How Do We Implement Continuity of Carer?

Providing continuity is an important part of my midwifery philosophy but isn’t currently in place where I work, but with the recent reports from The Department of Health and recommendations from NHS England, how long can it possibly be until things have to change? The Maternity Safety Ambition set out in the Department of Health’s ‘Safer Maternity care’ report is to halve the rates of stillbirths, neonatal deaths, maternal deaths and brain injuries, whilst also reducing pre-term birth. Continuity is a big part of meeting these targets, as the research clearly states this is exactly the kind of improvements that are seen when a woman knows her midwife.

The trust in which I completed my continuity project already have well established caseload teams, who had been around for some years when I started, I am aware starting them up will involve lots of hurdles and learning, but if you want to start something new you have to do just that, start. The experience I have had as a student and now as a qualified midwife and the many discussions I’ve had with students, peers and managers within maternity, has given me an understanding of the complexities of caseload care both from a midwifery and organisational perspective. This emphasises how beneficial it would be to try and share stories of when it has been successful.

So this is a plea for those who have successfully implemented continuity of carer to get in touch. We have all the literature, government and health policy and union support to start continuity, but how exactly can we start something ourselves? I think inspiration would be helpful from those who have done this already to help others see how achievable it is.

Have you started caseload in your area? If so I would love to hear how you went about this? How did you go about presenting this idea to the senior management team within the trust? What kind of barriers did you come up against and how did you overcome them? I’d love to share how this has been done successfully to help others who want to be drivers for change in their local areas. Please get in touch at continuitymatters@gmail.com  if you would be happy to chat with me and answer a few questions to help spread the knowledge to improve maternity services!!

13 thoughts on “How Do We Implement Continuity of Carer?

    • Fiona Rochelle says:

      Hi My team have been case loading young mums for over 2 years. We are now looking at now case liad care for all vulberabilites. Do you have any examples of pathways, criteria and evidence of good practice please?

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  1. Angela Weatherley says:

    Morning
    I am interested in where the midwives come from. The community midwives in my Trust have caseloads much larger than they should (according to birthrate plus), and are working under strain accordingly. so I do not feel able to pull from them. Taking from the hospital based midwives will create greater gaps in the rota that already are often unfilled-with ban on agency.
    These are the practical questions I have. I’m sold on the philosophy as I have previously set up and worked in a midwifery group practice for vulnerable and complex families and nothing, nothing is more satisfying in my opinion. Just a question of how to balance the service for me.

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    • Michala Marling says:

      I think this is the most asked question and the one that forms the biggest barrier in the implementation of this model. I’m asking around to try and find someone who can answer your question. My trust sounds the same as yours and I would also like to really understand how to present an answer to this question as part of proposing implementation of continuity of carer! Thanks for getting in touch and hopefully I’ll get back to you soon. Michala 😊

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      • Angela Weatherley says:

        Thank you Michaela
        Would really love to implement proper continuity across the patch too rather than ‘elite’ small pockets 😁

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      • Michala Marling says:

        Where is it you’re based? Are you at full staff capacity? If not could you use the FTE to create a team? I’m just thinking out loud and I’m sure it’s not as simple as that, but I think it had to be started small and gradually introduced. Have you considered contacting the RCM to ask for advice relating to your specific trust? Hopefully I will find someone to provide a general answer to your question, but it might not be as relevant as information that will be specific to the situation of your trust. Michala

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      • Angela Weatherley says:

        Hi Michala
        I am based at Milton Keynes Hospital. We have vacancies in the hospital and currently unable to recruit into the band 6 posts. Perhaps a continuity model would attract some midwives to join us. Will approach RCM if they can offer ideas, that would be great.
        Thanks
        Angela 😊

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      • Michala Marling says:

        Oh that’s so wonderful to hear, MK is my hometown, I would love to see caseload there! If you have FTE you can’t recruit into I would definitely look at using these unfilled posts to start a caseload team to attract Midwives if it’s a possibility! I’d be interested in hearing more if it is something that you do implement. Please keep me updated 🤞🏼 Michala 😁

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      • Michala Marling says:

        It certainly is! I am indeed, I’m newly qualified, trained in London where I had the most amazing experience with a lovely caseload team and currently 4 months into my preceptorship in Oxford. How is the newish homebirth team getting on there? Michala x

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      • Angela Weatherley says:

        For me it is the best way to work! Just a bit tricky convincing everyone else!
        The homebirth team have been going for a year now, and have plans to increase numbers this year to build in their success. They get great feedback- naturally!
        How is your preceptorship going in Oxford? Big tertiary unit, do you have any models that offer continuity of carer?
        I’ve emailed Lia, thank you for that- hope she can offer me some advice 😊

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