Guidance
The Workforce report has a chapter dedicated to flexible working. Flexible working is not just about the working arrangements of individuals but is also about creating ways of team working which promote flexibility, resilience and cultures of co-operation within organisations. This recent blog by Dr Jo Mountfield, discussed the findings of the 2022 Workforce Report.
The Roles and responsibilities of the consultant presents recognised methods and techniques for clinical practice, based on published evidence, for consideration by obstetricians/gynaecologists and other relevant health professionals. This comprehensive report acknowledges adequate staffing: “Levels of activity have been recognised as an important determinant of patient safety. While inadequate activity may hamper training opportunities and hence the ability to maintain technical proficiency, excessive levels of activity may increase likelihood of errors or impair patient experience.”
A Good Practice Paper (No 10) on Labour ward Solutions is aimed mainly at those responsible for implementing the RCOG and Clinical Negligence Scheme for Trusts (CNST) maternity standards. It highlights the many challenges and issues that arise from the process of expanding consultant presence on the labour ward and presents facts, helpful tips and potential pitfalls that may be encountered by those responsible for implementing changes.
Another Good Practice Paper (no 17) on Maternity Triage is directed at stakeholders responsible for developing and improving maternity services. It presents the recommendations for the operational structure and pathways within maternity triage to improve safety and experience for both women and staff, through prompt standardised initial assessment and the use of symptom-specific algorithms to determine urgency, and outlines the key requirements for successful implementation.
Currently there are widespread shortages of suitably-qualified obstetricians and gynaecologists who can safely undertake the role of senior resident doctor out of hours with indirect supervision from a consultant who is non-resident. You can find all our guidance on safe staffing.
The RCOG has developed this guidance on the engagement of locums in maternity care in collaboration with the NHS. A locum can also be a doctor in a short-term placement who is an employee of the organisation for a short, fixed term. There may also be doctors in training who work as locums outside their training. An NHS certificate of eligibility for locums in O&G will be a pre-requisite for employment of short-term locums for tier 2nd and 3rd on call rotas (2 weeks or less) from February 2023. There is guidance on the Certificate of Eligibility for short-term locums (CEL) and guidance on long term locums (longer than 2 weeks).
The College has also produced position statement on ensuring safe out of hours support for complex emergency obstetric and gynaecology surgery.
The College has also produced guidance on consultants and SAS doctors acting down to cover short-term absence. This guidance is about situations where units are unable to cover their O&G service requirements at short notice, primarily because of sickness absence, by either using their own junior medical staff or employing external locum doctors. When this happens, usually out-of-hours, cover may need to be provided by consultants or SAS doctors.’
Guidance on compensatory rest. The guidance references the challenges of providing cover in small units, however a mechanism to facilitate compensatory rest must be in place and this should be actively supported by the management team, with constructive discussion between clinician and manager or clinical director rather than the decision to take rest being left to the individual consultant. Clinicians must consider the effect of disturbed sleep on patient safety and their own welfare. Similarly, there are situations such as when a consultant has been present and working overnight in the unit, with inadequate rest, where managers should ensure that clinical activity is not undertaken by a consultant even if they express a wish to do so.’
The College can also support the job plan approval process for new consultants. This is a transparent approach to job planning linked to developmental objectives of the new appointee and the department.
Advocacy
In response to The Safety of Maternity Services in England Report (House of Commons Health and Social Care Committee 2021) the College jointly responded with the RCM to support that “maternity staff have been working incredibly hard, under extraordinary pressure for many, many years to deliver the safest and best possible care”.
Projects
The RCOG have been commissioned by the Department of Health and Social Care to develop the Workforce Planning tool to more accurately quantify the number of obstetricians and obstetric anaesthetists required in maternity units in England taking into consideration factors such as existing staffing levels and predicted population changes.