My GP won’t provide antenatal care

[Fluffydino21]

Hi everyone,

Found out I’m pregnant at the weekend (4-5 weeks) and have already encountered a bit of a big bump in the road. It’s my first time being pregnant so I don’t know what to expect, have a lot of questions and could do with advice and reassurance. I’m vaguely aware that I’m supposed to have an appointment with a midwife at 8 weeks, and scans at 12 and 20 weeks. I’ve no doubt there’s other appointments and milestones too.

I called the GP straight away Monday morning and they said they would refer me to the midwife team. Great!

But then the midwife called and said although I’m in the catchment area for my GP practice I’m not in the catchment area for the midwife team. Essentially my GPs will only provide antenatal care for approx. 25% of the catchment area their patients fall in…

After I asked a lot of questions she gave me two options:

1. Move to a new GP immediately - she was strongly pushing this and originally stated it as the only option I had. However she also said it usually takes 4-6 weeks with their processes to sort everything out / transfer my records etc. so even if I find a new GP who’s taking on new patients tomorrow, all my appointments may have to be after my first trimester.
2. Drive to these midwives for every single appointment - she said she would strongly recommend I don’t do this as it wouldn’t be practical for the appointments a few days after birth with a 3 day old baby etc. especially if I’d had a caesarean / baby was unwell / sleep deprived. I’m not 100% sure where this would need to be. I think they’re probably about a 20 minute drive away. I thought part of the point of some of these appointments was for them to see you with your baby in your home though?

I asked about starting with these midwives (and driving to them) so I didn’t have to delay my appointments while I sort a new GP but she pushed against this. Apparently it’s vital it’s the same midwife throughout..

DP is pretty angry and wants to complain to the GP and insist they provide me with care. He doesn’t think panicking and going with any random GP that’s willing to sign me up at 24 hours notice and then having no care indefinitely until they transfer things between them is the answer.. maybe he’s right. He says he’ll make a commitment to drive me to every appointment with the baby if I needed him to. I don’t know how many appointments were talking about and how practical that is.

I feel like I’m just choosing between 3 shit options here tbh.

I would really appreciate hearing from some people who have been through all these appointments before and know what would be most practical.

thank you!

All my appointments for 3 pregnancies have been with midwives in the community or at my hospital. For baby one they came to visit me, baby 2 I did have to go to hospital to have midwife check up and I was post c section. It was okay.
GPs don’t do antenatal stuff around here

But yeah, to echo other PPs comments, no GP involvement whatsoever. (I did actually move GP midway through pregnancy due to a house move - made no difference to anything related to my antenatal care).

Agree with other posters - I don’t think your GP will have any involvement in your pregnancy unless you encounter issues such as hyperemesis.

I’ve lived in a different area for each of my three pregnancies - two in London and one outside. With my first pregnancy I called the GP surgery and was advised about self-referral to my preferred hospital. With the other two I have gone straight to self-referral. Appointments have variously been at the hospital / children’s centre / another random GP practice, between 25 and 50 mins away on foot or public transport. Had home visits after birth for babies 1 and 2 (3 still pending).

I would try self-referring to your local hospital?

This does sound a bit odd with having to change GP's etc - there must have been some misunderstanding?

It is pretty normal for the GP to have nothing to do with antenatal care but normally there is a midwife covering the area and that's who you would be referred to.

In my area, you self refer online to the midwife, completely bypassing the GP. All appointments are then done directly with the midwife (mine works between 2 GP surgeries and a local hospital so appointments can be at any of the 3 locations). The GP is not involved and does not confirm pregnancy etc - the first appointment you would have is the booking in appointment which isn't until 8-10 weeks.

I am almost 30 weeks and have just moved house which meant moving GP surgeries. This has also meant I have to 'move' to a new midwife covering my new area. Not ideal but certainly doable and not a problem.

I will still be having the baby at the same hospital and first midwife has done a handover to new midwife

Unless antenatal care differs vastly between regions, I'm really confused by this post...

I've been followed by 3 different midwife services in the south east and never went through my GP. I registered with the MW services attached to the hospital I wanted to give birth at...
The GP did perform some of the appointments on behalf of the MW but if they couldn't then it would have been done by the MW team.

And I had to transition between services during pregnancies when we moved house, it absolutely did not take 6 weeks to get set up and I didn't miss a single appointment.

And I did all my antenatal MW appointments up for my second pregnancy with a team 45 min from my home (by choice). Yet when I was discharged from hospital with the baby, we were automatically transferred to our local hospital for the postnatal care as it was based on our address and not the hospital of birth.

It was all very simple really, I doubt it can vary that much!

I don't understand why the midwife is so anti option 2. Option 2 sounds totally normal. Apart from the not getting a home visit which I suspect is bollocks.

I lived in London when I was pregnant. My hospital was in a different borough to my GP. Some of my friends saw a midwife at their GP practice, I had to go to the hospital for all my appointments. Which was really no issue at all.

After birth I was transferred from Lambeth to Croydon midwifery service so I got my home visits as normal.

The midwife in this case is very confused.

The GP provides no antenatal care where I live its all through the midwives (and hospital if there are any special requirements) - its the norm to drive to them apart from if there is a need (Mum is poorly), a safeguarding concern or they are visiting post natally.

The midwives maybe striving for best practice and consistency- in trying to have one midwife to one mum - but in reality thats hard to achieve.

If the GP’s are not commissioned to provide antenatal care to all then they won’t have the resources to do so.

It was a while ago, but just wanted to share that I didn’t see the same midwife at all when I had my first child. My initial midwife broke her arm and went off sick; I saw a lovely gp for almost everything up to about 24 weeks, when she gently told me it might be good to see my midwife. Baby wasn’t delivered by a community midwife so they were all (fab) new to me in hospital and I had another midwife visiting me for postnatal follow up. Didn’t worry me too much; perhaps I was extremely lucky with the calibre of the help I had. Hope that you can resolve this for yourselves - I’d switch gps early unless I wasn’t worried/was able to do the drive.

Exactly right. OP take a breath and drive 20 minutes to an appointment. To be honest I’m sure your hospital isn’t much closer than this so it’s hardly a hardship.

Not a big bump just one of those irritating things.

Just for those saying GP has no involvement at all in antenatal care: that's not the case in my current area.
The process is set up and managed by the MW team, and I registered directly with the MW, but every other appointment was done by my GP (and I am certain it was a GP, not a MW at the GP practice).

I want to emphasise I’m not the one with the issue about traveling to them. It’s the midwife.

I asked if me coming to them was possible to avoid switching GPs (as she said was my only option) and delaying appointments. She was very reluctant and trying to deter me from it. She made out me committing to travel to them every single time was madness, completely impractical and unheard of.

I assume they really don’t want to take on patients outside of their catchment area even if they’ll drive to them. Presumably because they don’t have the resources to handle more patients as someone suggested above.

What a load of stress for you, I’m sorry you are having to deal with this!

If it makes you feel any better, I honestly don’t think we saw the same midwife more than once during my entire pregnancy- literally a different person each time, and then a whole new team at the hospital where I gave birth. I don’t think it’s that’s important, provided all your records etc are kept up to date throughout x

Wow what chaos they’ve given you!

For clarity - I’ve never told my GP about pregnancies, they’ve never had anything to do with it.
I self refer to our main large hospital using their website. I give birth at that hospital and will have my scans at that hospital.
I have my midwife appointments at a smaller community hospital.
I had to drive to the smaller community hospital for post birth appointments too. They didn’t come to our home.
Ive only had 1 pregnancy where I’ve seen the same midwife throughout. 2 pregnancy’s where I saw a different midwife for each appointment.

your area will absolutely have a midwifery service covering you. I don’t think the GP surgery is at fault here, it’s not essentially anything to do with them. I would call the hospital you’d plan to give birth at, and ask them what the hell to do!

As @leakycauldron said, you self refer @Fluffydino21

here it's very straightforward

Congratulations to you both! 👶

I think so much of the public’s grievances with GPs could be alleviated by understanding that GPs are contracted (and funded) to provide a service which is written into their practice contract. No more and no less.

Those bloods or referrals your specialist has ‘asked them’ to do because they can’t be bothered to do themselves? No. Those ‘shared care’ agreements with private providers for the rapidly increasing number of new ADHD diagnoses? No. Antenatal care? In the overwhelming majority of cases, no. There will be a clear outline of the duties of the practice in this respect as per local agreements.

This wouldn’t be such an issue if the demands on the service weren’t already at absolute breaking point. Don’t get me wrong, the system is far from perfect and Primary care is in a total mess due to chronic underfunding but this rhetoric of blaming GPs constantly for the failure of other professionals to step up and do their contracted duties and then ‘demand’ that care from their ‘obstructive’ GPs who are ‘refusing’ to do work they aren’t funded to do is a huge and hidden problem. Midwife seems uninformed here.

Hi OP,

im sorry it sounds as though you’ve been misled somewhat. Your GP doesn’t really have anything to do with your antenatal care , they simply fill in the form to the hospital to say you’re pregnant and then you’re seen by the midwife team attached to the hospital you choose to give birth in. You can also fill in this form yourself and self refer (I have been pregnant a number of times and always do my own now). You can choose to have care in any hospital you like, regardless of your GP location.

I have had 3 babies in hospitals outside of my local catchment. On both occasions I attended my midwife appts in the hospital (which all the other pregnant women were doing, I don’t think the GP would be the right place to do them cause you have to go to blood clinics/ scan department etc all in the same building). I know some health centres sometimes have a couple of community midwives too, so maybe that’s what was being referred to. I did have some appointments in one of those with a midwife but to be honest it was more of a faff then just going to the hospital for my check ups. But I personally don’t think 20 minutes is long to get to your appointments.

once my baby was born my care was immediately transferred to the community midwife team in my local area (a different bus trust). They came to my house, and I understand it is a duty of care and essential check up for this. It only happens once or twice after birth and then you get transferred to the health visitor for regular check ins as needed.

this was my experience, I may be slightly wrong given it will depend on commissioning and your local area- but what they have said doesn’t quite make sense.

hoe that helps OP

My eldest was born in Covid so we had to go to a children’s centre for appointments both before and after birth. I would really try to avoid having to travel to appointments immediately after birth if you can avoid it. I had a c-section and a baby that lost a lot of weight and had jaundice, the midwife wanted to see us every other day for the first few weeks. Having said that my youngest was also a
c-section and lost loads of weight and had jaundice so they were coming to our house every other day and it was really annoying having to stay in waiting all day when we wanted to take advantage of my husband being on paternity leave. So both had there pros and cons really.

Also my GP had nothing to do with my pregnancies. I had my appointments with the midwife physically at my GP surgery with my youngest but it was just because the midwife basically rented a room there a few days a week to do antenatal appointments for the area. If you go on the website for your local
hospital and search for antenatal care. There will
be a section telling you how to self refer.

OK. This is a commissioning issue and not the fault of the GP - going apeshit at them will just get you chucked off their list.

I would just move GP - the 4-6 week thing is bollocks, just go into a GP in the right area and register. In the meantime, obviously you just drive to the midwife for now. Why wouldn't you?

I just googled 'what to do if I am pregnant'and the name of my area and it took me straight to the self referral maternity services / booking form page with a phone number for my local Trust. Try that

That's a shitty situation and something has to give.

The midwife does not have to be the same throughout though. That's a lie that they told to get you off their books and reduce their budget pressure.

You need to make sure you get your first trimester scans on time, so stick with this midwife team for now. Immediately once you have had your 12 week scan, or after your 20 week scan if you prefer, put in your form to transfer to a different practice.

Some women move from London to Newcastle at 30 weeks. It's not a problem to change HCP mid pregnancy

Just to show a difference in area, all my midwife appointments are at my GPs and you have to phone GP when pregnant to book appointment with midwife who's based at the GPs (one day a week) same one every time.

The MW sounds very confused.

Do not change GP as a result of this.

Choose your hospital and ask their advice. Choose one that is easy to get to when you go into labour or need reassurance. Or who have a great homebirth team if that is of interest.

Where are you based? We used to be in West Wimbledon where my GP was part of Merton and therefore St George's.

However that was a pig to get to so I had the baby at Kingston hospital. Equidistant on the map but half the actual travel time due to traffic.

I also had all of my antenatal appointments at Kingston Hospital so I travelled there for each one. I did not see the same MWs during antenatal and on the ward. So there was no continuity of care. Yes it is meant to help with better outcomes for mother and child but that is not how the U.K. health system works today!!!

So choose your hospital / birthing centre and speak to them about how antenatal / post natal care works.

My post birth local MW team were actually St Helier & Epsom. Kingston hospital handed me over to her and it worked well. I saw the same MW over the first 2 weeks. She made 2 home visits and I saw her at a local clinic which was 10 mins on the bus from me.

However you are only "under" the MW for 10 days post birth and then they hand you over to the HV team.

FWIW I wanted to go with the St Heliers team originally as they have a great HB team but my OH is from a family of drs and he couldn't deal with that as a choice and St Helier hospital didn't have such a great rep. Hence I chose Kingston. Which was a mostly good experience.

Good luck to you. And congratulations!!

Where I am midwife care is provided through the hospital you choose to give birth in. You do a self referral via the hospital website and then all appointments are done by the midwives at a local hospital. Post birth the midwives came to my house although after the birth of my second (during COVID) I was asked on the day if I would mind going to the hospital for our check as the midwife that was due to see me had COVID and they were struggling to find a replacement that could come to my house but they could do the same check on the antenatal ward.

There are some very long stretches in between appointments especially in the first half of your pregnancy. I think after booking, you have a scan, then appointment at 16 weeks ... might be 24 weeks after that. It does feel weird as you think you'll be seen much more often. So you have lots of time to change GP in between.

Re the post birth visits, you should be seen at home but I wonder if they are saying you should be seen there due to being out of their catchment and so they wouldn't come to you ...

20 mins hardly seems worth stressing about.

I’ve done an hour and a half round trip every other day for the last two weeks for IVF appointments. My nearest local hospital (where I work, and could also give birth) is 20 minutes away.