Dr. Margaret O'Riordan:

Deputy Buttimer, members of the Joint Committee on Health and Children, ladies and gentlemen, I am thankful for the invitation to the Irish College of General Practitioners to present on the protection of life during pregnancy Bill. This is an extremely important Bill. The college welcomes the opportunity to be involved in the legislative discussions.

The general practitioner has a key role in supporting women during pregnancy. By way of introduction, I am a general practitioner and medical director of the Irish College of General Practitioners. I am accompanied by Dr. Seamus Cryan, president of the Irish College of General Practitioners, Dr. Darach O'Ciardha, chair of communications, and Mr. Kieran Ryan, chief executive officer.

Established in 1984, the Irish College of General Practitioners is responsible for postgraduate specialist medical education, training and research in the specialty of general practice. The college also provides an extensive range of practice management services focused on the effect of organisation of general practice. The college has a national advisory role in relation to clinical standards and it interacts regularly with the number of bodies, including the Medical Council, the Department of Health, the Department of Children and Youth Affairs, the Health Service Executive and the Health Information and Quality Authority, among others.

As a membership organisation, the Irish College of General Practitioners is responsible for providing continuing medical education for established general practitioners, who number more than 2,500 at present. The mission of the college is to serve the patient and its members, general practitioners, by encouraging and maintaining the highest standards of general medical practice. The core values of the college are quality, equity, access and service to the patient. The college has provided guidance for its members on the management of crisis pregnancy since 1995 and the latest guidance is available on open access on the college’s website.

At this point I would like to clarify that I am representing the specialty of general practice. Individual general practitioners have diverse views on this issue.

In the majority of cases, a termination of pregnancy is a decision taken as a last resort and in great distress. The college believes that the structures, resources and systems to support women during a crisis pregnancy should be enhanced. There is a need to improve access to social supports, counselling and psychology services. Perinatal psychiatry should be a priority for the Government in supporting women in crisis pregnancy.

The general practitioner is usually the first point of contact a pregnant woman has with the health service. The general practitioner has a key role in supporting women during pregnancy. All pregnant women are entitled to free antenatal care under the mother and infant scheme.

Current obstetric practice does not place a patient in the care of an obstetrician until 16 to 20 weeks gestation. General practitioner care is immediately available to every pregnant woman, and general practitioners routinely play a supportive role to women through the provision of antenatal and postnatal care. The general practitioner has knowledge of the woman's past medical and psychological health and of her social supports. In many instances, this knowledge extends over a number of years. General practitioners view every patient as an individual and care for them in their unique circumstances. Therefore, the general practitioner has a vital role in the assessment of risk. This role is supported by the expert group's report, which suggested "it may be appropriate that general practitioners are consulted as a matter of best practice in the course of the diagnostic process. This would provide access to their knowledge of the patient and establish continuity of care for the woman after the treatment has been delivered".

Consultation with a general practitioner should take place only with the woman's consent, and the importance of confidentiality should be emphasised in all aspects of the Bill. The current heads of the Bill could be strengthened in this regard. The legislation should not be enacted until a specific, well-defined referral pathway is in place with appropriate professional support. General practitioners will usually be the first persons to whom a woman with a crisis pregnancy presents, and they will need to know exactly how to refer the woman in a timely manner. The general practitioner has an important ongoing role as patient advocate and in providing non-judgmental support to women who have been involved in this process, regardless of whether they have had a termination.

The Irish College of General Practitioners recommends that the Department of Health commission an independent guideline consortium to develop evidence-based national clinical guidelines to underpin implementation of the legislation. Following the guidance provided by the national clinical effectiveness committee, this process should involve health care professionals and patients in the guideline development process and employ internationally agreed standards of guideline development methodology. The Irish College of General Practitioners has experience in this area and is willing to take an active role in the development of these guidelines.