The 9 caseloading teams that operate at Guys and St Thomas work across different geographical areas or based on a particular client group. The teams were first established in 1996 and a Caseload project/service innovation project was started in 2005 for complex case mix.
The projects was looking to achieve the following:
Outcome 1: Community based caseload model of care for women of social and medical complexity living in areas of deprivation is acceptable and feasible
Outcome 2: The model contributes to the delivery of national targets on choice and the reduction of inequalities /promising trends for improved maternal and infant outcomes
Quality and safety were measured and found to have positive impact including:
- 18% Reduction of DNA
- 8% Increase in HB
- 40% Increase in continuity of care
- 35% increase in the quality of information and contact with a midwife
More information about the teams are available online through the London Strategic Clinical Network (PDF document).
Here are some questions and answers about how the teams work directly from the Trust.
1. Whether the midwives in the teams had specialist training,
There is no special training but depending on speciality of the team they attend courses such as diabetic study day, mental health, etc.
2. Are they all full-time?
Yes, it is difficult to manage a fair rota and maintain continuity, so only one team manage job shares.
3. What proportion of women had the lead professional or partner present for labour and birth?
For lead professionals in community teams, about 60% to 70% are getting the lead professional or partner, providing the teams are full. However in high risk teams due to a highly prescribed schedule and teams being in high demand, the continuity of care in labour is poor 30%. Majority of women attend with their partners who can stay overnight on the postnatal ward but the figures are not available.
4. What happened when the women went to a unit, do they follow as an additional member of the team in the unit?
Yes for community teams, the midwife on call for the team comes in when they are called by either the woman, or midwife in charge as sometimes women go straight to labor ward. High risk teams however have rostered shifts and they are part of labour ward safe staffing rota. This is under review at the moment.
5. What type of on-call they have and what type of rota did they work?
Community caseload have 12 hour on-calls.
6. What is the caseload for the teams working with a continuity model?
I don’t have exact figures but on average community caseload have 250 per year for a team of 6 midwives. High risk teams are based on 30% of a caseload of 700 per year with two teams of 7 midwives.
7. And how long has the continuity teams been in place?
The original caseload dates back to early late 90s and has evolved, the last caseload team was set up in 2008.
8. What is the definition of continuity that is being used for your teams?
Community caseload teams is classified as team of 6, two models combination of shared caseload and team caseload.