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Sustainable maternity services in remote and rural Scotland? A qualitative survey of staff views on required skills, competencies and training
  1. J Tucker1,
  2. V Hundley2,
  3. A Kiger2,
  4. H Bryers3,
  5. J Caldow4,
  6. J Farmer5,
  7. F Harris2,
  8. J Ireland2,
  9. E van Teijlingen6
  1. 1Dugald Baird Centre, Department of Obstetrics and Gynaecology, University of Aberdeen AB25 2ZL, UK
  2. 2Centre for Advanced Studies in Nursing, University of Aberdeen, Aberdeen AB25 2AY, UK
  3. 3Raigmore Hospital, NHS Highland, Inverness IV2 3UJ, UK
  4. 4Department of General Practice and Primary Care, University of Aberdeen, Aberdeen AB25 2AY, UK
  5. 5University of Aberdeen Management School, Old Aberdeen AB24 3QY, UK
  6. 6Department of Public Health, University of Aberdeen, Aberdeen AB25 2ZD, UK
  1. Correspondence to:
 Dr J Tucker
 Dugald Baird Centre for Research on Women’s Health, Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen Maternity Hospital, Cornhill Road, Aberdeen AB25 2ZL, UK;


Objectives: To explore staff views on their roles, skills and training to deliver high quality and local intrapartum services in remote and rural settings against national recommendations.

Design: Interview and postal survey.

Setting: A stratified representative sample of remote and rural maternity units in Scotland (December 2002 to May 2003).

Participants: Staff proportionally representative of professional groups involved in maternity care.

Results: Staff interviews took place at 11 units (response rate 93%). A subsequent postal survey included the interview sample and staff in a further 11 units (response rate 78%). Medical specialisation, workforce issues, and proposed regulatory evaluation of competencies linked to throughput raised concerns about the sustainability and safety of services, particularly for “generalists” in rural maternity care teams and for medical cover in small district general hospitals with large rural catchments. Risk assessment and decision making to transfer were seen as central for effective rural practice and these were influenced by rural context. Staff self-reported competence and confidence varied according to procedure, but noted service change appeared to be underway ahead of their preparedness. Self-reported competence in managing obstetric emergencies was surprisingly high, with the caveat that they were not independently assessed in this study. Staff with access to video conference technology reported low actual use although there was enthusiasm about its potential use.

Conclusions: Considerable uncertainties remain around staffing models and training to maintain maternity care team skills and competencies. Further research is required to test how this will impact on safety, appropriateness, and access and acceptability to rural communities.

  • clinical competence
  • rural health services
  • maternity care

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  • This study was supported by NHS Education for Scotland (grant number CP123).

  • JT was responsible for study design, sampling and analysis and is a co-author; AK was responsible for study design, qualitative analysis and is a co-author; VH was responsible for study design, questionnaire design, quantitative analysis and is a co-author; JF was responsible for interview design, qualitative analysis and is a co-author; JC was project manager, interviewer and data collection; FH interviewer and qualitative analysis; EvT JI and HB literature review. Guarantors: JT, VH and AK. The views expressed are those of the authors.

    Steering Group NHS Education for Scotland: Mrs Sue Hickie (Professional Officer, NHS Education for Scotland), Dr Sue Kinn (Programme Leader, Nursing Research Initiative for Scotland), Dr Margaret McGuire (Midwifery Development Officer, SEHD/Royal College of Midwives/UK Board for Scotland); Dr Brian McKinstry (Director of Research, NHS Education for Scotland); Dr Tricia Murphy-Black (Professor of Midwifery, University of Stirling); Mrs Monica Thompson (Professional Officer (Midwifery), NHS Education for Scotland); Dr Sally Wyke, Director, Scottish School of Primary Care, NHS Education for Scotland.

    Professional Advisory Group: Joanne Thorpe and Jaki Lambert, Clinical Midwifery Specialist, Lochgilphead, Argyll; Sarah MacLeod, Midwifery manager, Belford Hospital, Fort William; A Gordon Baird, General Practitioner, Dumfries & Galloway; Liz Coutts, General Practitioner, Lerwick, Shetland; Beverly Beasant, NES researcher on Telemedicine in Training, University of Dundee; Norman Smith, Consultant, Director of Clinical Obstetric Services, Aberdeen Maternity Hospital; Bill Haining. Scottish Ambulance Services, The Scottish Ambulance College, Barony Castle; Rita Finlayson, Advanced Neonatal Nurse Practitioner, Raigmore Hospital, Inverness; Mike Munro, consultant neonatologist, Aberdeen Maternity Hospital; David Godden, Professor of Remote and Rural Health Care Issues, Director, Highlands and Islands Health Research Institute, University of Aberdeen, Inverness; Helen MacLean, Western Isles Health Council, Benbecula Office; Anne MacKay, Senior Lecturer, School of Nursing & Midwifery, Robert Gordon University, Aberdeen.

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