Education
The core curriculum is divided into 14 Capabilities in practice (CiP’s). Each CiP outlines the key skills expected, along with a set of descriptors to help assess progress.
Within the curriculum specifically the following CiP’s address aspects of patient centred care
CiP 1 – the doctor is able to apply medical knowledge, clinical skills and professional values for the provision of high quality and safe patient-centred care. Facilitates discussions, modifies their approach to the patient when cultural background or personal values may have an impact on engagement and care. Ability to facilitate women’s decision making, shares information with patients and their families clearly, in a timely, non-judgmental fashion and facilitates communication (including use of a translator, advocate or supporter when needed)
CiP 13: The doctor is able to champion the healthcare needs of people from all groups within society: Promotes non- discriminatory practice and recognises how health systems can discriminate against patients with protected characteristics and works to minimise this discrimination. Is able to perform consultations addressing the specific needs of a disabled person and being mindful that not all disabilities are visible. Understands the specific needs of transgender and non-binary individuals and is able to perform consultations and refer appropriately to specialist services
Guidance
The Roles and Responsibilities of Consultant guidance references the role of the consultant as a patient advocate and in modelling respect towards patients and empowering them. ‘In any situation, consultants must respect the diversity of women, their individual risks and opinions thus promoting personalised care within a standardised framework. This is a fundamental tenet of maternity care.’ The guidance also supports that ‘Typically for an obstetric ward round, the midwifery coordinator, obstetric consultant, junior tier and anaesthetic team should be present. However, it is not essential for all those present on the ward round to enter the room of each woman. All team members should be mindful of patient dignity and preferences during labour. This is particularly the case for women in active labour, those separated from their babies immediately after birth and those who have suffered a pregnancy loss. If all team members do not see all women, it remains important that information is shared with all team members and everyone can input into the woman’s care.’
The Workforce report highlights that family involvement and choice is paramount “Delivery of person-centred care relies on prioritising the needs and preferences of women. This extends to ensuring the involvement of women and their families in investigating adverse events, enabling their views to be heard, valued and respected.” The report also supports the gathering of patient feedback to truly learn from women, and ensuring to include diversity of opinion to understand the needs of all women who receive O&G care, irrespective of age, ethnicity or location in the UK.
Advocacy
Addressing Inequalities
The College have issued a statement on maternity care for women in prison in England and Wales. Women in prison should have access to high quality maternity care that is equitable to all other women living in the community, and the prison system must ensure that imprisonment does not compromise maternal or neonatal outcomes.
Existing policies and practices relating to the care of refugee, asylum seeking and undocumented migrant women – particularly in England – disrupt antenatal, intrapartum and postnatal care, prevent women from accessing services and ultimately influence maternal and perinatal outcomes. Access to timely, safe and appropriate maternity care should not depend on a woman’s immigration status or ability to pay. Addressing additional barriers to a safe pregnancy experienced by migrant women is a vital part of ending the UK’s persistent inequities in maternal and perinatal outcomes. A College position statement on access to maternity care for refugee, asylum seeking and undocumented migrant women
The College have worked with Fivexmore to develop 5 steps for healthcare professionals to help reduce inequalities in maternity care. This sets out five actions for healthcare professionals to adopt that will help drive change, change attitudes and put an end to these devastating inequalities.
Maternal Mental Health
Mental health is now recognised as a national priority by Government. In particular, we need more focus on the mental health journey and issues which face pregnant women and new mothers. The RCOG has launched the results of a survey of over 2300 women about their experiences of mental health problems during and after pregnancy.
Projects
The Tommy’s National Centre for Maternity Improvement (the Centre) is an alliance of the Royal College of Obstetricians & Gynaecologists (RCOG), the Royal College of Midwives (RCM) and Tommy's set up to reduce the number of babies born prematurely or stillborn each year in the UK. The Centre has developed an online clinical decision support tool, a web application shared by maternity care professionals and women and pregnant people, to help improve maternity care by reducing variation in care. The tool provides decision support, informing pregnant women and people directly of their care recommendations according to their personalised assessment of needs during pregnancy and enables them to take informed decisions about their care as well as to self-advocate where care may not have been offered in line with recommendations on their care pathway.