Moray Maternity Services Review: report

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