Moray Maternity Services Review: report
Report of the independent review into maternity services for the women and families of Moray, commissioned by Cabinet Secretary for Health and Sport, Jeane Freeman in March 2021.
Appendix G: Required Staffing by Model
Model 3: Community Midwifery Unit | ||
---|---|---|
Clinician Type | Staff Grade / Level | Number of staff required |
Obstetrics | Consultant WTE Middle grade or equivalent Junior doctor - part of hospital at night cover | No extra staff at Dr Gray's but additional staffing at receiving units |
Paediatrics | Not applicable | No paediatric support required for community midwifery unit |
Anaesthetics | Not applicable | No anaesthetic staff required to support community midwifery unit |
Theatre staffing | Not applicable | Not applicable |
Midwifery | Please see information on separate document | Please see information on separate document |
Model 4: Moray Networked Model | ||
---|---|---|
Clinician Type | Staff Grade / Level | Number of staff required |
Obstetrics | Consultant WTE Middle Grade or equivalent Junior Doctor - part of hospital at night cover | No extra staff at Dr Gray's. Additional staffing at receiving units likely particularly if "outreach" clinics |
Paediatrics | Not applicable | No specific paediatric input required to support community midwifery unit in Dr Gray's as part of networked model |
Anaesthetics | Not applicable | No specific anaesthetic input required to support community midwifery unit in Dr Gray's as part of networked model |
Theatre staffing | Not applicable | Not applicable |
Midwifery | Please see information on separate document | Please see information on separate document |
Model 5: Rural Consultant-supported Maternity Unit | ||
---|---|---|
Clinician Type | Staff Grade / Level | Number of staff required |
Obstetrics | Consultant WTE Middle grade or equivalent Junior doctor - part of hospital at night cover | 6-8 depending on risk assessment Middle grade - Non-essential, but may be valuable training opportunities Junior - 8 required to sustain this tier, recognising that the team may be covering a variety of specialities. |
Paediatrics | Consultant WTE Middle grade or equivalent Junior doctor - part of hospital at night cover | No additional paediatric input required to support rural consultant supported maternity unit |
Anaesthetics | Consultant WTE | 12+ (incl. current establishment) |
Theatre staffing | On-call theatre team required: (theatre nurses / operating department practitioner (ODP) / health care support workers) | Requires work force planning to be undertaken |
Midwifery | Please see information on separate document | Please see information on separate document |
Model 6: Consultant-led Maternity Unit | ||
Clinician Type | Staff Grade / Level | Number of staff required |
Obstetrics | Consultant WTE Middle grade or equivalent Junior doctor | 6 - 8 8 8 |
Paediatrics | Junior doctors trained in neonatal life support Consultant WTE | 6-8 depending on working pattern 6 |
Anaesthetics | Consultant WTE Junior doctor (trained in obstetric anaesthesia) - on call for hospital - but should be immediately available for maternity | 12+ (incl. current establishment) 6-8 |
Theatre staffing | Resident theatre team required: (theatre nurses / operating department practitioner / health care support workers) | Requires work force planning to be undertaken |
Midwifery | Please see information on separate document | Please see information on separate document |
The Midwifery Model of Care
Please note: the below suggestions are only focused on workforce for Dr Gray's. Dependent upon model, further review for Raigmore Maternity Unit and Aberdeen Maternity Hospital will be required.
Model 1: The Status Quo
Midwifery staffing – no change
Model 2: No Intrapartum Service in Dr Gray's
If this model were to be explored, and no intrapartum services were to be in Dr Gray's, this would mean that only a community midwifery workforce model would be required.
Therefore, approx. 1000 women per year = 11.1 WTE[26] midwives (caseload max 90 women)
Model 3: Community Maternity Unit linked mainly to Aberdeen
This model will require a workforce review to align with "Best Start" recommendations.
This can either be staffed by 24 hours / 7 day a week core staffing, or an on-call / rota system for when women are requiring intrapartum midwifery care. This means that all midwives would work in an integrated way across community and midwifery unit to allow a continuum of care for families as per "Best Start" recommendations.
The primary midwife will normally have a caseload of approximately 35 women at any one time, and be the first point of contact for women in pregnancy (Best Start, 2017).
Therefore, for example, with 1000 women in the area, the requirement would be 21.4 WTE Midwives for full integration for the whole of Moray area.
This could be undertaken in a stepped approach, dependent on workforce availability and implementation of "Best Start" recommendations:
Community Area | Approx. Booking per year | Approx. caseloads at one point in time | WTE MWs caseload max 35 | WTE MWs caseload max 40 | WTE MWs caseload max 45 |
---|---|---|---|---|---|
Moray | 1000 | 750 | 21.4 | 18.75 | 16.7 |
If core staffing for the Dr Gray's maternity unit is preferred, this would require 2 midwives and 1 health care assistant (HCA) on shift at all times; therefore, 10.5 WTE midwifery workforce and 5.26 whole time equivalent (WTE) health care assistant would be required to staff 24/7. Suggested for full team as below:
Health care assistant | 5.26 |
---|---|
Registered midwife | 10.52 |
1 WTE Senior charge midwife | 1.00 |
1 WTE Ward assistant | 1.00 |
Total | 17.78 |
However, again, there can be creative models explored, such as 1 midwife and 1 maternity support worker, and this would be dependent on NHS Grampian's desire to explore and risk assess safety.
Model 4: Community Maternity Unit linked to Raigmore ("Moray Networked Model")
As above in Model 3, however, on days where there are planned caesarean sections, the staffing model would need to encompass a 24-hour model. This could still be staffed by the woman's named midwife and team to ensure continuity.
Model 5: Rural Consultant-supported Maternity Unit
This would require staffing from midwifery and maternity support workers 24/7, therefore, as below:
(2 MW and 1 HCA every shift)
If 12 hour shifts
Health care assistant | 5.26 |
---|---|
Registered midwife | 10.52 |
1 WTE Senior charge midwife | 1.00 |
1 WTE Ward assistant | 1.00 |
Total | 17.78 |
If 7.5 hour shifts (9.5 night)
Health care assistant | 5.60 |
---|---|
Registered midwife | 11.20 |
1 WTE Senior charge midwife | 1.00 |
1 WTE Ward assistant | 1.00 |
Total | 18.81 |
This would then need to increase when elective / planned caesarean sections are implemented.
Model 6: Obstetric Consultant–Led Unit
This model would be an increased Intrapartum presence from Model 5; therefore, 3 midwives and 1 health care assistant would be required to staff the unit in a core manner.
If 12 hour shifts
Health care assistant | 5.72 |
---|---|
Registered midwife | 17.15 |
1 WTE Senior charge midwife | 1.00 |
1 WTE Ward assistant | 1.00 |
Total | 24.87 |
If 7.5 hour shifts (9.5 night)
Health care assistant | 5.60 |
---|---|
Registered midwife | 16.81 |
1 WTE Senior charge midwife | 1.00 |
1 WTE Ward assistant | 1.00 |
Total | 24.41 |
Contact
Email: Kirstie.Campbell@gov.scot
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