCLUSIONWe implemented protected postnatal appointments with proactive invitation via SMS and demonstrated a sustainable improvement in practice service delivery over 12 months of implementation. The protocol required no additional workforce resources, had a low administrative burden and used digital communication tools easily available to general practices nationwide. Our intervention provides a model of access for the provision of postnatal care in general practice to reduce inequality and inequity in healthcare.