GMSC's advice differs from royal college's

EDITOR,—The maternity task group of the Royal College of General Practitioners recently published its report The Role of General Practice in Maternity Care.1 Involvement in intrapartum care is a particular issue for general practitioners, and in its attempt to clarify the issue the report clearly differentiates between domiciliary intrapartum care and that which can be undertaken in an institutional setting.

At home the principal professional involved will always be the midwife. The role of the general practitioner is to ensure that his or her patient receives appropriate advice and care; it is not to provide specialist obstetric or neonatal care.

The General Medical Services Committee's recent report Maternity Medical Services Legal Advice takes a different standpoint and recommends that “practitioners who are going to provide intrapartum care should be the relatively few [general practitioners] who are highly skilled and practised in this area and that only they should undertake home deliveries and deliveries in [general practitioner] maternity units.”2 This raises important questions. What does the committee consider to be the role of the general practitioner in domiciliary care, and what skill does it expect him or her to have? If the committee expects the ability to undertake certain obstetric interventions then it can be strongly argued that, even if the general practitioner did possess such skills, it would be inappropriate for him or her to use them in the home setting.

The General Medical Services Committee's recommendations emanate from a legal opinion. The objective is clearly to minimise a perceived danger of litigation, which is very different from that of wishing to optimise the delivery of health care. Intentionally or not, this report will have far reaching implications for services and education by deterring practitioners from becoming involved in the intrapartum care of women requesting home births (particularly those general practitioners who at present provide this form of service). As a result, trainees will probably question the value of including obstetrics in their vocational training. This is the exact opposite of the view expressed in the report of the Royal College of General Practitioners, which suggests that vocational training should ensure that general practitioners are prepared to provide total primary maternity care.

It is to be hoped that the different approaches contained in these two reports will stimulate a discourse between the Royal College of General Practitioners and the General Medical Services Committee for the benefit of both general practice and pregnant women.