Brief overview of the Birthrate Plus workforce review and acuity tools
The Birthrate Plus workforce planning tool has been used extensively over the last 20 years by more than 100 NHS Trusts in the UK as well as maternity providers in Ireland and Australia.
It is based upon an understanding of the total midwifery time required to care for women based on a minimum standard of providing one-to-one midwifery care throughout established labour. The principles underpinning the BR+ methodology are consistent with the recommendations in the NICE safe staffing guideline for midwives in maternity settings, and have been endorsed by the RCM and RCOG.
BR+ measures the workload for midwives arising from the needs of women, from initial contact in pregnancy until final discharge from midwifery care. It measures the demand for midwifery care through the retrospective allocation of women and babies to five outcome categories, which are based on a composite of clinical factors of process and outcome. It then calculates the number of hospital and community midwives required to meet this demand.
BR+ is based on the total activity, not just the number of births per unit, needed to meet the needs of women including:
• all antenatal and postnatal care
• antenatal outpatient activity
• antenatal inpatient activity and ward attenders.
• delivery in all settings.
• all postnatal care in hospital.
• service redesign, for example by developing services that women can receive outside of acute settings.
• role redesign, for example assessing the time needed when suitably trained midwives undertake the neonatal examination of the newborn previously undertaken by junior paediatricians.
• local, regional and national strategic planning.
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