Implementing A Framework for Maternity ... - Scottish Government

Midwifery
11. Midwives face significant challenges to their traditional patterns of working. They need to
adopt innovative approaches to care and build on, enhance and refresh their skills and
competencies to provide a modern maternity service. Alongside enhanced responsibilities,
this will bring more autonomy, confidence, and different working relationships within
maternity service delivery teams. These changes will require investment of resources and
time to enhance all maternity professionals’ existing skills and competencies. Nevertheless,
services should not suffer.
Hospital doctors
12. Doctors in training have traditionally provided a large proportion of direct medical care.
Continuing tensions between training and service imperatives can be anticipated, particularly
at Senior House Officer (SHO) grade.
13. The Scottish Executive is currently consulting on the proposals contained in the Unfinished
Business report on reform of the SHO grade. The report argues that after graduation, doctors
should enter a two-year foundation programme. Any such reform of training at SHO level will
impact on the hours of service delivery by SHOs, and therefore on the working patterns of
doctors at other grades and other members of the clinical team.
14. The new consultant contract sets the expectation that consultants will provide an increasing
proportion of direct care, and will also revise remuneration for out-of-hours work. The contract
offers an opportunity to recruit and retain consultants for all aspects for intrapartum care.
General practitioners
15. GPs are important in helping provide intrapartum care, particularly in remote and rural
areas. But fewer GPs are willing to take training in obstetrics and be involved in intrapartum
care. The moves to a new contract for GPs, with maternity care being designated as an
‘additional’ or ‘enhanced’ service, may also have an impact on the way GPs contribute to
the care models of the future.
16. These developments make it imperative that planners of maternity services take a strategic
look at workforce issues.
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