The key components of a successful model of midwifery-led continuity of carer, without continuity at birth: findings from a qualitative implementation evaluation.

BACKGROUND: Recent UK maternity policy changes recommend that a named midwife supports women throughout their pregnancy, birth and postnatal care. Whilst many studies report high levels of satisfaction amongst women receiving, and midwives providing, this level of continuity of carer, there are concerns some midwives may experience burnout and stress. In this study, we present a qualitative evaluation of the implementation of a midwife-led continuity of carer model that excluded continuity of carer at the birth. METHODS: Underpinned by the Conceptual Model for Implementation Fidelity, our evaluation explored the implementation, fidelity, reach and satisfaction of the continuity of carer model. Semi-structured interviews were undertaken with midwives (n = 7) and women (n = 15) from continuity of carer team. To enable comparisons between care approaches, midwives (n = 7) and women (n = 10) from standard approach teams were also interviewed. Interviews were recorded, transcribed and analysed using thematic analysis. RESULTS: For continuity of carer team midwives, manageable caseloads, extended appointment times, increased team stability, and flexible working patterns facilitated both care provided and midwives' job satisfaction. Both continuity of carer and standard approach midwives reported challenges in providing postnatal continuity given the unpredictable timing of labour and birth. Time constraints, inadequate staffing and lack of administrative support were reported as additional barriers to implementing continuity of carer within standard approach teams. Women reported continuity was integral to building trust with midwives, encouraged them to disclose mental health issues and increased their confidence in making birth choices. CONCLUSIONS: Our evaluation highlighted the successful implementation of a continuity of carer model for ante and postnatal care. Despite exclusion of the birth element in the model, both women and midwives expressed high levels of satisfaction in comparison to women and midwives within the standard approach. Implementation successes were largely due to structural and resource factors, particularly the combination of additional time and smaller caseloads of women. However, these resources are not widely available within the resources of maternity unit budgets. Future research should further explore whether a continuity of carer model focusing on antenatal and postnatal care delivery is a feasible and sustainable model of care for all women.

Improving access to cancer genetics services in primary care: socio-economic data from North Kirklees.

A primary care cancer genetics project, funded by Macmillan Cancer Support and the Department of Health, has been running in North Kirklees since 2004. North Kirklees has a high ethnic minority population (mainly South Asian) and 50% of its wards lie in the most deprived quintiles in England. Previous audits in the department of genetics have shown lower than expected referral rates for patients from lower socio-economic classes and no referrals from ethnic minority patients. The aims of the project included improving access to cancer genetics services for disadvantaged patients from lower socio-economic groups and the ethnic minority population. A practice nurse and a General Practitioner with a Special Interest in genetics, both with appropriate language skills, and a 0.5 FTE genetic counsellor have set up local clinics in several primary care sites in North Kirklees where they provide full genetic counselling services in the community. Demographic details, ethnic origin and education information are collected from each patient seen. Comparing information prior to and during the project demonstrates an increase in numbers of referrals for patients from lower socio-economic classes, those with educational achievements at GCSE level or below, and those from South Asian backgrounds. Local clinics and increasing awareness of cancer genetics services for professionals and the public can improve access to such services.