The risk of litigation in the practice of obstetrics mainly relates to the conduct of labour. Recently litigation has also occurred when antenatal screening tests have failed to be performed, serious medical problems or obstetric complications have not been detected during the pregnancy, or there has been a delay in management.

To participate in and be indemnified for the practice of maternity shared care with GCHHS, a GP must adhere to the following guidelines:

1. Every GP is to check with their professional indemnity provider as to the extent of cover provided and ensure they hold and maintain the necessary medical indemnity insurance cover. However, in general terms it is understood that GPs with non-procedural cover are covered for claims arising out of care (including any major antenatal complications) up until labour but are not covered for any intra-partum care or treatment. To be covered for intra-partum care, the GP must have GP obstetric cover.
   
2. Request all appropriate tests after discussion and informed consent and follow up the results.
   - Any investigations requested by GPs for any pregnant woman under their care must be followed up by the GP concerned.
   - While part of appropriate follow up is communicating relevant results to the shared care hospital, it is still necessary for the GP to check that appropriate action has been taken. The GP will not be relieved of all liability by simply communicating the results on the assumption the hospital will act on the results.
   
3. Ideally the woman will be referred to an antenatal clinic before 12 week’s gestation and triaged for consultation with an obstetrician for an Integrated Management and Planning (IMAP) review. Woman will be allocated a routine or complex schedule of care. An initial booking in appointment with the midwife will occur at 22 weeks: a. If GP shared care is planned, the antenatal clinic will consult the woman again at 31, 36 weeks and 40 to 41 weeks, provided that the antenatal course is uneventful. b. GPs may continue to see pregnant women for antenatal visits or for intercurrent medical problems, but in shared care, the responsibility for the obstetric care and the delivery of the baby must rest with the obstetric hospital/clinic, consultant obstetrician or with a GP who has GP obstetric insurance arrangements.
   
4. In an emergency, e.g. haemorrhage or pre-term birth, any doctor, irrespective of their cover, must render whatever emergency assistance they can, and will be indemnified under Good Samaritan legislation. In Queensland, the Law Reform Act 1995 provides that a medical practitioner, nurse or member of an organisation listed in the regulations is not liable for acts done in good faith and without gross negligence. The Civil Liability Act 2003 also extends protection to persons who perform duties to enhance public safety for certain entities listed in the Civil Liability Regulations 2014.
   
5. If a shared care GP is planning to be away from his or her practice, the woman’s care including responsibility for required antenatal visits (as per Section 8.) and follow up of tests is to be handed over to another GP who is adequately indemnified, has experience with the practice of maternity shared care and is aware of the requirement to adhere to these guidelines. If an appropriate GP is not available within the practice, the woman can be referred back to the birthing facility. The shared care GP should discuss this with the birthing facility as soon as possible to determine capacity within the service and models of care.
   
6. GPs should obtain further information from their indemnifier if they have any concerns regarding their medical indemnity insurance cover.
   

Reference: Queensland Clinical Guideline: Maternity shared care operational framework. Website. Dec 2021
Reference: Metro North Hospital and Health Service Maternity GP shared care guideline – May 2019 Page 10 of 42 5.

Alignment and Quality Improvement
https://metronorth.health.qld.gov.au/wp-content/uploads/2017/10/maternity-sharedcare-guideline.pdf

• Refer to the intended birthing facility (before 12+0 weeks gestation whenever possible)
• Complete the PHR at each visit to communicate care decisions and results
• Review the birthing facility discharge summary with the woman and offer a copy if they do not have one
• Be familiar with and follow the guidelines and policies of Gold Coast Health and participate in training opportunities e.g. GP Maternity Alignment Program.
• Has current knowledge and skill in maternity care

• Acknowledge receipt of booking-in referral
• If required, commence the PHR and ensure documentation is completed at all clinical contact
• Facilitate timely and accurate clinical handover and documentation to PMC
• Provide a discharge summary outlining intra- and postpartum events to the PMC (and to the GP if the GP is not the PMC) preferably within 5 days of birth which enables providers to engage in prompt and targeted follow up
• Provide processes for PMC to access to an alignment program with information about shared care roles and responsibilities
• Offer hospital based postnatal outpatient appointment(s) (as required) to women who have experienced specific problems during pregnancy or childbirth. If there have been unexpected outcomes offer opportunities for debriefing, discussion and/or counselling
• If problems are identified, advise the PMC in a timely manner (e.g. using phone, discharge summary, letter) to allow for follow up and support

Queensland Clinical Guideline: Maternity shared care operational framework. Website. Dec 2021

Metro North Hospital and Health Service Maternity GP shared care guideline – May 2019 Page 10 of 42 5. Alignment and Quality Improvement https://metronorth.health.qld.gov.au/wp-content/uploads/2017/10/maternity-sharedcare-guideline.pdf