Models of care

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Models of care

• Andy Shennan
• Jane Sandall
• Jenny Leonard

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Maternity project
Needs Assessment
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Workstream objectives

• Review the evidence base for new delivery models
  of care along maternity pathways including role
  of obstetric units, development of midwifery led
  services, antenatal and postnatal provision,
  exploring
• the impact of workforce on provision of services
• the impact of womens choice
• interdependency with paediatric provision, in
  particular provision of neonatal support and
  implications of possible changes in paediatric
  provision on obstetric units
• Provide support to commissioners to enable them
  to commission along clinically evidenced pathways
  of care. Establish the requirements and
  implications of commissioning the models of care,
  specifically
• agreeing quality standards of care for maternity
  services to drive up improvements in practice
• the constraints (for example of travel times or
  the necessity to co-locate with any other
  services) of delivering the proposed models of
  care
• implications of PbR tariff issues that arise
• implications for workforce, training and
  education, including definitions for standards
  for practitioners and services, initiate work on
  a workforce model appropriate to the proposed
  model of care
• implications for information and IT, the
  development of common clinical guidelines, and a
  single integrated system of clinical governance
  across managed networks
• understand and address public concerns about the
  delivery and configuration of maternity and
  paediatric services

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Focus of work

• Identifying best practice for alternative models
  of provision
• Understand the implications of paediatric and
  obstetric configuration on neonatal services
• Work with Childrens services to understand
  impact of paediatric reconfiguration on provision
  of obstetric services
• Developing appropriate guidance and mechanisms to
  support PCTs in commissioning best practice
  models of care

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Deliverables

• Commissioning specification/guidance to support
  PCTs to commission safe pathways and define
  optimum models of care for all the core elements
  of the pathway including
• antenatal and post natal provision
• midwifery led units (co-located and stand alone)
• obstetric units required (service model options,
  numbers and reconfiguration plans for secondary
  care services in line with safe practice
  (workforce levels) and paediatric
  reconfiguration)
• Outlining
• the constraints (e.g. travel times, necessity to
  co-locate with other services) of delivering the
  proposed models of care
• implications of PbR tariff issues implications
  for information and IT
• the development of common clinical guidelines,
  and a single integrated system of clinical
  governance across managed networks
• implications for workforce, training and
  education, including definitions for standards
  for practitioners and services, initiate work on
  a workforce model appropriate to the proposed
  model of care

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Questions

• How can we balance offering choice for women
  whilst ensuring the quality, safety, financial
  viability, and sustainability of services?
• Should it be mandatory to have midwifery led
  units (co-located or stand alone) within each PCT
  area? What is midwifery led care?
• What aspects of service organisation and delivery
  improve access, acceptability and take up of
  antenatal services for women?

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