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GP Guidelines for materity referrals

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					                 REFERRING YOUR PATIENT
                  FOR ANTENATAL CARE
                          AT A
                     MATERNITY UNIT




                 A Guide for General Practice




                          Issued: July 2010

Author:   Sarah Oldfield Clinical Information & Referrals Manager Ealing PCT.
           020 3313 9332  sarah.oldfield@nhs.net




                                       1
CONTENTS                                                           PAGE



Introduction                                                       3

2010 Referral Guidelines                                           3

How should practices refer?                                        3


Maternity Matrix for booking process                               4


What information is available for women?                           5


What happens if practices refer women to the PCT?                  5


What happens if a woman’s referral is sent to more than one unit
at once?                                                           5


What happens if a woman’s referral is rejected from a unit?        5


Where can practices go for further information?                    5


Additional Information                                             6


MATERNITY OPTIONS                                                  7


Maternity Poster                                                   8




Updated: July 2010


                                           2
INTRODUCTION

2010 Update to the guidelines

Following a period of increased availability at local maternity units practices will now be
responsible for sending all antenatal referrals to an available unit.

These guidelines are to help practices send referrals to the most appropriate maternity
unit available for your patient


HOW TO REFER PREGNANT WOMEN?

All referrals should be sent using the North West London antenatal referral form.
Information should be typed not handwritten. EMIS and Vision compatible forms are
available from the Ealing PCT website
www.ealingpct.nhs.uk/LocalServices/CommunityServices/Maternity_Updates.asp

ALL sections of the referral form must be competed, including patient details and
contact telephone numbers. It is essential to include an Estimated Date of Delivery
(EDD) and Last Menstrual Period (LMP). Without these, maternity units can not ensure
women are given the appropriate antenatal appointment.

1.     CHOICE: Refer to the Updated Maternity Matrix (page 4) to see which units are
       available. Discuss with the woman which available unit they would like to be
       referred to and check if they meet that unit’s referral criteria. Current
       availability of maternity units is also updated monthly on PCT’s website:
       www.ealingpct.nhs.uk


2.     GESTATION: EDD is essential and if not known an accurate estimate must be
       given so that maternity units can offer appointments within 12 weeks and 6
       days. Type all details onto the maternity form, including EDD and LMP.

3.     FAX the referral form to the available maternity unit. DO NOT send a
       referral to more than one unit. This risks women being unable to get
       appropriate care and duplicate referrals being made.

      Some units may not accept women if they do not meet their criteria. Please tell
       women that the practice needs know if they have been rejected by a unit so you
       can find them another unit.

      Practices must process referrals for all women. Referrals should NOT be faxed to
       PCT’s Maternity Bookings or Clinical Assessment Service.



THE MATERNITY MATRIX GIVES FULL DETAILS OF THE BOOKING PROCESS.




                                             3
                                                                                                                             UPDATED: JUNE 2010

MATERNITY MATRIX FOR BOOKING MATERNITY
REFERRALS



                                                                    Client seen at surgery and EDD
                                                                               calculated



                           Discuss these local maternity units with the client. Further details of additional services offered at these
                           units are in Maternity Options on page 8 and the PCT’s website: www.ealingpct.nhs.uk

                           Details of other maternity units can be found on: www.drfosterintelligence.co.uk




 Ealing        Queen              North West               Hillingdon      West               Chelsea &       UCLH             St Mary’s
 Hospital      Charlottes’        London                   Hospital        Middlesex          Westminster
                                  FAX: 020                                 University
               FAX: 020           8869 2880                                                                                    FAX: 020
 FAX: 020                                                  FAX: 01895                                         FAX: 020
               3313 8518                                                                                                       3312 1831
 8967 5633                                                 279613                             Fax: 020        7380 9754
                                  Accepts all women.                       FAX: 020
                                                                                              8846 7910
               Always accepts                                              8321 5040                                           Accepts all
 Accepts all                                                                                                  Accepts all
               W3 & W4            All deliveries only at             FAX referral to ONE unit only. all                        women.
 women.                                                    Now open for                       Accepts         women.
               postcodes.         Northwick Park.                          Only accepts
                                                           all women.      mothers with       women
               A very popular
               unit - usually     Midwife led birthing                     Hounslow
                                                                           postcode,                          Unable to
               full by 8 weeks    unit moved to                                                               accept
               gestation for      Northwick Park.                          registered with
                                                                           Ealing GP.                         mothers with
               other                                                                                          social
               postcodes.         No maternity at                                                             problems or
                                  Central Middlesex                                                           mothers
               Women should       Hospital                                 Teenage
                                                                           Pregnancy                          needing
               tell surgery                                                                                   interpreting
               immediately if                                              Group
                                                                                                              services.
               they are not
               accepted.



                                                                           4
What information is available for women?
Page 7 of this guide and Ealing PCT’s website:
www.ealingpct.nhs.uk/LocalServices/CommunityServices/Maternity_Updates.asp
contain latest information for both women and GPs. The maternity webpage will continue to
be updated with details of admission criteria and catchment areas for all local units, together
with links to websites of local maternity units.

We also enclose a poster to display in your surgeries, encouraging women to book as soon
as they know they are pregnant.

What happens if a woman’s referral is rejected?
Of local maternity units, only Queen Charlotte’s and West Middlesex University Hospital have
strict catchment areas. All other units are open for all women. It is important that practices
stress to women that if they are rejected from any unit, they must let the practice know so you
can arrange a further referral to another unit.

Queen Charlottes: All women living in W3 or W3 postcodes will be accepted, however for
other postcodes, only women at or before 8 weeks gestation are likely to be accepted by
Queen Charlottes. If your patient is over 8 weeks pregnant, please discuss alternatives to
Queen Charlottes and refer to another unit.

West Middlesex University Hospital: For clinical safety reasons a cap on maternity
bookings is in place. They only accept mothers living in a Hounslow postcode area. This
also affects patients registered with Hounslow GPs. If your patient does not live within a
Hounslow postcode, please discuss alternatives to WMUH and refer to another unit.


What if a woman wants a maternity unit not in this guide?
The details in these guidelines focus on the maternity care provided by our nearest local
units. In some circumstances a woman may wish to deliver at another unit outside the local
area. Please contact that unit and if they are willing to take the woman, refer her directly to
them.


What happens if a woman’s referral is sent to more than one unit at once?
If a women’s referral is sent to more than one unit, this greatly reduces the existing capacity
at all maternity units and means some women are unable to access care, whilst others
receive multiple booking appointments. This has the potential to destabilise all maternity
units locally and we stress that WOMEN’S REFERRALS MUST NOT BE SENT TO MORE
THAN ONE UNIT AT A TIME.

We are working with local units to identify areas where duplication appears to be happening.
Where specific practices are identified as sending multiple referrals, these will be contacted
by the PCT and asked to stop.


Where can we go for further information?
If you have any queries please ring Sarah Oldfield on 020 3313 9332 or email
sarah.oldfield@nhs.net




                                                5
                                 ADDITIONAL INFORMATION

North West London Standardised Maternity Referral Form
A standardised referral form is used by all GPs and maternity units across North West
London to ensure a more effective antenatal booking system. This referral form collects key
information to help maternity units filter cases according to potential risks and help prioritise
the allocation of antenatal appointments. Copies of the forms are available from NHS
Ealing’s maternity webpages. Any queries please contact your IMT Trainer or
Heather Joseph, Heather.Joseph@nhs.net

12 week Medical and Social Risk Assessment
It is recommended that all women have a comprehensive medical and social risk assessment
by 12 weeks of pregnancy. This assessment has become a national standard which PCTs
are monitored against in 2010/11.
Approximately two-thirds of maternity referrals are made at around 10 weeks of pregnancy.
While this is encouraging, a significant number of women continue to book after 12 weeks.
The PCT is exploring various initiatives to help raise awareness of the benefits of accessing
maternity services early in pregnancy (i.e. from 8 weeks gestation).

Investment in Community Midwifery services
NHS Ealing has invested money to increase the number of midwives and midwifery support
workers at Ealing Hospital. We have established midwifery teams based mainly in the
community and accessible from a variety of venues across the borough. The teams will have
a specific caseload of women and will be able to provide individualised and more
personalised care to women during their pregnancy. Further details are available from:
www.ealingpct.nhs.uk/LocalServices/CommunityServices/Maternity_Updates.asp

Home Births
In addition to providing women with greater choice about where they access antenatal and
postnatal care, we are aiming to increase the provision of home births as an option for low
risk pregnancies. It is anticipated that the home birth service will be provided by the
community midwifery teams.

REFERENCE DOCUMENTS:
NICE guidelines on antenatal care: http://www.nice.org.uk/guidance/CG62

Department of Health National Services Framework for Children, Young People and
Maternity Services (2004) Standard 11: Maternity Services
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc
e/Browsable/DH_4094336

Maternity Matters: Choice, access and continuity of care in a safe service (DH 2007)
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc
e/DH_073312

Review of Maternity Services 2007 - Scored assessment EHT (Healthcare Commission
2007)
http://2008ratings.cqc.org.uk/findcareservices/informationabouthealthcareservices/overallperf
ormance/searchfororganisation.cfm?widCall1=customWidgets.content_view_1&cit_id=RC3&
element=SR_MATERNITY

Healthcare for London, A Framework for Action (July 2007)
http://www.healthcareforlondon.nhs.uk/a-framework-for-action-2/

Standards for Maternity Care, Report of a working party (Royal College of Obstetricians and
Gynaecologists 2008)
http://www.rcog.org.uk/womens-health/clinical-guidance/standards-maternity-care
                                                 6
MATERNITY OPTIONS FOR WOMEN
Options for women wishing to book maternity services within North West London sector                                                         Updated: July 2010
     Hospital               Telephone/                Website                 Catchment Criteria                  Nuchal Scan                 Home Birth          Midwife    Birth
     Address                 FAX                                                                        (only carried out between                              Birthing   Pool
                                                                                                            10-13 weeks gestation)                                  Unit
Chelsea and            Tel: 020 8746 8000    www.chelwest.nhs.uk         Accepts all mothers.                All women                   Not for women                     
Westminster             020 8846 7915/7916                                                                                                living in Ealing
Hospital                                                                                                                                  PCT area
369 Fulham Road,       Fax: 020 8846 7910
London, SW10 9NH
Ealing Hospital        Tel: 020 8967 5000    www.ealinghospital.org.uk   Accepts all mothers.               Now available for all         Subject to risk                  
Uxbridge Road,              020 8967 5578                                                                 women                           assessment      and
Southall,                                                                                                                                 staffing     levels.
UB1 3HW                FAX: 020 8967 5633                                                                                                 Ealing     Borough
                                                                                                                                          only. Not W3.
Hillingdon Hospital    Tel: 01895 238282     www.thh.nhs.uk              Accepts all mothers.              All women                     Not for women                      
Pield Heath Road,           01895 279300                                                                                                  living in Ealing
Uxbridge, Middlesex,        01895 279042                                                                                                  PCT area
UB8 3NN
                       FAX: 01895 279613
North West London      Tel: 020 8864 3232    www.nwlh.nhs.uk             Accepting Ealing Women.           All women                     Not for women          Now at     
Hospitals –                 020 8864 5252                                                                                                 living in Ealing       Northwick
Northwick Park                                                           All deliveries, including                                        PCT area               Park
Hospital                                                                 midwifery led now at                                                                    Hospital
                                                                         Northwick Park Hospital only.                                                           only.
                       FAX: 020 8869 2880
                                                                         No maternity at Central
                                                                         Middlesex Hospital
Imperial - Queen       Tel: 020 3313 1111    www.imperial.nhs.uk         Always accepts W3 & W4            All women                     Subject to risk                  
Charlotte's and             020 3313 3926                                postcodes.                                                       assessment. Only
Chelsea Hospital            020 3313 3526                                Very popular unit for all                                        women living in
Du Cane Road,                                                            postcodes - usually full by 8                                    QCCH catchment
London                                                                   weeks gestation for other
W12 0HS
                       FAX: 020 3313 8518                                postcodes
Imperial - St Mary's   Tel: 020 3312 6666    www.imperial.nhs.uk         Accepts all women                X     Integrated      testing   Not for women                     
Hospital                    020 3312 1244                                                                 available as alternative.       living in Ealing
Praed Street,                                                                                                                             PCT area
Paddington             FAX: 020 3312 1831
W2 1NY
West Middlesex         Tel 020 8560 2121     www.west-middlesex-         Only accepts mothers with         All women                     Subject to risk                  
University Hospital    Tel: 020 8321 5007    hospital.nhs.uk             Hounslow postcode,                                               assessment. Only
Twickenham Road,                                                         registered with Ealing GP.                                       for women living in
Isleworth, Middlesex   FAX: 020 8321 5040                                                                                                 area of       West
TW7 6AF                                                                  Teenage Pregnancy Group                                          Middx


University College     Tel: 0845 155 5000    www.uclh.nhs.uk             Accepts all women.                  All women                   Not available for                 
London Hospital             020 7380 9400                                                                                                 women living in
(UCLH)                                                                   Unable to accept       mothers                                   Ealing PCT area
Elizabeth Garrett      FAX: 020 7380 9754                                with social problems or
Anderson Hospital,                                                       needing interpreting services.
Huntley Street                                                                 7
London
                                          Could you be pregnant?




If you think you may be pregnant, you need to see your GP as early as possible, so that maternity care can be
started and a booking for a scan at 12 weeks of pregnancy arranged to help you and your baby.

If you are planning to get pregnant or are in early pregnancy, you should take Folic Acid before you get
pregnant and for the first 12 weeks of your pregnancy to reduce the risk of infants being born with neural
tube defects such as Spina Bifida. Folic Acid is available from your local pharmacy or GP. The earlier you
see your GP the more likely you are to get the hospital of your choice.
For further information on maternity units available to you, contact
www.ealingpct.nhs.uk/LocalServices/CommunityServices/Maternity_Updates.asp




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