GPs speak out amid birth services’ ‘significant shortcomings’

Frustrated GPs have used a Parliamentary investigation to highlight the importance of the right care at the right time when it comes to accessing high-quality birthing services.
 
The RACGP is calling for an overhaul of ‘inadequate’ services, saying GPs must be allowed to play a greater role in early assessment and the provision of holistic, community care.
 
On Wednesday, the college fronted a Tasmanian Parliamentary Inquiry, tasked with assessing the adequacy, accessibility and safety of services for parents and children.
 
While the inquiry is Tasmanian-based, its investigation and calls for change are ringing true for GPs practicing across Australia, as they face similar challenges in providing best-quality care.
 
Its scope included health workforce shortages and birth trauma, and invited discussion of disparities in availability of services, staffing and outcomes both between Tasmania and other Australian states and territories and within Tasmania.
 
Participants were asked to consider those living in rural, regional and metropolitan areas, and as well as those experiencing socioeconomic disadvantage.
 
The RACGP made a long list of recommendations to the committee for improved access to parenting supports, children’s health checks and assessments for developmental and behavioural concerns, and maternal and reproductive health services. 
 
‘In Tasmania reproductive health services face significant shortcomings with patients experiencing accessibility challenges which are compounded by time restraints and inadequate Medicare rebates,’ it said in its submission to the inquiry.
 
‘The nature of these reproductive appointments is inherently time-consuming, yet existing rebates inadequately support extended sessions.
 
‘Consequently, patients bear a higher financial burden, limiting access to these vital services, especially for more vulnerable populations impeding their timely access to reproductive care.’
 
Currently, Tasmania does not have the level of early parenting supports supplied free of charge through other state programs, including in New South Wales, Victoria and the Australian Capital Territory.
 
Tasmanian GP Dr Marita Jones, who represented the RACGP at the Parliamentary hearing, said every child deserves a start that is safe, but some parents need help to provide that.
 
‘When families come in, if we are able to help and support them early, then things improve, if not, things will snowball,’ she said.
 
‘In Tasmania, we don’t have any single point of call for families in need.
 
‘What’s needed is holistic, community based, wraparound services which don’t solely have a focus on mental health services.’
 
The submission stated there is an ‘immense, early intervention service gap’ for children aged under five years old in Tasmania, disproportionate even when compared to the challenges in other states.  
 
It says that health disparities among children are influenced by social, cultural and economic factors, with children from more advantaged families better able to access early assessment and care.
 
The submission cited less awareness of services and high associated costs contribute to these differences. 
 
‘Communication challenges across tertiary and primary care teams are a major barrier in addressing birth trauma,’ the submission says.
 
‘Community based providers often aren’t aware that there has been trauma as it reliant on patient disclosure.
 
‘This lack of information, especially in the first few weeks presenting to primary care providers after birth can lead to further challenges.’
  
Dr Tim Jones, Chair of RACGP Specific Interests Child and Young Person’s Health, also fronted the inquiry and said he is hearing from his patients that ‘almost all four-year-olds are missing out on health checks’.
 
‘We’re not picking up the kids with hearing impairment before they start school, which may mean they’re already moving out of the early intervention window where support may be available to them,’ he said.
 
The submission also points to the scarce resources currently available to families for the pregnancy planning phase of reproductive health, particularly in the public health system.
 
It says that termination services in Tasmania face ongoing accessibility issues, and that consumer awareness of the availability of these services is limited, in part due to limited advertisement and accessibility.
 
‘Health literacy is key to accessing information about pregnancy termination services,’ Dr Tim Jones said.
 
‘Access requires awareness of how to navigate the system.’  
 
The submission also highlighted the importance of support and education for parents and teachers, saying early parenting and teacher interventions are more effective than medications for many behavioural problems.
 
In the wake of these growing issues, the RACGP said the GP workforce shortage in Tasmania is impacting the ability of primary care teams to sufficiently deliver reproductive, maternal, and paediatric health services.
 
It says nursing and GP primary care must be integrated into early parenting support as only nurses and GPs can simultaneously treat both parent and infant and look at the whole family as a unit. 
 
‘GPs are uniquely placed to provide comprehensive, patient-centred primary care for both women and men for their reproductive health and experience of pregnancy,’ the submission said.
 
‘Essential staff for these services (perinatal mental health) are child and family nurses with experience in perinatal mental health or parent craft and primary care physicians (GPs), who are essential.
 
‘They can simultaneously treat parent and baby including mental health, sleep and settling, growth issues, and medical issues.’
 
It has also called for increased education for priority groups including Aboriginal and Torres Strait Islander patients, as well as virtual services being ‘part of the solution’, saying they offer more treatment to people living in more geographically dispersed areas.
 
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Parliamentary Inquiry reproductive health Tasmania women’s health