APPENDIX 45
Memorandum by Mr A S Banks (MS 54)
STAFFING STRUCTURE
OF MATERNITY
CARE TEAMS
1. The RCOG states that the Maternity Care
Team must be Consultant led and has recommended that all Consultants
should have set sessions devoted to Labour Ward/Delivery Suite
work. However, these are only during the working day—9.00
am—5.00 pm. The Labour Ward/Delivery Suite is then staffed
by junior doctors with the Consultant giving cover from home.
2. My recommendation is that the Consultant's
expertise should be available 24 hours a day. This was successfully
introduced at Pilgrim Hospital in 1997. The hospital had a delivery
rate of 1,900 babies per year and prior to this new system the
staffing consisted of a team of three Consultants with six junior
doctors.
3. A new staffing level of six Specialists
and the six junior doctors began immediately prior to the 24 hour
cover system. There were three teams consisting of two Consultants
and two junior doctors, each team providing emergency cover for
the 24 hours on a 1:3 rota. Each team of two Specialists/two junior
doctors further divided so that one Consultant and one junior
doctor provided the 24 hour cover which was then followed by 24
hours free time. The other pair in the team covered the routine
clinical work for that team. The working week of each pair averaged
48 hours even allowing for annual leave. This system was well
liked by the other staff of the Midwifery Team and even more so
by the patients and in my view was extremely successful since
it gave the patient complete specialist supervision.
4. The RCOG would not recommend this system
and despite requests no discussion was ever forthcoming. The current
RCOG recommendations came into force much later and because of
this the new younger colleagues became unhappy with their situation
and eventually the management at Pilgrim Hospital, who agreed
enthusiastically to the system being introduced, reverted back
to the previous system of emergency cover for the Labour Ward/Delivery
Suite. I personally was unhappy with this and was allowed to take
early retirement in April, 1999. The 24 hour Consultant cover
stopped in May 1999.
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