Links to changes in NHS Health Scotland website
Enhanced antenatal services for women within NHS Scotland (for health professionals)
http://www.healthscotland.com/documents/3983.aspx
KCND campaign materials
http://www.healthscotland.com/documents/3980.aspx
Letter advising of improvements to antenatal services for women within NHS Scotland for:
General Practitioners
CHP General Managers (for circulation to Health Visitors)
Heads of Midwifery
KCND Board Leads (for distribution to maternity services)
Screening Co-ordinators (for distribution to local screening contact)
Directors of Nursing
St Andrew's House, Regent Road, Edinburgh EH1 3DG
www.scotland.gov.uk
Health Directorates
Dr Margaret McGuire, Acting Chief Nursing Officer
T: 0131-244 2314 F: 0131-244 2042
E: margaret.mcguire@scotland.gsi.gov.uk
Dr Harry Burns MPH FRCS (Glas) FRCP(Ed) FFPH,
Chief Medical Officer
T: 0131 244 2264 F 0131 244 3477
E: ps/cmo@scotland.gsi.gov.uk
To: General Practitioners
CHP General Managers (for circulation to Health Visitors)
Heads of Midwifery
KCND Board Leads (for distribution to maternity services)
Screening Co-ordinators (for distribution to local screening contact)
Directors of Nursing
Dear Colleague
Enhanced antenatal services for women within NHS Scotland
This letter is to advise you of recent and planned improvements in maternity services across NHS
Scotland and, in particular, relating to antenatal care for women and families.
All NHS Boards have adopted the maternity policy principles outlined in the Framework for
Maternity Services in Scotland and the report of the Expert Working Group on Acute Maternity
Services, which advocate women and family centred services, with care tailored to need and
provided by the most appropriately skilled professional. In doing so, we have developed services
to take account of wider evidence around improving public health and ensure that maternity care
provision reflects wider policy direction.
Our public health and early years policies, including Better Health, Better Care, Equally well and
GIRFEC, outline our commitment to reduce health inequalities. Specifically related to maternity
care, they highlight the importance of seamless early access to services, alongside early targeted
intervention for women and families with additional social or medical need. We have been
working in partnership with women's representatives, professional Royal Colleges and all NHS
Boards to enhance maternity services and, in particular, antenatal care provision.
There are three key initiatives.
• We have introduced multi-professional maternity care pathways, which will facilitate robust
risk assessment in early pregnancy and timely intervention for women and families with
additional medical or social need. These pathways identify the most appropriate care
pathway for individual need and the most appropriately skilled professional to deliver that
care. Normally a midwife will have responsibility for the care of healthy women and an
obstetrician, supported by the wider maternity team, for those with added complexity. We
would expect the woman's general practitioner to continue to look after her general medical
care and participate in antenatal care as desired. This is already in place in most NHS
Boards. To view the pathways see: http://www.nhshealthquality.org/nhsqis/5989.html
• We are introducing significant changes to the Pregnancy and Newborn Screening
Programmes, as outlined previously in Chief Executive's Letter (CEL) 31 (2008). These
changes include:
o Enhancement of the existing Pregnancy Screening Programme offered for Down's
Syndrome and other congenital anomalies
o Introduction of haemoglobinopathy screening, both during pregnancy and for newborn
babies
o Extension of the newborn bloodspot screening programme to include screening for
Medium Chain Acyl CoA Dehydrogenase Deficiency (MCADD)
o Introduction of a routine second trimester fetal anomaly scan.
Updated information leaflets to support the revised Pregnancy and Newborn Screening
Programmes have been developed and local implementation plans will be supported by a
nationally co-ordinated training programme. Further information is available from
www.pnsd.scot.nhs.uk/ (NHS Scotland N3 network) OR External
http://www.elib.scot.nhs.uk/SharedSpace/communities/Pages/login.aspx?ContainerID=213
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• We are giving women the option of attending a midwife as the first point of professional
contact in pregnancy. To comply with the maternity care pathways, maternal history taking
needs to commence during this first contact, with relevant information being documented in
the Scottish Woman Held Maternity Record. Women will also be able to access the
enhanced pregnancy screening programmes through this early contact with maternity
services. Key public health messages should be delivered at this first contact and women
offered the most appropriate care pathway for their need. We are aware of the importance
of communication, therefore where midwives undertake the first contact, they will have a
duty to communicate outcomes to the woman's GP and refer women into GP services as
required. A number of NHS Boards are already offering women earlier access to maternity
services in this way; however any woman who wishes to continue to see her GP will be
supported to do so. An example communication tool currently used by NHS Tayside is
enclosed as part of the information pack.
The introduction of these changes should significantly improve antenatal care for women and their
families, by enabling earlier access to maternity services for most women; facilitating earliest
possible risk assessment and completion of maternal history taking and allowing early targeted
support and intervention for at risk women and families.
To support all of the above changes, a public communications campaign led by NHS Health
Scotland, will commence from January 2010. In particular, the campaign will identify midwives as
the first point of contact with the service and encourage all women to book appointments early to
allow for the best pregnancy care, including screening. Further information about the
communications campaign is included in the wider pack.
Yours sincerely
Dr Margaret McGuire, Deputy Chief Nursing Officer and Dr Harry Burns, Chief Medical Officer