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Continuity of Carer Midwifery guarantee

Continuity of Carer is a key implementation challenge for our current Maternity Transformation Programme and NHS LTP - with a target of the ‘majority’ of women receiving this carer by 2021. As yet only about 1/3 of midwives are both willing and able to provide CoC models of care. 

My networking and consultation suggests that concerns about understaffing / overwork are preventing midwives volunteering for CoC and a guarantee for conditions would increase uptake; incentivise some PT midwives to increase hours; and attract some to return to practice in the NHS. 

The four components of safe staffing of CoC are set out in Maternity policy but not all trusts are implementing them. Some are also threatening staff with transfers to these teams without their agreement which is making attracting staff more difficult: 


The guarantee: 


A place for 3 years minimum for any midwife who has reached band 6 and who requests work in a CoC team. 

A place of 1 preceptor per team made available.

A 5 year guarantee to 2024 for only ‘willing and able staffing’ (no rotation without request) 

Conditions guarantee of: 

1, Maximum caseload ratio per WTE RM of 36 women (and their babies) per year. Less if social or obstetric complexity.

2, Autonomy for working pattern with midwives having control over own diary in a system delegated to each team to agree. 

3, No call to staff other areas unless the unit is about to close. SOP (as per Chelsea and Westminster best practice excludes CoC midwives from escalation until a specified manager on call decision) 

Models set up in teams of 4-8 WTE RM but maximum 8 Individual RM per team (so PT staff working in job share if required but no more than 8  people as MW staff - may have additional support staff)

Link obstetrician for each team to champion MDT support. 

4, Teams set up to enable the named midwife to personally provide the majority of scheduled care for antenatal and postnatal care - The named midwife to personally provide intrapartum care with back up from known-to-the-woman members of the team in a system the team mutually agree  with a KPI women are attended by < or =4 midwives for scheduled and intrapartum care (this balances the need for relational care as per evidence with autonomy and workload) 

edited on 30th March 2019, 15:03 by Rachel Wild

Tanveer DHSC 1 month ago

The idea has been progressed to the next milestone.

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Rachel Wild 1 month ago

this is very difficult to link to social media - no success getting a link or URL

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