Procedural scope in rural general practice — KFP-style written assessment

KFP 1 (10 marks)

Your town's hospital is deciding whether to re-establish GP obstetrics. A sceptical colleague quotes anecdotal safety concerns. The local maternity unit closed three years ago; two women have since delivered on the roadside. ^{[23] [12]}

1. Quote the comparative outcome evidence for GP obstetric care in similar Australian settings. (4) ^{[23] [8]}
2. What does the closure trend data predict for your town if the unit stays closed? (3) ^[12]
3. What satisfaction evidence supports the re-establishment case? (3) ^[22]

Model answers

1. In the Murrumbidgee study, smaller GP-obstetric hospitals had more normal vaginal births (70.0% vs 57.2% and 58.6% at base hospitals), fewer neonatal resuscitations, fewer stillbirths, no difference in newborn deaths, and neonatal special care admission under 3% versus over 25% at base hospitals. The WA rural audit found a reassuringly high spontaneous vaginal delivery rate and low elective and non-elective caesarean rates in a low-risk referred population. ^{[23] [8]}
2. Between 1992 and 2011, Australian maternity units fell 41% (623 to 368) while born-before-arrival births rose 47% nationally (836 to 1,233 per year) and 206% in Queensland; BBA rates correlated negatively with unit numbers (r=0.837). Your roadside deliveries are the local expression of this documented dose-response. ^[12]
3. In rural WA, 116 women completing all three surveys reported 78-100% agreement with positively worded satisfaction statements across antenatal, intrapartum and postpartum GP obstetrician-led care, with continuity of care the valued theme. ^[22]