1. Developments in maternity care in the Blacktown Mt Druitt Area HEALTH Area Health Service Western Sydney

2. Staff changes n Appointment of staff specialists at Blacktown Hospital n Appointment of GP co- ordinators for the WSAHS antenatal shared care scheme HEALTH Area Health Service Western Sydney

3. Developments at Mt Druitt hospital n New Antenatal clinic at Mt Druitt Hospital n Outreach midwifery care n Indigenous health centre n Community centre HEALTH Area Health Service Western Sydney

4. Teenage pregnancy n New research initiative with NSW Health funding n Western Sydney GP Division involved n Review pregnancy care for young women n Investigate potential preventive strategies (e.g campaign to promote emergency contraception) HEALTH Area Health Service Western Sydney

5. HEALTH Area Health Service Western Sydney Early pregnancy assessment clinics The current situation GP sees the patient Emergency Dept.

6. HEALTH Area Health Service Western Sydney Early pregnancy assessment clinics The current situation GP sees the patient Emergency Dept. Not unwell so waits….

7. HEALTH Area Health Service Western Sydney Early pregnancy assessment clinics The current situation GP sees the patient Emergency Dept. Not unwell so waits…. Seen by ED Dr (limited experience in gynaecology)

8. HEALTH Area Health Service Western Sydney Early pregnancy assessment clinics The current situation GP sees the patient Emergency Dept. Not unwell so waits…. Seen by ED Dr (limited experience in gynaecology) Painful internal examination Behind a curtain on a trolley in ED

9. HEALTH Area Health Service Western Sydney Early pregnancy assessment clinics The current situation Needs an ultrasound scan Painful internal examination behind a curtain on a trolley in ED

10. HEALTH Area Health Service Western Sydney Early pregnancy assessment clinics The current situation Not unwell so waits…. Needs an ultrasound scan Painful internal examination behind a curtain on a trolley in ED

11. HEALTH Area Health Service Western Sydney Early pregnancy assessment clinics The current situation Not unwell so waits…. Needs an ultrasound scan Painful internal examination behind a curtain on a trolley in ED Scan result cannot be interpreted by inexperienced ED Dr Needs a gynaecologist

12. HEALTH Area Health Service Western Sydney Early pregnancy assessment clinics The current situation Not unwell so waits…. Needs an ultrasound scan Painful internal examination behind a curtain on a trolley in ED Scan result cannot be interpreted by inexperienced ED Dr Needs a gynaecologist Not unwell so waits….

13. HEALTH Area Health Service Western Sydney Early pregnancy assessment clinics The current situation Gynaecology reg finally comes out of theatre Decides she needs a curette Not unwell so waits….

14. HEALTH Area Health Service Western Sydney Early pregnancy assessment clinics The current situation Not unwell so waits…. Gynaecology reg finally comes out of theatre Decides she needs a curette Not unwell so waits….

15. HEALTH Area Health Service Western Sydney Early pregnancy assessment clinics The current situation Not unwell so waits…. Gynaecology reg finally comes out of theatre Decides she needs a curette Not unwell so waits…. ??????After curette

16. HEALTH Area Health Service Western Sydney Early pregnancy assessment clinics The proposed system Pain or heavy bleeding?? GP sees a patient with threatened miscarriage Emergency Dept. Contact local EPAC Yes No

17. HEALTH Area Health Service Western Sydney Early pregnancy assessment clinics The proposed system Emergency Dept Will perform rapid assessment If in pain or bleeding there will be direct referral to on-call gynaecology registrar who will scan there and then If no need for urgent intervention will be followed up in EPAC

18. HEALTH Area Health Service Western Sydney Early pregnancy assessment clinics The proposed system EPAC Contact by leaving message on answering machine Midwife calls each patient back to arrange appts that morning. Seen and scanned at EPAC Follow-up/counselling at EPAC Referral back to GP once resolved

19. Shared antenatal care Family care at your family doctor n With appropriate training and protocols, it is safe n Much more convenient for the women involved n Strengthens the continuum of GP care HEALTH Area Health Service Western Sydney