This document serves to provide options for staffing obstetrics & gynaecology units for the current COVID-19 pandemic.
The options include reducing commitments outside the unit, reducing elective and/or non-essential work within Trusts and Boards and reorganising staffing within the Obstetrics & Gynaecology service.
The options are presented for escalating levels of staff shortage. Implementation of options should be made at unit level dependent on local context, workload and staffing.
Preparatory Work/Low level of staff shortage
- Cancel/reduce non-critical activities, including:
- Mandatory training
- Other routine but non-mandatory training
- Routine non-urgent internal management meetings
- Preparation for CQC inspections, HSIB, NHS Resolution Early Notification & other investigations. Please check their websites regularly for updates
- Consider reducing elective activity in the private sector to support core services where safe
- External responsibilities, including: DHSC/NGO/NICE/Royal College, etc
- Prepare telemedicine facilities to deliver triage and essential remote patient contact. Consider the use of clinically well but self-isolated doctors to deliver some telemedicine from within their isolation setting, e.g. home.
- Review and consider cancellation of study leave initially followed by annual leave restrictions, if required.
- Doctors in management roles to suspend any non-essential managerial duties, and temporarily increase their clinical duties.
- Cancel elective gynaecology outpatient clinics and surgery.
- Consider flexible working for full-time doctors with possible compensatory additional annual leave once the pandemic has passed.
- Approach doctors on part-time contracts to establish whether they are able to contribute additional hours.
- Approach research clinicians at all grades who have the necessary skills to reduce research (where safe) and contribute additional hours to the clinical service.
- Make arrangements with local maternity units for sharing arrangements of clinical staff where there units are differentially affected. Temporary contract arrangements may need to be prepared.
- Units and staff to consider options for childcare for working staff.
- Set up drills and skills/simulation sessions and maternity unit induction sessions to refresh those who have recently stopped working in acute obstetrics. These would usefully include simulations for CV-19 scenarios.
- Consider centralisation of births into maternity units and larger birth centres so as to optimise the use of midwives and obstetricians.
- Consider greater use of telemedicine to provide early medical abortion services, to minimise time within a healthcare setting
Additional options for moderate and severe staff shortages
- Use Consultant gynaecologists or senior nursing staff to perform remote triage in the following:
- Cancer diagnostic pathways
- Early pregnancy
- Emergency gynaecology
- Stop or significantly reduce gynaecology workload for seniors working in both obstetrics and gynaecology and ask those who perform only gynaecology to take on the liberated gynaecology work, if appropriate.
- Divert gynaecologists to elective and/or emergency caesarean section lists.
- Release senior trainees from gynaecology theatres to deliver obstetrics and ‘double up’ consultant gynaecologists in cancer and emergency theatre where assistance is required.
- Gynaecology consultants to work with nursing staff and/or recently qualified doctors to run emergency gynaecology services.
- Consider changes to the usual delivery of service, where needed, by consultants or SAS-LED doctors acting down, both in and out of hours
- Senior obstetric consultants with limited or no on call commitments to work additional weekend days and/or evenings.
- Nominated ‘baton’ phone to consultant on call to allow rapid communication
Edward Morris, Ranee Thakar, Jo Mountfield, Sue Ward, Tim Draycott, Pat O’Brien, and Matthew Jolly and Corinne Love