Independent investigation: Chloe Sutherland (8 mnths), Edinburgh (2015)

ensure that there is enough flexibility in referral criteria so that women with significant histories who have been seen within the service can be re-referred until the child is one year of age.

Review the remit and staffing of the perinatal mental health service community team to ensure they can work towards meeting the quality standards of the perinatal network.

Priority should be given to establishing a national managed clinical network as recommended in SIGN 127 (2012) which states: 'A national managed clinical network for perinatal mental health should be centrally established in Scotland. The network should be managed by a coordinating board of health professionals, health and social care managers, and service users and carers. The network should: Establish standards for the provision of regional inpatient specialised mother and baby units, community specialised perinatal teams and maternity liaison services. Establish pathways for referral and management of women with, or at risk of, mental illness in pregnancy and the postnatal period. Establish competencies and training resources for health professionals caring for pregnant or postnatal women with, or at risk of, mental illness, at levels appropriate to their need. Ensure that all pregnant and postnatal women with, or at risk of, mental illness have equitable access to advice and care appropriate to their level of need.'

The RCGP and the Centre for Mental Health in England produced a report, ‘Falling through the gaps’ in 2015.15 This report highlights the role of GPs in disclosure, identification and support of women who develop a mental illness in the perinatal period. The recommendations are equally pertinent to Scotland and we would recommend that the RCGP Scotland make similar recommendations to the Scottish Government. The establishment of a managed clinical network would be well placed to lead on and advise how these recommendations could be implemented.

Ensure that there are clear pathways to access specialist perinatal mental health expertise within their board area, including pathways for urgent assessment by local mental health teams as appropriate.

Review the PNMHS referral criteria to ensure that there is enough flexibility so that women with significant histories who have been seen within the service can be re-referred until the child is one year of age.

Ensure that specialist perinatal mental health services complete a late pregnancy and early postnatal care plan in late pregnancy (28-32 weeks) for women at high risk of postnatal major mental illness, as detailed in Sign Guideline 127. This should be shared with maternity services, community midwifery team, GP, health visitor, mental health services and the woman herself. All letters should be structured in a way that highlights the risk and management plan at each contact.

Ensure GP systems identify and highlight risks from perinatal mental health service assessments, these are Read12 coded and alerts set up on practice systems including a Key Information Summary (KIS)13 to capture and share information.

Review IT systems and consider the use of electronic referral systems, for example using the SCI gateway system14. Ensure that general practices review and consider improvements to their IT systems. This could include having two PC monitors to allow access to different electronic systems simultaneously. This would allow access to the GP clinical system and document management systems at the same time and reduce the risk of missing important information toggling between two systems on one screen.

Ensure GP practices, particularly large practices, consider identifying a “go-to” GP with a particular interest in perinatal mental health. This may help minimise inconsistencies in the approach and response of different GPs to perinatal mental health issues.

Review the protocols in place between primary care, specialist teams and other agencies to ensure effective communication and information sharing.

Ensure that there is local good practice guidance on discharge planning in keeping with the Service Standards developed by the RCPsych PQN.

Ensure that patients treated with antidepressants are reviewed in line with NICE and local good practice guidance.