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Midwifery-led care and choice of place of birth facilitating change through sharing research and good practice
Thursday 2nd July 2015 University of Birmingham
#copobconf
place of birth facilitating change through sharing research and good - - PowerPoint PPT Presentation
place of birth facilitating change through sharing research and good - - PowerPoint PPT Presentation
Midwifery-led care and choice of place of birth facilitating change through sharing research and good practice Thursday 2 nd July 2015 University of Birmingham #copobconf Commissioning a home birth service Diane Reeves Accountable Officer
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Why we commissioned the service
Why now?
- Patient choice not
available
- Patient experience
- Clinical commissioners
- Evidence base
- Maternity capacity
review
- For mothers with a
previous uncomplicated birth, homebirth is preferred option for
- ptimum clinical and
psychosocial outcomes
- Giving birth outside an
- bstetric unit
substantially and significantly lowers the risk of episiotomy, CS and instrumental delivery for multips
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Commissioning a home birth service
- Long history of trying to get it off the ground
- Finance and tariff issues- introduction of
more granular tariff
- Lack of published evidence-Birthplace study
endorsed the safety- published 2011 BMJ
- Interaction of evidence with clinical
commissioning
- Increasing population, young city, high birth
rates- links to capacity
- Under-used home birth service because not
dedicated - leading to patients not satisfied (promised service not happening). Not promoted as a result
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What made it happen?
Key success factors
- Evidence, data, choice and capacity issues creating a
mandate
- Enthusiastic provider team, enthusiastic (female) GP
commissioners- desire to improve choice and reduce interventions for low risk women
- Non recurrent spending requirements- initial pump priming
- Work to promote it to GPs- educational events, GP
networks
- MSLC support
- “Big social conversation” engagement events- reaching
diverse communities (but BSC patients only at present)
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What were the GPs concerns about the service?
GP survey circulated in July 2013 42 surveys completed Main concerns:
- Medications
- Attendance
- Transfers
- New baby checks
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First Year
- Was operational every day of the first year
- 2013: 0.31% of planned deliveries were home birth
- 2014-15: slightly over 1% (target) (88 births v 80)
- 2015-16: target 2%
- 2016-17: target 3%
- Great user feedback
- Transfer rate for multips 14% cf 12% in Birthplace
study
- GPs concerns not realised
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Commissioning for Quality
- Intra-partum transfer review and
benchmarking
- Continuity of care: 3 or fewer
midwives through whole package
- f care
- Breastfeeding rates 75%
- Incident reporting and monitoring
- Diversity of users
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What are the commissioning barriers?
- Funding-3rd year should be self funding through tariff
240 births (breakeven point)
- GP uncertainty
- Cultural beliefs amongst professionals and public
- Equity of provision
- Sustainability
- Capacity expansion needed for roll out
- MSW and development of new professional roles
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