October 09

Doncaster

NHS Doncaster

Local Enhanced Service for Pre- conceptual care

All practices are expected to provide essential and those additional services they are contracted to provide to all their patients. This enhanced service specification for pre conceptual care sets outa more specialised service to be provided which is beyond the scope of essential services. No part of the specification by commission, omission or implication defines or redefines essential or additional services.

Background

This service has been identified to respond to the Healthy Ambitions Maternity and newborn pathway, the strategic plan World Class Commissioning spotlight imitative 1, Maternity Matters agenda, Infant Mortality Strategy.

This service will be to address the health inequalities and support women and couples who are more vulnerable, with complex needs to attend and engage with services early, prior to pregnancy.

In general, healthy women have healthier babies who grow into healthy children. Improving the general health of the whole population through increasing knowledge and understanding of healthy lifestyles should be an underlying philosophy of all health, education and social services.

Early access to pre conceptual care is an important initial step.

This service model meets the following standards and recommendations cited within the Healthcare Commission review:

ROCG Standards of Maternity Care June 2008

  • Standard 1 Looking forward to pregnancy
  • Standard 2 Pre – pregnancy care for women with existing medical conditions or significant or medical history

Recommendation of the HCC towards Better Births: A review of maternity services in EnglandJuly 2008: section 2 preparing for pregnancy.

Aims

  • To increase access to pre pregnancy information and advice including nutrition and exercise, benefits of breastfeeding, sexual health and avoidance of substance misuse, alcohol and smoking.
  • To contribute to the reduction of mothers known to be smoking at the time of delivery
  • Increase in promotion of and communication for pre conceptual services
  • Fast access to antenatal services before 10 completed weeks of pregnancy
  • Reduction of infant and child mortality
  • Support a culture of positive parenting, through early support and signposting
  • To ensure contact details for midwives are available and accessible for all women in Doncaster. The option for all women to access a midwife as the first point of contact, as an additional choice to their GP will be publicised.
  • To ensure consistent care between professionals through the appropriate care pathways.
  • To provide services that comply with best practice, relevant guidelines in clinical practice and robust governance arrangements.

Service Outline

1.To offer face to face confidential counselling and support opportunistically for women of child bearing age (minimum age 16)with existing serious medical conditions or mental health conditions for example:

  • Epilepsy,
  • Diabetes(NICE Guidance suggest diabetic women considering planning for pregnancy need to be referred for pre-conceptual advice)
  • BMI 30 and above
  • Auto immune disorders
  • Cardiac disease
  • Hypertension
  • Cancer
  • Poor Obstetric History
  • Mental Health Illness (which may be aggravated by pregnancy)

The above list is not designed to be exhaustive.

Offering this service will require a diplomatic approach; clinicians should ask if the patient would like to receive pre conceptual advice:

  • if patient accepts then practitioner should give full advice in line with specification
  • if patients declines the service should not be provided but ensure that the patient is aware of who to approach should the service be needed in future.

2.To offer face to face pre pregnancy counselling and support to women of child bearing age (minimum age 16)with no existing disease who actively seekpre pregnancy advice.

Pre conceptual care advice must cover as a minimum:

Women

  • Offer relevant up to date advice on the avoidance of substance misuse, alcohol and smoking. Making onward referral if appropriate.
  • Provide patients with information on positive sexual health messages and provide opportunistic screening.
  • Offer advice and information in developing a healthy lifestyle including nutrition and exercise, healthy weight and weight management advice, calculating BMI and referral as appropriate.
  • Ensure availability of healthy lifestyle and pre-pregnancy literature
  • Advice on folic acid supplements
  • Screening for immunisation status e.g. rubella
  • Advice and screening for haemoglobinopathies should be discussed/undertaken if appropriate
  • Discussion around any pre existing medical conditions, family history and requirements for genetic counselling
  • Explore the benefits of breastfeeding and positive promotion of breastfeeding.
  • Fast access to ante natal clinics accessing maternity care as soon as pregnancy is confirmed.
  • To ensure contact details for midwives are readily available and accessible to all women
  • To offer Chlamydia screening for patients under the age of 25

For couples attending additional advice should be given to men that must include:

  • Offer relevant substance misuse, alcohol and smoking advice
  • Offer advice and information in developing a healthy lifestyle including nutrition and exercise, healthy weight and weight management advice
  • Offer advice on comfortable underwear (loose)
  • Discussion around pre existing medical conditions, family history and requirements for genetic counselling

Clinicians should ensure that appropriate written information is given which may include one or more of the following leaflets:

  • Thinking of having a baby: Folic acid – an essential ingredient in making healthy babies
  • Just found out your that you are pregnant? Advice and information on what to do next
  • Eating while you are pregnant
  • Pregnancy and alcohol
  • Smoking during pregnancy

Standards/Accreditation

Patients with existing medical conditions or mental health problems

GPs and Practice Nurses delivering disease management clinics are able to provide this service to registered patients.

Patients with no existing medical conditions

GPs, Practice Nurses and Health Care Assistants are able to provide this service to registered patients. Health Care Assistants providing the service to confirm they have received appropriate in house training from GP/Practice Nurse

Performance management

1/4ly computer search of patients offered pre conceptual care to be submitted to NHS Doncaster as at 10th January, April, July, October. Search is to include numbers of patients who have received pre conceptual advice

This LES will be subject to annual review and can be cancelled with three months notice by the PCT or the contractor.

Read Codes

Pre-conception advice (CTV 3) Xalwm

Pre-conception advice (5 Byte) 671J

Suggested code for patients who decline advice (practices may use different code if more appropriate)

Healthy Life style programme declined XaPpd (CVT3)

Healthy Life style programme declined 8IA8 (5 Byte)

Costing and Payment mechanism

A fee of £10.50 will be made for each consultation detailed on the quarterly return. No additional fee will be given for advice given to couples.

With affect from 1stSeptember 2009 all claims for this service must be submitted within three months following the month in which the service has been provided.

Equality and Diversity

The Commissioner is committed to the expectations with regard to Equality, Diversity and Inclusiveness and expects that the Provider will hold equality clear and complementary views and will communicate this to all their employees whilst ensuring that there is an explicit commitment to this in all that it does. This should include thinking, working and behaving to ensure that it recognises and takes account of the health needs and rights of all sections of the community including ethnicity, disability, gender, age, sexual orientation, religion/belief or any other non- medical characteristics.

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