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Graded Care Antenatal (GCP2A)

About the tool

An evidence-informed assessment tool to help professionals understand potential risks and support parents

The antenatal period and early years of a child’s life can have a profound impact on their future physical and emotional safety and wellbeing. It’s important that parents are given support to provide the best care for their developing baby and newborn infant1.

Graded Care Antenatal (GCP2A) helps a range of professionals working with expectant parents to identify areas of strength and areas where they may benefit from support.

How it works

The tool is split into three sections. Each section uses a graded scale of 1 to 5 where 1 indicates no concerns and 5 indicates high concerns.

Sections one and two focus on the antenatal period. Section one is designed to be used at the earliest point in the pregnancy when expectant parents comes into contact with services - or can be completed when concerns arise. Section two is completed when there are areas of vulnerability or concern identified in section one.

These sections cover physical safety and the emotional and developmental consideration the expectant parents give to the unborn baby. Section three covers the early postnatal period (birth to three months) and looks at the quality of care given to the baby.

The tool includes areas of known risks that are linked to safeguarding concerns in babies. It will help professionals build a picture to identify where concerns emerge in relation to the impact on the developing baby. It can also be used as an indicator for potential safeguarding issues after birth.

Graded Care Antenatal is a reflective tool which highlights areas for professionals to explore when making decisions. It grades what is currently happening but doesn’t look at the reasons or causes for what is happening. This tool should be used to inform a wider assessment of need.


Gerhardt, S. (2004) Why love matters: how affection shapes a baby's brain. New York: Routledge.

Ready to find out more?

If you’re interested in finding out more about Graded Care Antenatal, email

Background and evidence

Background and evidence

Graded Care Antenatal (GCP2A) builds on the GCP2 tool and was developed in response to feedback from sites delivering GCP2 and a request from the Family Nurse Partnership (FNP) Central Unit (part of the Early Years Directorate at Public Health England) to develop an antenatal version of the tool. Our insights analysis also highlighted there was a gap in provision for an evidence-based tool for pregnancy and early years.

We designed the tool in collaboration with Dr Srivastata, who created the original GCP tool, and practitioners. We then worked with eight NHS trusts and local authorities to help us understand how effective the tool was.

Phase one: initial testing

Phase one aimed to find out how practitioners, parents, service leads and experts viewed and experienced the antenatal tool - and how we could improve it.

We approached practitioners and families for their views on the tool’s language, accessibility and usability. We asked how it impacted practitioners’ decision-making, how families found the process of being assessed, and how behaviour had changed as a result of the assessment. The findings from the phase one evaluation were reviewed in September 2022 and it was agreed the project should move to phase two.

From the feedback we further consulted with practitioners who used the tool to further develop the tool. This version will then be used from the inter-rater reliability testing.

Phase two: inter-rater reliability

All tools should be exposed to inter-rater reliability testing. This tells us if the tool tests what we want it to. It also demonstrates how close the results are when two individuals use the tool with the same family. This phase of testing is expected to conclude in early 2024.