YOUR MIDWIFERY BUSINESS
WAYNE ROBERTSON EXECUTIVE DIRECTOR, MMPO
building and maintaining better practices One of the tools community midwives have at their disposal, to help ensure continued access to primary maternity care in Aotearoa as well as a sustainable profession, is to form together into midwifery group practices. Mostly, these practices evolve and grow naturally through relationships built during study or clinical placements, and a clear shared philosophy around the provision of midwifery continuity-of-care.
Key features of a sustainable practice There are some critical components and considerations that need to be built into any practice, to help ensure not only its sustainability, but also that of the midwives within it. These are: • A clear, sustainable, and agreed sense of purpose • Adopting a supportive legal structure for the practice and the individual midwives • Being clear and fair about a way of providing midwifery care and distributing workload evenly amongst the midwives • Connecting and fostering good relationships with the wider maternity team in the area • Identifying and managing risks well • Balanced use of digital technology • Understanding cash flow (including bank accounts, Section 88 revenue, business costs) and taxation.
The main purpose when forming a group practice is to ensure access to quality midwifery care by making sure each community midwife is working as sustainably as possible. This is done through strong collegiality and teamwork, and specifically through managing and sharing time, money, knowledge and risk. Usually, no two practices are structured or operate in exactly the same way, as each is required to adapt not only to the pregnant population cared for, but also the locality within which this care is generally provided. WHERE TO START? The optimal time to ensure a practice is set up to be sustainable, is before it’s initiated. However, whilst there are always new practices being established, most LMC community midwives start their midwifery career by joining an existing practice. In all situations, the most important element to ensuring a sustainable practice is setting aside specific time to connect with each other and discuss the practice itself. Many LMC community midwives do this through their regular practice meetings, however currently due to workforce pressure, there isn’t always enough time available to fully discuss important sustainability areas such as those identified above. More specifically, the questions practice members should be asking themselves are: • How will the practice induct and train new midwives? And how will retiring midwives exit? • Will the practice share on-call requirements? And how will this be performed? • How will the practice support professional development?
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• How will annual and other leave (such as sick, emergency and bereavement) requirements be managed? • If care is to be shared (by agreement or necessity) how will this be paid out? • Irrespective of the way a practice is formed or currently exists, it is critical that a formal and written record is retained of all practice items discussed and agreed. This could be in the form of a signed practice agreement that can be easily added to and iterated as time goes by.
OTHER CONSIDERATIONS WHEN SETTING UP AND/OR MANAGING A GROUP PRACTICE? Dependent on the size of the practice and in an ideal world, the responsibility and accountability for safeguarding the sustainability of the midwifery practice does not rest on the shoulders of just one midwife. Every midwife possesses specific skills and attributes, such as being: • A good communicator • A strong negotiator • An empathetic supporter • An organiser • Finance or business minded • An administrator • A mentor • Uniquely expert or skilled
The success of any practice, therefore, lies in sharing the practice workload wisely by matching each midwife’s unique skillset to a practice need and/or responsibility.
