Midwifery Continuity of Carer (MCoC)
The RCM Position Statement 2018 promotes and supports the Maternity Transformation Programme (MTP) ambition for MCOC as set out in Better Births 2016.
There is research knowledge showing how MCoC can make a difference for women and midwives but not necessarily on how to establish continuity teams and enable them to also work for maternity staff and be sustainable. It is acknowledged that outcomes and experience are improved in healthcare for those who receive care delivered by the same health care professional or team and that RCM members would aspire to a high standard of care provision for all women and families.
In 2020 deliverable targets for implementation for MCoC to become the central model of maternity care by March 23 were set by NHSE/I. However due to staffing levels and issues with sustainability of some team models, concerns with the implementation of MCoC across many services were raised by members including midwifery leaders.
Gill Walton RCM CEO and General Secretary highlighted in her blog Jan 2022 that despite some areas of success, for many providers there were concerns about workforce and safe staffing and unintended consequences to some areas of maternity services that made moving forward with further implementation safely difficult. These difficulties were acknowledged by the Maternity Transformation Programme (MTP) and the requirement for Local maternity and neonatal systems (LMNS) implementation action plans to be submitted were delayed.
The guidance for the need for building blocks to be in place and implementation to be done at a pace sustainable for the services as set out in the NHSE/I planning guidance - Delivering Midwifery Continuity of Care at Full scale –Guidance on planning, implementation and monitoring was also reiterated by the MTP and welcomed by the RCM .
These building blocks include having a safe level of midwifery staffing; adequate funding; dedicated project management and leadership; coproduction and consultation with all those affected by the change including all staff and service users.
Members often ask what role does the RCM play in the implementation of the MTP MCOC policy?
The RCM role as a professional body and Trade Union is to support our members in implementing the NHSE/I national policy for MCoC where it is possible in a safe sustainable way with the building blocks in place. Implementation to date has been successful in some services but in many areas has led to a significant shift in working environments and normal place of work for many midwives which they believe have impacted on their ability to deliver safe hospital based and community care.
Education and training
The RCM has since the publication of Better Births supported the education of our members and supported managers and services with organisation change processes to move forward with implementation of MCoC teams. We have produced educational sessions, support tools and publications these include:
i-learn modules on Midwifery Continuity of Care:
Introduction to Midwifery Continuity of Care
This module provides short easy to understand summaries of current research evidence on this topic, together with brief overviews of the current national maternity policies that recommend continuity of carer. It also includes interactive resources to bust some of the myths that we know are out there and lessons from the front line helping us learn from earlier successes (and failures) in establishing sustainable continuity models.
Implementing Midwifery Continuity of Carer
This module enhances and deepens the knowledge and understanding of midwifery units (MUs), so that midwives can support women with their choice for place of birth. It will enable midwives and other maternity care providers to feel more confident and informed when supporting women to choose care within a midwifery led setting following continuous assessments.
The MCOC What if? Series focuses on key aspects of the model and core principles that can help and guide continuity teams in sustainable planning and implementation. The series draws not only from the knowledge of MCoC experts but also from case studies of teams operating in the UK and internationally.
The series includes:
Focusing on good rostering practice, including self-rostering and contractual and legislative principles.
This publication focuses on how to engage staff and get them involved in co-production of local service to improve care.
This publication focuses on the role of the MSW can be embedded in continuity models. It is directed at midwives working in continuity models wondering how MSWs can support and at MSs considering working or currently working within and around MCOC teams.
Exploring the role of student midwives on placement with continuity teams and how educators, midwifery managers and midwives can best support them.
Wondering about pay and pension? Exploring the different remuneration models for those working in continuity teams and their effect on pensionable pay.
The RCM has stated that it is vital that difficulties with organisational change and concerns from midwives and the wider maternity teams are discussed and solutions found.
The RCM therefore has supported managers to positively lead change and support members where they have challenges in adapting the way they work, this included publishing these country specific employment rights and regulations documents:
- Continuity Models: The ‘Nuts and Bolts’ Scotland- employment rights and regulations guide relating to continuity (RCM, 2018)
- Continuity models: The 'Nuts and Bolts' - England and Wales- employment rights and regulations guide relating to continuity (RCM, 2018)
The RCM on behalf of its members has also repeatedly highlighted issues with implementation and the need for the workforce concerns to be addressed:
- Blog highlighting links between safety and MCOC implementation: Maternity under the spotlight (rcm.org.uk);
- We must get workforce planning rights says RCM submitting evidence to workforce consultation
- Power in numbers: the future of maternity services (rcm.org.uk)
- June 2020 saw the RCM write to members sharing our position on further continuity roll out during the pandemic
- 2021 Midwives Magazine article by Head of Policy highlighting staffing and implementation concerns.
- August 2021, saw a letter from RCM to CMO NHSE sent and shared with our members
The RCM will continue to influence at national, regional, and local level to ensure that solutions are found to resolve the concerns raised with the implementation of MCoC and ensure plans for further rollout have the safe staffing levels in place with a sustainable workforce plan going forward.
Where the foundational building blocks are not yet in place for implementation of the full pathway MCoC across maternity services, the RCM would recommend seeking to increase the level of midwifery continuity provided in the antenatal and postnatal periods. All women, whatever the model of maternity care, must receive continuous one to one support from a midwife throughout active labour.
The RCM will continue to work locally to influence working practices to ensure that all midwives and maternity support workers have appropriate pay, working conditions and an appropriate home life balance to enable them to deliver safe midwifery care to all.
Data analysis, evaluation, and research of MCoC are ongoing which the RCM welcomes.
The RCM would like to see this include some issues that have arisen during the implementation phase, these include determining:
- Evidence at service level to compare implementation across the whole pathway compared with 100% antenatal and postnatal care.
- A review of the unintended consequences of implementation where the building blocks may not have been in place.
- Sharing the evaluation of the full continuity pathway for very vulnerable women and women from minority ethnic groups so this is prioritised.
- Evaluation of the sustainability of the full range of implementation models.
- Determine what resource is needed to move forward.
- Consider how to ensure obstetricians and other members of the maternity team can provide continuity.
Other publications and training provided:
- Dec 2017 ‘Can Continuity work for us? interactive workbook for members
- 2017-2018 Workshops in Scotland and 8 regional workshops for maternity staff prior to roll out of NHSE training.
- 2018 RCM internal training and sessions at annual and activists conferences.
- 2018 Launch of “Continuity Counts" Game
- RCM represented on all four UK national implementation and planning groups for MCOC.
- 2019 Midwives Magazine article highlighting implementation issues pdf (rcm.org.uk)
- RCM Employment principles for developing continuity teams in England when an inclusive pay arrangement is proposed
- Monitoring and evaluation framework