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

BACKGROUND It is assumed that there is universal provision of the maternal postnatal 6 to 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 to 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 AIM To design a primary care model of access to improve the uptake of the maternal postnatal check that prioritised equitable access to care. DESIGN AND SETTING Cohort study and quality improvement project; women who had delivered a baby or stillborn delivery over 24 weeks gestation METHOD A 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 intervention performance after 12 months. RESULTS Pre-intervention audit showed 58% (70/121) of eligible women had a maternal 6WC and 60% (42/70) were performed within 6 to 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 to 8 weeks improving from 46% to 75% (80/106). CONCLUSION We 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. KEYWORDS General Practice, Maternal Health, Healthcare quality Improvement, Delivery of health care, Health Inequalities