March 22, 2021
Shared Care - Keeping it Local and Familiar
So, suddenly your period’s late, you don’t feel like breakfast and you’ve let your private health insurance lapse. Quelle horreur! Or you’ve taken a Covid 19 financial hit and you can’t afford the out-of-pocket fees for a private Ob/Gyn. What to do? Here’s the thing. We have great network of public maternity hospitals in town. And, if you want the personal touch, there’s shared care too.
I worked for over 20 years as a ‘cradle to the grave’ country GP. It was very satisfying to practice old style family medicine ie look after a woman during the pregnancy, treat her partner for his footy injury, help her dad stop smoking, manage her toddler’s croup, care for her grandma in hospital and deliver the baby – often on the same day!
When I moved to the big smoke I realised that metro GPs don’t do labour rooms, then discovered the next best thing - I became a shared care affiliate - meaning that I could conduct most of a patient’s antenatal care, still maintaining that rewarding GP/patient relationship and continuity of care.
So, what is Shared Care?
Shared care means that your antenatal (pregnancy) care is shared between a public maternity Hospital like the Royal Women’s, and a community doctor or midwife who is affiliated with the hospital.
This means that the most of your antenatal care is provided by that affiliate. You have to book into the hospital, attend there for a few visits along the way and then have your baby there. After that your affiliate sees you and your baby for the post-natal check.
Typically, antenatal care consists of ~ 4 weekly visits until 28 weeks, ~2 weekly visits until 36 weeks, then weekly until the big day.
Shared care GPs have to be credentialled with the relevant hospitals, providing evidence of prior experience and training in obstetrics, be involved in the ongoing educational activities based at those hospitals and apply for re accreditation every 3 years. We have key referral and contact points at the hospital with a direct line to the shared care coordinator, and can arrange prompt specialist assessment if necessary, along the way. The crucial communication channels involving your care from the hospital to us and vice versa is seamless. It’s a team thing -and you’re the captain.
Patients are zoned to a particular maternity hospital depending on where they live. Because I practice in the inner bayside area, most of my shared care patients are with the Royal Women’s Hospital, either at Parkville or Sandringham.
Shared care is a popular choice for healthy women with a normal pregnancy. However, if you have significant medical problems like diabetes, or a complicated past obstetric history such as previous Caesarean Section or certain issues arising during the pregnancy eg. twins, then you may not be regarded as suitable for shared care.
How does it all happen? Well, you miss that period, feel a little off, do a urine test (or three) and bingo! Then you come to your GP to discuss the game plan. It’s good to see a doctor with interest and experience in that particular game. If you choose to go the shared care route, then you need a GP who is an affiliate, who does the referral to the relevant hospital.
Your first visit at the hospital is usually not until 15-20 weeks, so the GP will arrange the initial antenatal blood test, advise you about diet and vitamin supplements and discuss and arrange appropriate screening tests eg. another blood test at 10 weeks (either the simple maternal screening test – bulkbilled, or cell free DNA test eg. Harmony – a better test but @ $400 or so), then ultrasound scans at 12 and ~ 20 weeks, which may also attract a private fee.
Then at your first hospital visit, they will discuss with you their different models of antenatal care including shared care, and if you choose the latter, provide you with the routine schedule of visits, including 2 additional hospital appointments, and arrange antenatal classes. Currently some of this is done by phone. You see your GP face to face for the regular visits along the way, until towards the end you don’t turn up one day and we figure you’ve done the deed! (Actually, the hospital does send us a comprehensive discharge summary about you and your bub.) Then we see you both at 6-8 weeks, and before then if any issues arise with either of you.
Why would you go private?
Well, I guess because it’s probably always been part of the master plan for you and your partner, and if you’ve been paying private health insurance forever, why not use it?
Plus, you get a choice of Ob/Gyn, so you can ask around and look them up and decide who might suit your needs. And it is nice to see the same doctor all the way through the pregnancy – and then on the big day too (hopefully!) Whereas in the public system you will see a range of staff – all capable and well trained.
And there is the issue of décor. Private hospitals are more schmick than public hospitals. With better carpet. And you might get to spend a few days in a swanky hotel.
Why would you go the public option?
If you don’t have appropriate private health insurance, it’s the only realistic choice. But don’t despair – it’s great. I do lots of shared care and hear very few complaints about the public system.
What about if you are privately insured?
Well, for a start, the public option is still way cheaper. You still have to pay for some scans and the Harmony test, but the hospital facilities, obstetricians, paediatricians and anaesthetists are all on the taxpayer. And those docs are not playing golf or down the beach when you need them – they are rostered on and in the building.
There is usually an out-of-pocket gap to pay in the private system, depending on the obstetrician’s fees plus the paediatricians etc. charge as well.
I always bulkbill shared care visits because I see them as an extension of the public system. So money saved there too. And shared care is convenient. If your shared care GP is close to home, then less time travelling to your private Obstetrician’s rooms, and the clinic is often familiar to you as well.
If that GP is your normal family doctor, you know him/her and so does your family, and that relationship is useful when you bring that new baby home. If it’s not your usual GP, ‘this could be the start of a beautiful friendship.’ (Apologies to Casablanca.)
So, there you go. I must admit to a bias towards shared care, because I like doing it and am a big fan of the Royal Women’s.
Something to think about, anyway, while you’re wondering about that late period.
Mama You've Got This
Dr Bill Bateman
GP & Shared Care Expert