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Implementing A Framework for Maternity Services in Scotland
Education, Training and Workforce Issues
1. The report of the Education, Training and Workforce Issues Subgroup of
A Framework for Maternity Services in Scotland described the challenges in developing a well-equipped and well-resources obstetric workforce. The report concluded that local solutions, combined with significant resources, are required to ensure a high-quality maternity service for all women in Scotland, irrespective of geographical location.
The competency approach
2. The EGAMS has defined and described the competencies maternity care professionals need to provide effective and safe care for low-risk women and to manage obstetric emergencies within remote and non-specialist units. Competencies have subsequently been developed to cover all types of maternity care facilities in Scotland; all staff must achieve the range of competencies set for low-risk care (Level I), and specialist staff will need to achieve those at Levels II and III.
3. All the competencies correlate to established good practice. They are designed to ensure that all professionals working in maternity units have the confidence, skills and attitudes to deliver a consistently high standard of care, to ensure patient safety and comply with the requirements of good clinical governance. The full description of the competencies can be found in Appendix 3.
Principles |
3.1 Maternity care professionals working in units throughout Scotland should achieve the competencies appropriate for the level of care their Unit provides. 3.2 Maternity care professionals should identify present and required competencies within their individual job descriptions, personal development plans (PDPs) and continuing professional development (CPD) portfolios. |
Continuing professional education and training
4. Once achieved, it is vital that competency-based practice is maintained. This may be relatively easy to achieve in larger units caring for large numbers of women. In smaller units, and in units in remote and rural areas there are likely to be fewer opportunities. These units will need to collaborate with other larger Units to ensure that professionals have the chance to update their skills, knowledge and competencies on a regular basis. They should consider innovative approaches to training and CPD, for example using video-conferencing to enable staff to participate in educational events.
Principles |
3.3 Small units and those in remote and rural areas should consider using computer technology to enable staff to update their skills, knowledge and competencies on a regular basis. 3.4 Staff in small and remote and rural units should be offered opportunities to take clinical placements/secondments in larger units as a means of updating skills, knowledge and competencies. |
5. Even in the larger Level III units it is important not to be complacent about maintaining skills. Larger numbers of professionals may be vying for opportunities to develop their skills and competencies, reducing the potential 'bank' of developmental opportunities.
6. It is therefore crucial that, in addition to CPD opportunities offered by employing organisations, maternity care professionals take some responsibility for the maintenance and development of their own skills, knowledge base and required competencies. This might include formal or informal education through study at a university or other education institution; private study, conferences and study days, meetings with colleagues, clinical placements, clinical rotations and visits, all of which can serve to maintain and develop competencies. Wherever possible, new learning opportunities should be designed to meet the needs of a multi-disciplinary audience.
Principles |
3.5 Maternity care professionals should share responsibility for their educational development, in partnership with their employing organisations. They should explore and undertake a variety of uni- and multi-disciplinary CPD opportunities. 3.6 Maternity units and Regional Services should explore options for delivery of CPD activities within multi-disciplinary settings. |
7. At higher education level, a co-ordinated programme of learning opportunities leading to the award of academic and/or professional credits should be developed to reflect the competencies set for each level of maternity service. They should also, whenever possible, have a multi-disciplinary focus.
Principles |
3.7 A national, post-registration, multi-disciplinary curriculum for maternity services in Scotland should be established. NHS Boards and Trusts, NHS Education for Scotland, professional bodies and education providers should form an alliance to plan and deliver the programme. 3.8 A Lead Co-0rdinator for maternity services education should be identified within NHS Education for Scotland to oversee the development, delivery and evaluation of the education programme. 3.9 Education curricula at post-registration level should reflect the competencies set for different types of maternity services delivery. |
Workforce issues
8. Maternity services in Scotland are facing challenging workforce pressures. Solutions will require NHS Boards and Trusts, individually and collectively, to identify and plan workforce requirements for the full range of maternity services in their areas. They will need to work closely with the regional and national mechanisms introduced in the national action plan on workforce development,
Working for Health, to align workforce and service planning in NHSScotland.
9. Traditional workforce planning approaches are no longer sustainable. Meeting the needs of the future will require creative thinking about how to make sure that multi-disciplinary teams have the skills and competencies necessary to provide the highest standards of care. Options for action will need to include alternative working patterns and changes in the composition and deployment of staff from different professions and disciplines.
10. Some of the key workforce drivers (such as the
New Deal for Junior Doctors and the
European Working Time Directive) are primarily concerned with achieving safer working conditions for employees and, as a result, enhancing the quality of care for NHS service users. The enforcement of limits on the extent to which care can be provided by trainees and constraints on medical and midwifery hours of work are undoubtedly welcome, but nevertheless increase pressure on services.
Midwifery
11. Midwives face significant challenges to their traditional patterns of working. They need to adopt innovative approaches to care and build on, enhance and refresh their skills and competencies to provide a modern maternity service. Alongside enhanced responsibilities, this will bring more autonomy, confidence, and different working relationships within maternity service delivery teams. These changes will require investment of resources and time to enhance all maternity professionals' existing skills and competencies. Nevertheless, services should not suffer.
Hospital doctors
12. Doctors in training have traditionally provided a large proportion of direct medical care. Continuing tensions between training and service imperatives can be anticipated, particularly at Senior House Officer (SHO) grade.
13. The Scottish Executive is currently consulting on the proposals contained in the
Unfinished Business report on reform of the SHO grade. The report argues that after graduation, doctors should enter a two-year foundation programme. Any such reform of training at SHO level will impact on the hours of service delivery by SHOs, and therefore on the working patterns of doctors at other grades and other members of the clinical team.
14. The new consultant contract sets the expectation that consultants will provide an increasing proportion of direct care, and will also revise remuneration for out-of-hours work. The contract offers an opportunity to recruit and retain consultants for all aspects for intrapartum care.
General practitioners
15. GPs are important in helping provide intrapartum care, particularly in remote and rural areas. But fewer GPs are willing to take training in obstetrics and be involved in intrapartum care. The moves to a new contract for GPs, with maternity care being designated as an 'additional' or 'enhanced' service, may also have an impact on the way GPs contribute to the care models of the future.
16. These developments make it imperative that planners of maternity services take a strategic look at workforce issues.
Developing the maternity workforce - investing in skills
17. Developing the maternity services of the future relies on developing a workforce that has the appropriate skills, attitudes and competencies to deliver safe, clinically effective care across all types of service. Education and training are key to workforce development.
Principles |
3.10 Integrated workforce plans for maternity services should be driven by the core competencies necessary for the safe and clinically effective delivery of services. The involvement of the full range of education providers in this process is crucial. 3.11 Opportunities for multi-disciplinary education and training should be maximised. |
18. The maternity services workforce faces similar pressures to the rest of the health workforce and the solutions, for the various professional groups involved, will follow the same pattern. The need to plan and organise maternity services at regional level has been emphasised in this summary overview report. This is consistent with the general thrust of the new workforce arrangements, which aim to integrate workforce planning with service planning at regional level. Already, with Level III maternity specialist sites in the North, East and West of Scotland, there is a sound basis for consolidating models of service provision - and with them the workforce arrangements - that are necessary to meet the various requirements of the service.
19. Each of the three regions will have workforce planning co-ordinators in place to assist integrated workforce and service planning. The Regional Workforce Planning Co-ordinators will work closely with the National Workforce Committee, developing national strategies for workforce issues for all staff groups and specialities.
Principles |
3.12 NHS Boards and Regional Service Planning Groups should work closely with Regional Workforce Co-ordinators on workforce development issues. 3.13 Specialist staff should be available to undertake some duties on a regional basis. |
Remote and rural issues
20. Remote and rural areas of Scotland present particular challenges for the provision of maternity care and need innovative ways of accommodating and supporting pregnant women in remote and rural parts of the country before, during and after childbirth. Innovative solutions to local problems may require professionals to develop a different range of skills and devise different arrangements and patterns of provision.
Principles |
3.14 Maternity courses should be set up for midwives, obstetricians, GPs, paramedics and other health professionals working in remote and rural areas. This will help to ensure that these professionals receive the appropriate education and support to equip them to make decisions about care and know when to refer to specialist maternity care professionals. 3.15 GPs in rural and remote areas must be trained and competent to care effectively for pregnant women and their babies. Most GPs in remote settings will be involved (directly or indirectly) in the delivery of maternity care, especially in cases where the mother has an illness which may require GP input. 3.16 Other health professionals' role and competencies should be reviewed in relation to delivering a safe and effective maternity service in remote and rural areas. |
21. New arrangements for considering workforce development alongside service planning will be overseen by a national Maternity Services Workforce Group, which will promote a skills and competency driven team-based approach. Multi-disciplinary training and development will be a feature and special consideration will be given to the issues in remote and rural areas.
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