Leith has 11 teams where each team has the equivalent of between 7.6 to 13 WTE in each team. They serve around 2000 births per year. This is a fifth of the births in the Lothian area as a whole.
Continuity of care is for antenatal and postnatal period with the aim of reaching 85% of the care being delivered by the named midwife and no more than 3 midwives being involved in their care. This is for approximately 7 to 9 appointments in the antenatal period and between 2 to 10 visits in the postnatal period which takes place within 3 days of the birth and for 10 days or more. The service provided is from 9am to 5pm, 7 days a week.
These visits are at taking place at home at the moment, however this may change in the future with GP locations being sought. There are drivers in place for combined visits with Health Visitors and this is being operated successfully in this model.
Prior to the introduction of caseload, women were seen by GPs and more than 3 midwives without continuity being the priority. Caseloads for midwives were variable with up to 200 for some midwives and others with far less.
Additional points mentioned include:
– reduction in sickness-absence amongst staff since the introduction
– rostering has to take into account 8weeks annual leave given seniority of the staff
– Leith is in mixed area for social status although this is not aiming to target any particular group
– electronic systems are in place for easy monitoring and laptops etc. are all provided for the midwives
– there is general enthusiasm from the staff about the model
– Rosters are planning in 8-9 week periods and all staff are required to be at least 0.5 for part-time, so there is the possibility of rostering a WTE as shared posts.
The current model is based on a centralised booking system with manual checks to ensure that caseloads are divided appropriately based on expected time of birth. The aim is to maintain caseload at 95 per midwife. GP locations could be used for the appointments, but this is under negotiation as the team would the flexibility to schedule appointments for women not registered at the GP surgery itself.
The current model has been running for 6 months, is still in early stages and can be used to document the change process. There is a birth centre at the Royal Infirmary and a consultant-led unit for the intrapartum care. Edinburgh also has a Pregnancy Centre for general information which may be relevant for the system approach. Maria will have access to 0.5 post for a research midwife and they have academic links in Lothian to support this process.