Commissioning maternity care: little room for manoeuvre?

Abstract

![][1]</img> At the time of writing, the Bill set to ‘reform’ the NHS is shortly to be debated in the House of Commons. Gazing into the uncertain future, it seems inescapable that GPs in England will collectively be taking on at least part of the responsibility for commissioning medical care. In this month's BJGP , three papers, all studying different aspects of maternity care, illustrate some of the questions that commissioners are going to have to grapple with when that happens. Pierce and colleagues report a study where clinicians were asked about their follow-up of women who had experienced gestational diabetes mellitus.1 Not surprisingly, the authors identified considerable variety in practice, and found that the guidelines from the National Institute for Health and Clinical Health (NICE) were not being followed consistently. Non-compliance with authoritative guidelines is a familiar finding, and such a conclusion raises again the vexed question of precisely what guidelines are, and how far clinicians are expected to follow them.2 The question will still be a live one for clinicians, though it may not trouble commissioning groups much. Where NICE gives very clear instructions it is very likely that they will be followed to the letter in commissioning contracts. The particular guidelines that are the starting point for this study include specific recommendations for gestational diabetes: not to screen routinely by urine analysis for glucose; also for a 6-week follow-up with a single fasting blood glucose and not a glucose tolerance test. They should therefore be welcomed, since they limit activity rather than encourage more.3 NICE has also … [1]: /embed/graphic-1.gif