Written evidence submitted by the Royal College of Obstetricians and Gynaecologists (MSE0113)





Several high-profile enquiries, most recently the Ockenden Report, have highlighted the need to gain a deeper understanding of what constitutes safe staffing in maternity care. 90% of obstetrics and gynaecology (O&G) junior doctors report rota gaps in their units and attrition and burnout rates are high at all career stages. 1   Obstetric incidents can be catastrophic and life changing for women and their families. In 2019/20 maternity litigation claims accounted for 50% of the value of new negligence claims against the NHS, almost

£2.4 billion. By comparison, HEE’s entire postgraduate medical training budget for all specialties is approximately £2 billion.2


Birthrate Plus exists as a framework to calculate safe midwifery staffing levels. However, no such tool exists for medical staffing. Medical staffing is complex due to a multitude of factors at the unit, regional and national levels (see figure 1).


This proposal outlines how the RCOG could undertake a rapid research and workforce planning exercise to determine the number of obstetricians required in units across England and Wales. In preparation for this process, we have had detailed discussions with the CQC, HEE and leading academics in the field. We all recognise this is urgently required to drive improvements in the safety of maternity services and therefore have agreed to share information and work collaboratively, aligning the long-term shared priorities of each organisation.





























Primary Aim


To calculate the number of obstetricians at all grades required nationally to provide a safe, woman centred maternity service within the context of the wider workforce.


Subsidiary to this aim, a number of further objectives will be addressed:







To fully understand the complexities outlined above, a mixed methods approach of gathering qualitative and quantitative data will be required. This will need to encompass current staffing models within each unit in the country alongside determinants of quality and acuity of their service and patient population.

The gathering of data will include:







The RCOG aims to provide workforce calculations for the number of obstetricians required within six months of funding being granted. Subsidiary objectives will be delivered within 12 months.



Anticipated Financial Costs



Costs (inclusive of oncosts)

1 x Fellows (over 12 months)

£73 484

2 x Data Analyst/Methodologist


Project Manager


Senior Clinical Oversight


Support services


Non-pay costs (IT kit, travel misc.)


Data collection staff





While the Department of Health will be keen to understand the medical staffing requirements for England and Wales, the RCOG would recommend that this approach is also applied to the devolved nations.





Following several recent high profile maternity inquiries there stands an opportunity to evaluate current maternity services and staffing to transform the future workforce.

Failure to act now risks further spiralling of litigation costs, loss of public trust in the profession and poorer outcomes for mothers and their babies.



Response to:

Mr Edward Morris, President






1.      RCOG. O&G Workforce Report 2018. Available from: rcog-og-workforce-report- 2018.pdf


2.      NHS Resolution 2021, Maternity Incentive Scheme, NHS Resolution Viewed 5/2/21 Available at: https://resolution.nhs.uk/services/claims-management/clinical- schemes/clinical-negligence-scheme-for-trusts/maternity-incentive-scheme/


3.      RCOG. Providing Quality Care for Women Obstetrics and Gynaecology workforce Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/working- party-reports/maternitystandards.pdf


4.      RCOG. Providing Quality Care for Women. A framework for maternity service standards. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/working-party- reports/ogworkforce.pdf


February 2021