The recommendations take account of the significant variation in service provision around the country in terms of workload complexity, geography and current middle-grade staffing. Therefore, the report recognises that there is no single solution to delivering safe maternity and gynaecological services.
The report specifically looks at the need for some degree of resident consultant working as a solution to workforce issues and recommends the use of hybrid rotas, which include both resident and non-resident out-of-hours shifts.
The report also includes case studies demonstrating how this model is working in practice across the country, and proposes RCOG standards for consultant job descriptions and job plans to support the recommendations.
- All units need to ensure a locally agreed, safe and sustainable solution to address workforce issues to manage care in both obstetrics and gynaecology.
- Safe service delivery can only be achieved with safe staffing levels in both maternity and gynaecology units.
- All solutions should take into account the national issue of lack of availability of middle grade doctors (doctors who have attained the required competencies to undertake out-of-hours work within labour ward and emergency gynaecology settings but who still require support from consultants) leading to recurrent rota gaps.
- Workforce solutions must optimise training opportunities and accommodate the changing needs of trainees at different stages of their careers.
- All solutions should allow for multidisciplinary training, development of quality services and good clinical governance.
- All units should have consultant labour ward presence during weekday daytime working hours Monday to Friday, with the intention to extend this to every day of the week.
- Resident consultant working (where a consultant delivers a service directly to patients out-of-hours and remains on site for the duration of the shift) within a hybrid rota (including both middle grade doctors and consultants) is recommended to ensure appropriate medical staffing. In most units, this will involve all consultants working in a hybrid rota with some out-of-hours shifts.
- Remodelling job plans to include evening and weekend daytimes working must be considered in order to maintain equity among the consultant team. Involving only newly recruited consultants in resident working can be divisive.
- Culture change within the profession is needed since a contribution to resident working will be required throughout a consultant’s career.
- Resident consultants must be treated equally to non-resident consultants by all staff.
- The RCOG’s standards for job descriptions and job plans should be used by all units to help implement the above recommendations.
- The RCOG must explore novel methods for assessing work intensity and out-of-hours staffing levels in both obstetrics and gynaecology.
- The RCOG should develop a repository of good medical workforce models that are available to all.
- Units must ensure that high standards of care are maintained by having the appropriate workforce, with the necessary competencies, in the right place at the right time.
Previous workforce reports
These recommendations replace the guidance in Safer Childbirth (2007) in light of subsequently published evidence.
Other RCOG reports provide additional context:
Standards for maternity and gynaecology care
To accompany the O&G worforce report, we have also published new frameworks of high-level service standards that aim to improve outcomes and reduce variation in maternity and gynaecological care. The frameworks are designed for commissioners and service providers.