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.

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.

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. 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? • 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.

SOMETIMES THERE JUST ISN’T ENOUGH TIME In reality, sometimes there isn’t enough time available to work on sustaining the practice, or a required skillset may not exist within a particular group.

There are several ways that these challenges can be managed, ensuring that the right amount of time and money are invested in sustaining and protecting the practice, such as:

1. Using digital applications that are proven to save time (and are cost effective) by automating relevant practice needs and workflows:

a. Tiaki app for referrals, practice calendar, actions, and contact/ address navigation

b. Xero accounting software for business and finance requirements

c. Microsoft Teams for a more central, secure, and private practice connection including video meetings, in-practice messaging, emails, knowledge base, document sharing and storage.

2. Employing or contracting a practice administrator (for a minimum number of hours) to perform more indirect midwifery care tasks and manage business and financial needs. This could include:

a. Managing and actioning emails as required

b. Managing the overall practice calendar, including on-call, leave, practice meetings, key re-certification dates and actions, and professional development opportunities.

c. Being the initial point of contact for women seeking a midwife

d. Managing and communicating sector updates

e. Managing Section 88 claims and payments

f. Managing day-to-day banking and Xero transactions

g. Managing insurances

WE ARE HERE TO SUPPORT YOU WITH THESE DECISIONS

When considering these types of initiatives for any practice, it is sometimes difficult to properly assess the benefits achievable against the expected cost outlay.

The MMPO, together with the College, continue to build a more comprehensive toolkit and supportive framework to help practices and LMC community midwives. If you wish to discuss any aspect of this article further, please email mmpo@mmpo. org.nz or call to discuss on (03) 377 2485. square

MMPO, the Midwifery and Maternity Providers Organisation provides self employed community midwives with a supportive practice management system.

www.mmpo.org.nz mmpo@mmpo.org.nz 03 377 2485

LMC Midwife/Midwives Buller Region

If your idea of a perfect work life balance is being part of a small community with the backdrop of the spectacular West Coast, then this is the role for you!

Your day will be spent providing antenatal and postnatal care to the wāhine of the Buller region as well as supporting homebirths or births in our primary birthing unit at Kawatiri, Buller Hospital and the new facilities when they are complete. Outside of work, you will have access to some of Aotearoa’s best kept scenic secrets as well as low cost housing and daily flights from Westport to Wellington and Queenstown. You will also have access to education, training and support from the team at Te Nikau and collegial support from your central and southern colleagues providing LMC care.

You will be eligible to access some great benefits including:

• a current caseload • a sustainability package per woman under your care • remote rural mileage (all women qualify) • support via the College of Midwives Rural Midwifery Recruitment and Retention Service including nine days locum cover per year + extra locum days paid by WCDHB.

You will need current:

• NZ Midwifery Registration and a current practicing certificate • Be vaccinated for COVID-19 under the governments mandate • A new graduate midwife will be considered.

To apply please call Dawn Kremers 03 7697803 or email: dawn.kremers@wcdhb.health.nz

looking after you supporting your practice

Complete community midwifery support, including:

• Care data and digital records (including Tiaki) • Notice 21 (Section 88) claiming • Business set up (including Xero) and day-to-day support • • Equipment insurance • Workforce and locum services