COVID-19 Outbreak: RCOG Staffing Options for Obstetrics and Gynaecology Services

The document offers some options for staffing obstetrics & gynaecology units for the present COVID-19 pandemic. Different options are – lessening commitments outside the unit, decreasing elective or non-essential work within Boards and Trusts as well as rearranging staffing within the Obstetrics & Gynaecology service.
The options have been presented for escalating levels of staff shortage. Proper implementation of options will be made at unit level dependent on local context, staffing and workload.

Preparatory work/Low level of staff shortage

  • Lessen/cancel non-critical activities such as:
     
    • Compulsory training.
    • Other non-mandatory regular training.
    • Non-urgent internal management meetings daily.
    • Preparation for HSIB, NHS Resolution Early Notification, CQC inspections and other investigations.
    • Decrease elective activities in the private sector to maintain core services for safety purposes.
    • External responsibilities such as – DHSC/NICE/NGO/Royal College, etc.
       
  • Organise telemedicine facilities to deliver remote patient contact. Use self-isolated doctors who are clinically safe to deliver some telemedicine from their isolation setting like home.
  • Assess and consider study leave cancellation which is then initially followed by yearly leave restrictions, if needed.
  • Doctors who are in management roles may suspend non-essential managerial duties, and increase clinical duties for the time-being.
  • Cancel elective gynaecology outpatient clinics and surgeries.
  • Flexible working option for the doctors with compensatory extra annual leave after the pandemic is over.
  • Contact doctors and private gynaecologists in London on part-time contracts to know if they can contribute to additional hours.
  • Approach research clinicians who possess in-depth skills to lessen research work and give extra hours to their clinical service.
  • Necessary arrangements with maternity units to share arrangements of clinical staff where the units are affected in a different way. Temporary contract arrangements might be prepared.
  • Staff and units to look for different options for childcare of the working staff.
  • Set up drills and simulation sessions and maternity unit induction sessions to refresh the ones who have already stopped working in acute obstetrics. These would include simulations for CV-19 scenarios.
  • Choose centralisation of births into larger birth centres and maternity units to optimise using obstetricians and midwives.
  • Use of telemedicine to provide early medical abortion services to reduce the time within a healthcare setting.

Other options for moderate staff shortages

  • Use gynaecologists or nursing staff to carry out remote triage in the following:
     
    • Early pregnancy.
    • Cancer diagnostic pathways.
    • Emergency gynaecology services.
       
  • Stop or reduce gynaecology workload for the seniors who are associated with obstetrics and gynaecology. Ask the ones who perform gynaecology only to take on the gynaecology work, when required.
  • Gynaecologists to emergency caesarean section lists.
  • Release seniors from gynaecology theatres to deliver obstetrics and ‘double up’ gynaecologists in emergency theatre and cancer for further assistance.
  • Gynaecology consultants work with nursing staff or qualified doctors to administer emergency gynaecology services.
  • Changes to usual delivery of service by SAS-LED doctors or consultants for in and out of hours.
  • Senior obstetric consultants with limited or not on call commitments to work for weekends and evenings.
  • Nominated ‘baton’ phone for phone consultation to allow quick communication.