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Continuity of Carer

Mary Ross-Davie - RCM Director for Scotland
29 November, 2018

Continuity of Carer

Midwifery Continuity of Carer (MCOC) is a big issue in maternity care.  The Scottish and English maternity polices published since 2016 both recommend that MCOC becomes the central model of maternity care in both countries.  The RCM team is committed to ensuring that midwives and maternity teams across the UK feel well prepared and supported to make this big change to the way we work and the service that women and families can expect.

To this end, the RCM has set up a team to work together across the UK to develop resources for our members, which includes members of RCM staff with employment relations and professional perspectives. We have updated our position statement on MCOC to reflect the conditions that we believe need to be in place to make the change sustainable and to define the RCM's role in supporting the implementation of MCOC.

Perhaps more interesting to many of you today is the announcement of the distribution of our new game, Continuity Counts. I developed the game on my kitchen table with my son a year ago: I wanted to make something that helped midwives understand what it might feel like to care for a caseload of 35 women a year, as is proposed in both the Scottish and English maternity policies. I had begun running a series of workshops across Scotland and wanted to have a resource that would be fun and interactive. The game a year ago was very "homemade", so it's pretty exciting to see it now turned into a professional product. We tested the homemade game at our workshops all over Scotland and got great feedback about how it worked and what might improve it.

So what is Continuity Counts? It's an activity with a year-long calendar board. Each of the six midwives playing the game places around 35 'baby' counters on this calendar to show how many births a team of six whole/full time equivalent midwives would attend across the year. The team then concentrate on one month and look at not only the births but also the other care and activities each midwife would be involved in: antenatal appointments and classes, postnatal appointments, team meetings and training. There are also 'elephant' and 'lightbulb' cards that can be read throughout the game to highlight some of the myths and the evidence for benefit in terms of outcomes. We have found that midwives who play the game feel that they understand more how it would feel to provide continuity of carer with a team to a caseload of women.

How can you get to play Continuity Counts? The best way to have a really good group activity session is by inviting your local RCM regional officer or your local learning organiser along to your unit or your RCM branch meeting, have several teams playing the game at the same time and then having a discussion about the issues raised afterwards. To arrange this, either speak to your local RCM branch officers or stewards and ask them to invite the RCM team, or call RCM Connect on 0300 303 0444. Each regional officer and learning organiser employed by the RCM has received training on continuity of carer and has received five copies of the game each.   

Another option, if you're still at university, is to ask your local lead midwife for education, your head of midwifery or your consultant midwife if you can borrow their copy of the game for a team session. The RCM have offered all of these lead midwives across the UK the opportunity to receive a game. They just need to email us on ContinuityCounts.Game@rcm.org.uk to let us know where they would like us to send the game.

As well as the game and the position statement, we have developed a whole range of other resources on Continuity of Carer over the last 18 months:

  1. 'Can Continuity work for us?' an interactive workbook to help you have team discussions and reflect on what is needed to develop a continuity model locally: 
  2. Midwifery continuity of carer, an e-learning introductory module available for members on i-learn: http://www.ilearn.rcm.org.uk/
  3. A publication on the employment relations aspects of continuity of carer, called the 'Nuts and Bolts' for Scotland 
  4. RCM employment relations publication The Continuity Models: The Nuts and Bolts England and Wales

The English version is available here:

  1. A range of PowerPoint presentations that we have provided to more than 80 senior midwives  across the UK in ‘train the trainer’sessions – look out for local sessions near you and find out more about continuity.

And we have lots more planned for 2019 - watch this space!


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Having recently returned to practise as a midwife after an absence of 20 years I am fascinated by the changes in our profession. And whilst I am an absolute supporter of continuity of care and recognise the evidenced benefits, I am also touched by the magic that can occur in a moment when we are truly present with and connect to anyone we work with. The reason I point this out is that in the throws of change and the reintroduction of a continuity model, let's enjoy the responsibility we have to build our self-awareness and the quality we bring to our days.