General Practitioner Involvement in Remote and Rural Maternity Care

Too Big a Challenge?

Jan Caldow, Vanora Hundley, Edwin van Teijlingen, John Reid, Alice Marian Kiger, Janet Tucker, Jillian Ireland, Fiona Harris, J Farmer, H. Bryers

Research output: Contribution to journalArticle

Abstract

BACKGROUND: In the United Kingdom, general practitioner (GP) involvement in maternity care has declined significantly over the past decade. This is particularly so in remote and rural areas where midwives have stepped up and taken over units to ensure that women in these areas continue to have a service.
A recent report by the King’s Fund argues for a greater role for the GP in maternity care provision; however, this raises questions about whether GPs have the skills and training to provide such care.
AIM: To explore the views of GPs on the skills and training required to deliver safe and appropriate local intrapartum services in remote and rural settings.
METHODS: Mixed-method study consisting of qualitative interviews with a purposive sample of GPs in six remote and rural sites. To triangulate the interview findings and identify features that might have been missed in the interviews, a questionnaire was developed using initial key themes identified.
FINDINGS: Maternity care accounted for less than 10% of most remote and rural GPs’ workload, yet interviewees reported that their role required them to be competent in a wide range of procedures. This was seen as a major barrier to recruitment and retention in rural areas. Although self-reported competence and confidence was high, several GPs felt de-skilled and felt that they were fighting a losing battle to maintain skills. GPs regarded isolation, need for comprehensive expertise, limited resources, and transportation difficulties as factors affecting the decline in their contribution to remote and rural maternity care.
CONCLUSION: Although rural GPs and midwives might traditionally have been in competition, providing a woman-centered service in remote areas may be easier to achieve through collaborative working. However, if GPs are to play a greater role, then they will need to be prepared to make a strategic commitment to the maintenance of remote and rural maternity care. This will require innovative methods of training, special consideration of educational needs, and incentives for practitioners to settle in rural areas, but it may already be too late for GPs to have a substantial input into maternity care.
Original languageEnglish
Pages (from-to)27-38
Number of pages12
JournalInternational Journal of Childbirth
Volume1
Issue number1
DOIs
Publication statusPublished - 2011

Fingerprint

General Practitioners
Midwifery
Interviews
Workload
Mental Competency
Motivation
Maintenance
United Kingdom
Surveys and Questionnaires

Keywords

  • general practitioners
  • multidisciplinary education
  • midwifery
  • maternity care
  • remote

Cite this

General Practitioner Involvement in Remote and Rural Maternity Care : Too Big a Challenge? / Caldow, Jan; Hundley, Vanora; van Teijlingen, Edwin; Reid, John; Kiger, Alice Marian; Tucker, Janet; Ireland, Jillian; Harris, Fiona ; Farmer, J; Bryers, H.

In: International Journal of Childbirth, Vol. 1, No. 1, 2011, p. 27-38.

Research output: Contribution to journalArticle

Caldow, J, Hundley, V, van Teijlingen, E, Reid, J, Kiger, AM, Tucker, J, Ireland, J, Harris, F, Farmer, J & Bryers, H 2011, 'General Practitioner Involvement in Remote and Rural Maternity Care: Too Big a Challenge?', International Journal of Childbirth, vol. 1, no. 1, pp. 27-38. https://doi.org/10.1891/215652811795481159
Caldow, Jan ; Hundley, Vanora ; van Teijlingen, Edwin ; Reid, John ; Kiger, Alice Marian ; Tucker, Janet ; Ireland, Jillian ; Harris, Fiona ; Farmer, J ; Bryers, H. / General Practitioner Involvement in Remote and Rural Maternity Care : Too Big a Challenge?. In: International Journal of Childbirth. 2011 ; Vol. 1, No. 1. pp. 27-38.
@article{19aea7677c6947cea6faf5a1536bb55e,
title = "General Practitioner Involvement in Remote and Rural Maternity Care: Too Big a Challenge?",
abstract = "BACKGROUND: In the United Kingdom, general practitioner (GP) involvement in maternity care has declined significantly over the past decade. This is particularly so in remote and rural areas where midwives have stepped up and taken over units to ensure that women in these areas continue to have a service. A recent report by the King’s Fund argues for a greater role for the GP in maternity care provision; however, this raises questions about whether GPs have the skills and training to provide such care. AIM: To explore the views of GPs on the skills and training required to deliver safe and appropriate local intrapartum services in remote and rural settings. METHODS: Mixed-method study consisting of qualitative interviews with a purposive sample of GPs in six remote and rural sites. To triangulate the interview findings and identify features that might have been missed in the interviews, a questionnaire was developed using initial key themes identified. FINDINGS: Maternity care accounted for less than 10{\%} of most remote and rural GPs’ workload, yet interviewees reported that their role required them to be competent in a wide range of procedures. This was seen as a major barrier to recruitment and retention in rural areas. Although self-reported competence and confidence was high, several GPs felt de-skilled and felt that they were fighting a losing battle to maintain skills. GPs regarded isolation, need for comprehensive expertise, limited resources, and transportation difficulties as factors affecting the decline in their contribution to remote and rural maternity care. CONCLUSION: Although rural GPs and midwives might traditionally have been in competition, providing a woman-centered service in remote areas may be easier to achieve through collaborative working. However, if GPs are to play a greater role, then they will need to be prepared to make a strategic commitment to the maintenance of remote and rural maternity care. This will require innovative methods of training, special consideration of educational needs, and incentives for practitioners to settle in rural areas, but it may already be too late for GPs to have a substantial input into maternity care.",
keywords = "general practitioners, multidisciplinary education, midwifery, maternity care, remote",
author = "Jan Caldow and Vanora Hundley and {van Teijlingen}, Edwin and John Reid and Kiger, {Alice Marian} and Janet Tucker and Jillian Ireland and Fiona Harris and J Farmer and H. Bryers",
year = "2011",
doi = "10.1891/215652811795481159",
language = "English",
volume = "1",
pages = "27--38",
journal = "International Journal of Childbirth",
issn = "2156-5287",
publisher = "Springer Publishing Company",
number = "1",

}

TY - JOUR

T1 - General Practitioner Involvement in Remote and Rural Maternity Care

T2 - Too Big a Challenge?

AU - Caldow, Jan

AU - Hundley, Vanora

AU - van Teijlingen, Edwin

AU - Reid, John

AU - Kiger, Alice Marian

AU - Tucker, Janet

AU - Ireland, Jillian

AU - Harris, Fiona

AU - Farmer, J

AU - Bryers, H.

PY - 2011

Y1 - 2011

N2 - BACKGROUND: In the United Kingdom, general practitioner (GP) involvement in maternity care has declined significantly over the past decade. This is particularly so in remote and rural areas where midwives have stepped up and taken over units to ensure that women in these areas continue to have a service. A recent report by the King’s Fund argues for a greater role for the GP in maternity care provision; however, this raises questions about whether GPs have the skills and training to provide such care. AIM: To explore the views of GPs on the skills and training required to deliver safe and appropriate local intrapartum services in remote and rural settings. METHODS: Mixed-method study consisting of qualitative interviews with a purposive sample of GPs in six remote and rural sites. To triangulate the interview findings and identify features that might have been missed in the interviews, a questionnaire was developed using initial key themes identified. FINDINGS: Maternity care accounted for less than 10% of most remote and rural GPs’ workload, yet interviewees reported that their role required them to be competent in a wide range of procedures. This was seen as a major barrier to recruitment and retention in rural areas. Although self-reported competence and confidence was high, several GPs felt de-skilled and felt that they were fighting a losing battle to maintain skills. GPs regarded isolation, need for comprehensive expertise, limited resources, and transportation difficulties as factors affecting the decline in their contribution to remote and rural maternity care. CONCLUSION: Although rural GPs and midwives might traditionally have been in competition, providing a woman-centered service in remote areas may be easier to achieve through collaborative working. However, if GPs are to play a greater role, then they will need to be prepared to make a strategic commitment to the maintenance of remote and rural maternity care. This will require innovative methods of training, special consideration of educational needs, and incentives for practitioners to settle in rural areas, but it may already be too late for GPs to have a substantial input into maternity care.

AB - BACKGROUND: In the United Kingdom, general practitioner (GP) involvement in maternity care has declined significantly over the past decade. This is particularly so in remote and rural areas where midwives have stepped up and taken over units to ensure that women in these areas continue to have a service. A recent report by the King’s Fund argues for a greater role for the GP in maternity care provision; however, this raises questions about whether GPs have the skills and training to provide such care. AIM: To explore the views of GPs on the skills and training required to deliver safe and appropriate local intrapartum services in remote and rural settings. METHODS: Mixed-method study consisting of qualitative interviews with a purposive sample of GPs in six remote and rural sites. To triangulate the interview findings and identify features that might have been missed in the interviews, a questionnaire was developed using initial key themes identified. FINDINGS: Maternity care accounted for less than 10% of most remote and rural GPs’ workload, yet interviewees reported that their role required them to be competent in a wide range of procedures. This was seen as a major barrier to recruitment and retention in rural areas. Although self-reported competence and confidence was high, several GPs felt de-skilled and felt that they were fighting a losing battle to maintain skills. GPs regarded isolation, need for comprehensive expertise, limited resources, and transportation difficulties as factors affecting the decline in their contribution to remote and rural maternity care. CONCLUSION: Although rural GPs and midwives might traditionally have been in competition, providing a woman-centered service in remote areas may be easier to achieve through collaborative working. However, if GPs are to play a greater role, then they will need to be prepared to make a strategic commitment to the maintenance of remote and rural maternity care. This will require innovative methods of training, special consideration of educational needs, and incentives for practitioners to settle in rural areas, but it may already be too late for GPs to have a substantial input into maternity care.

KW - general practitioners

KW - multidisciplinary education

KW - midwifery

KW - maternity care

KW - remote

U2 - 10.1891/215652811795481159

DO - 10.1891/215652811795481159

M3 - Article

VL - 1

SP - 27

EP - 38

JO - International Journal of Childbirth

JF - International Journal of Childbirth

SN - 2156-5287

IS - 1

ER -