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NICE indicator promotes postnatal mental health assessment in primary care

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General practice staff would be expected to assess the mental health of all women who have recently given birth, under a series of new measures for surgeries proposed by guideline makers.

Practices would also be encouraged to keep a register of all patients with autism and step up efforts to ensure eligible women received regular screening for cervical cancer, under planned new indicators for primary care.

“Up to 20% of women are affected by mental health problems in pregnancy or the postnatal period”

Janet Fyle

The National Institute for Health and Care Excellence is currently consulting on a number of new indicators for its “indicator menu” for GP practices, aimed at monitoring performance locally and nationally and informing efforts to improve primary care.

These include a requirement to assess the mental health of new mothers, ideally at routine six-week ante-natal appointments.

The move follows concerns about variations in support for women with mental health problems during or after pregnancy.

NICE said the new indicator would help ensure maternal health was assessed “so that women do not suffer in silence”.

Dr Andrew Black, deputy chair of the NICE indicator advisory committee, said: “These indicators, put forward by NICE, could help GPs to identify and support their patients who are most at risk. This can only be a good thing.”

“Indicators are a key part of NICE’s drive to improve people’s lives”

Daniel Keenan

Janet Fyle, professional policy advisor at the Royal College of Midwives, said healthcare professionals should place equal importance on a women’s mental and physical health, not only after birth, but throughout the entire pregnancy.

“We know that suicide is a leading cause of death in new mothers in the UK and up to 20% of women are affected by mental health problems at some point in pregnancy or the postnatal period – within the first year after birth,” she said.

She added that it was vital for primary care staff and midwives to “work closely together so warning signs and symptoms are not missed”.

In November 2015 the RCM published a standards framework for specialist maternal mental health midwives to improve care for women whose pregnancy and postnatal experience was complicated by mental health problems.

Royal College of Midwives

Janet Fyle

Janet Fyle

Another draft indicator would encourage practices to keep a register of patients with autism spectrum disorders, as part of efforts to ensure this group get the support and care they need.

“Without this indicator, GP surgeries cannot be expected to make reasonable adjustments for patients with autism and patients will continue to feel that their healthcare needs are going unmet,” said Emily Christou, national strategy co-ordinator for the Westminster Autism Commission, which has called for such a measure to end the “invisibility” of autism in healthcare.

Other draft indicators featured in the consultation include those aiming to increase the number of women participating in cervical screening programmes, developed with Public Health England.

The move follows a study that suggests many women are “dying needlessly” due to not attending screening and as many as 350 lives per year could be saved if everyone eligible took part.

Dr Anne Mackie, director of screening at Public Health England, said the new measures would work alongside other efforts to encourage women to attend screening appointments, including providing better information and tailored reminders.

Dr Anne Mackie

Dr Anne Mackie

Dr Anne Mackie

The consultation on the indicators runs until March 8 with the final “indicator menu” due to be published this summer.

Professor Daniel Keenan, chair of the NICE indicator advisory committee, urged clinicians to have their say.

“Indicators are a key part of NICE’s drive to improve people’s lives, enhance the quality of care in the NHS and use its resources wisely,” he said.

“The indicators in this consultation are not final and I would strongly encourage everyone with an interest in the development of evidence-based indicators to tell us their views,” he added.

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