Rural doctors hit out at 'unsafe' birthing services model amid shortages

Doctors have hit out at a new birthing program for hospitals in South Australia's Mid North, calling the model "unsafe" and "unsustainable".

In a joint letter to the health minister, four GPs expressed "urgent concern" about changes to maternity service delivery at Jamestown and Crystal Brook hospitals, which took effect this week.

The six-month trial by the Yorke and Northern Local Health Network (YNLHN) would entail a one-team, one-site birthing model that would alternate between the two hospitals.

The trial was in response to ongoing midwifery shortages across the health network.

However, local doctors said the rotation of maternity sites between Crystal Brook and Jamestown restricted doctors from simultaneously providing maternity and emergency on-call roles, while complicating and heaping pressure on clinical handovers.

"Fragmented care and unintentional gaps in handover have been associated with 80 per cent of serious preventable medical errors,"

the letter said.

"The mandated model effectively closes one maternity unit. It is well known that closures of maternity units reduce risk to that health service but conversely significantly worsen health outcomes in those affected communities by increasing the rates of babies born before arrival to hospital and increased rates of birth trauma.

"It also places significant financial stress, psychological stress and family separation when mothers are required to relocate away from their home communities for childbirth.

"This will also further impact the already understaffed volunteer ambulance service, and at times will remove a critical emergency ambulance from the region while it is required to transfer patients across sites."

Jamestown GP Simon Jackson, one of the letter's signatories, said the change would have flow-on effects to the wider health system and community, including around staffing and recruitment.

"So although this may appear as though it might fix one area of maternity, I think it will have a flow-on effect with potential implications for the whole community, especially non-maternity services," he said.

"I'm trained as a rural generalist; I cover primary care, obstetrics, so delivering babies, but also emergency care. And with this change in the model, I was restricted to only being able to provide obstetric care on Monday [when it came into effect]. And so that resulted in a shortage of doctors in the region … This has the potential in the future to also affect emergency services and lead to widespread doctor shortages throughout the region.

"Then that has a future flow-on effect in terms of putting pressure on public health systems in Adelaide, which are already under a huge amount of stress with ramping and bed blocking."

Speaking to ABC Radio's North and West Breakfast's Tom Mann on Wednesday, Shadow Health Minister Jack Batty said the local practitioners' concerns needed to be taken seriously by Blair Boyer.

"He should be explaining how those concerns around continuity of care and clinical handovers and patient safety are being assessed and what safeguards might be in place. But most importantly, [he needs to] sit down and work with them on a model that they're comfortable with, but also delivers reliable maternity care for regional families closer to home," Mr Batty said.

"We can't sort of just settle for some sort of timeshare arrangement that local doctors themselves are warning is unsafe and unsustainable."

Safety at sites disputed

Mr Boyer said the change to Jamestown and Crystal Brooks' birthing services was made on advice by the then-SA Health chief, adding that neither hospital complied with the Maternity and Neonatal Clinical Service Capability Framework — something the local GPs "strongly" disputed in their letter.

"The framework is there to make sure no catastrophic event can take place. And I can't be a minister who receives that kind of advice from someone like [Dr] Robyn Lawrence and others who are … doctors themselves who tell me that there is a risk of a catastrophic event for a mother and/or her bub if we don't make a change," the health minister said.

"So that's why we put this change in place to trial a different model where we rotate between the two sites … and see how that goes.

"We do want to keep birthing services in these parts of South Australia, but we have to find a way to make sure that I could look prospective parents in the eyes and say that it will be safe for them to give birth at these sites."