GUIDANCE FOR GP PRACTICES

GPs are ideally placed to ensure that parents who have experienced a miscarriage, stillbirth or neonatal death get the care and support they need. They do not need to give this support themselves but they can make sure that someone does, either a health visitor or practice counsellor or a voluntary organisation such as Sands, the Miscarriage Association, ARC, TAMBA or another local organisation. This support can make all the difference to the future wellbeing of the parents and family. 

It is now 2 years since Louis died, and during that time I have always experienced a warm welcome at the surgery, almost open access to my GP, and recognition of the effect such a loss can have on all our family. My husband has received similar support. As a mum the things that have made the care I have received from my GP so fantastic have been that everyone in the surgery has shown real concern and care for my family and me. This starts with the receptionists when I phone and for me has emphasised what an important role they can play. I will never forget our first visit to the surgery after Louis’ death and one of the receptionists sitting with us as I shared his photos with her. She was clearly moved and cared about what had happened. This meant so much. Mother

 There are several ways in which GP practices can ensure that they offer the best possible care to bereaved parents. Some of these can be organised within the practice, others require liaison and agreement with local hospitals and the Primary Care Trust.

 1.      The initial contact from the hospital is extremely important. A verbal handover is preferable to receiving only a discharge summary. However, it is difficult and inappropriate for GPs to handle calls of this kind while they are seeing patients.

Hospital staff are rightly concerned about maintaining confidentiality and may refuse to talk to practice receptionists. However, receptionists are used to passing messages on to doctors and understand the importance of confidentiality. Practices with one or more experienced receptionists should consider informing the relevant staff in hospitals in their area that messages about childbearing losses can be left with them and that they will ensure that the doctor phones back as soon as possible.

 2.      Each practice should consider identifying a GP to develop a clear policy for the whole practice which will ensure that all parents who have had a miscarriage, stillbirth or neonatal death are offered the care and support they need.

 3.      Practices should consider allocating the task of co-ordinating the care that grieving parents receive from the GP, the health visitor and the midwife to a designated member of staff. An experienced receptionist is well placed to take on this role.

 4.      Practices should consider marking the notes of all the members of a family that has experienced a childbearing loss (for example, with a Sands teardrop sticker - see Informing other carers in Chapter 12), so that all GPs who may see them as patients are alerted to the family’s loss. This is particularly relevant in large practices or where a number of locums are employed. It may also be appropriate to communicate this information to the Out of Hours Service in case the family contacts them. Parents who have lost a baby may become particularly anxious and distressed if one of their other children is ill.

 5.      GPs should consider offering parents an appointment after their hospital follow-up appointment. This gives them an opportunity to discuss what they have been told and to raise any new questions that they may have. It also gives the GP an opportunity to see how the family is faring.

 6.      The offer of regular appointments with the GP during the first few months after a loss can help parents through a time of crisis. In the early weeks, GPs should offer parents a double appointment to ensure that there is sufficient time for discussion and questions.

 7.      GP practices, perhaps in conjunction with the Primary Care Trust, could consider producing a leaflet for parents who have experienced a childbearing loss. This leaflet could suggest:

• the types of support that are available through the NHS and how to access them, plus the contact details of local voluntary support groups (see Appendix 2).
• that parents mention their loss when they book an appointment with the GP, so that extra time can be allocated, and also if they call the Out of Hours Service, so that the doctor is alerted to their situation.