Committee is out of touch with needs of professionBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7052.305b (Published 03 August 1996) Cite this as: BMJ 1996;313:305
EDITOR,—As one of few local NHS general practitioners who provide patients with a comprehensive, personal 24 hour medical service I often feel isolated, vulnerable, and exposed to censure. I question the motives behind the General Medical Services Committee's recent advice about the provision of intrapartum care.1 A G Baird and colleagues confirm the ability of most general practitioners to provide a satisfactory intrapartum obstetric service,2 and, in accord with Jeremy Bradbrook and colleagues, I consider the committee's advice to be damaging.3
I recently received correspondence from the clinical director of my trust's maternity unit, who states that the trust considers any medical intervention during pregnancy to be the sole responsibility of hospital obstetricians. I was particularly concerned that this same manager also seems to believe in a planned “place of normal confinement” and considers that planned home deliveries under his nominal supervision are safe with the support of paramedics alone. Surely all general practitioners are qualified in midwifery; vocational training must equip them to manage most obstetric problems more adequately than any paramedic. If standards are as low as the General Medical Services Committee supposes then perhaps we should examine the educational content of current senior house officer posts in obstetrics and call for refresher courses to improve standards.
Bradbrook and colleagues overlook a major conflict of interest.3 When attending any patient, doctors still carry vicarious liability in common law for the acts and omissions of any midwife or ambulance paramedic working with them, although they have no managerial control since the midwife or paramedic is answerable firstly to his or her employing trust and works to various protocols dictated by the trust. These protocols may not correspond with the patient's wishes or needs or the doctor's professional judgment, and I find this to be a continuing source of conflict as the trusts have a powerful vested interest in generating a monopoly in the provision of services.
Intrapartum obstetrics is one of the most rewarding aspects of family medicine, but, like all aspects of immediate care, it requires skill and practice. Obstetrics also takes time and so cannot be provided by any deputising service or cooperative. I believe that the General Medical Services Committee's advice and its call for the removal of maternity care from general medical services have more to do with the drive towards corporate medical services and privatisation than with any hypothetical issues of negligence and malpractice. Furthermore, they suggest that its members are out of touch with the needs of the profession.