Albany in Peckham


History of the Practice

In the early 1990s the midwives who would go on to form the SELMGP were working as independent midwives in South East London, England. Independent midwives are fully qualified midwives who choose to work outside the NHS and therefore are paid directly by the women. Working independently gives midwives increased autonomy and enables them to work on a one-to- one basis with women rather than in the fragmented system common in the UK. Although we all enjoyed working in this way, we felt passionately that the associated degree of continuity of carer could and should be available to women free of charge within the NHS. We believed that a midwifery model based on continuity of carer would not only improve outcomes for women and babies, but would also increase satisfaction for midwives. We came together in order to find a way to provide a model of midwifery care that would offer women choice, control, and continuity of care (Changing Childbirth 1993).

The SELMGP evolved over a two year period. Six of us, working in three pairs, were drawn together by a common philosophy and the practical need to provide support and cover for each other. We were all working within a closely defined geographical area, providing a service that offered continuity of carer and choice of place of birth. Believing fundamentally in the principles of the NHS that care should be free at the point of delivery and accessible to all, we felt strongly that all women should have access to this type of care. In order to accommodate these beliefs, we had been making our services available to local women on a sliding scale basis, with wealthier clients subsidizing those who were on benefits. We saw this as an interim measure while we worked towards secure funding to become an NHS project.

One of our intentions was to see if the excellent statistics associated with independent midwifery in the UK (Weig 1993) could be maintained when the same model of care addressed the issues of inner city deprivation and inequalities in health. Outcomes for the years in which we had been working independently were encouraging, showing a high rate of normal births and breastfeeding, and low rates of medical intervention.

Since the 1970s, maternity services in the UK have been organized around an increasingly medicalized institutional model with a consequent erosion of the traditional, more autonomous role of the midwife. By 1980 the home birth rate had reached an all-time low, with less than 1% of women giving birth at home. This wholesale move to hospital had led to fragmentation of care during pregnancy, birth, and the postnatal period, and a “production line” experience for the majority of women as they were herded into hospitals. Increasing dissatisfaction led to more and more support for consumer groups, whose members provided a voice for those women who, as described by Nicky Leap (one of the original SELMGP midwives), “were not prepared to tolerate a system that left many feeling powerless” (Leap 1996). The campaigning of the Association for Improvements in Maternity Services (AIMS), the National Childbirth Trust (NCT) and the Active Birth Movement, together with the Association of Radical Midwives (ARM) paved the way for the ground-breaking Health Committee Report on Maternity Services (House of Commons Health Committee 1992).

The early 1990s were a time of change in maternity care in the UK. The 1992 Health Committee Report recommended that a medical model of care was not appropriate for all women, and that maternity services should be based around the needs of women and their families. The government response to this report was to set up an Expert Maternity Group, under the chairmanship of Baroness Cumberlege, to review NHS maternity care including the role of professionals to ensure that the service offered women choice, control, and continuity of care. The Group took evidence from a variety of maternity service providers, including the independent midwives who were to become the South East London Midwifery Group Practice (SELMGP). The SELMGP model of midwifery care was recommended in the ensuing government report Changing Childbirth (DOH 1993):

The (Expert Maternity) Group also heard and discussed evidence about midwifery group practices which aim to provide a high degree of support and continuity….These appear to demonstrate high quality practice and the most complete continuity of carer…The Group would like to see some experimental schemes being introduced within the NHS in the next five years.

Following the publication of Changing Childbirth, the SELMGP was successful in a bid to become one of three midwifery group practice pilot sites chosen by South East Thames Regional Health Authority (SETRHA). These pilot projects were launched in January 1994, and the (initially) two year SELMGP project began in April of that year.

SETRHA awarded us £30,000 set up money but we still needed to fund the ongoing project. We embarked on a lengthy and complicated negotiation process with the local health authority, and by the end of the first year we had managed to secure funding for the care of 150 women. We made a decision to become a partnership, employing a practice manager. We would be self-employed, having a direct contract with the local health authority, the first midwifery practice in the UK to set up in this way. We held a firm commitment to providing a midwifery service within the NHS that would serve as a replicable model for implementation nationwide.

The SELMGP:

  • Was a community based project offering a self-managed midwifery service ensuring continuity of care and carer to women living in a deprived inner-city area.
  • Targeted women who were most vulnerable in terms of socio-economic need; worked with women choosing either hospital or home birth, including those with known medical or obstetric complications.
  • Operated from shop-front premises in a busy community centre, offering free pregnancy testing, antenatal and post-natal groups, walk-in advice and information, and midwifery care that was free at the point of service.
  • Eventually undertook the total midwifery care of 200 women per year: each woman was allocated two midwives who looked after her throughout her pregnancy, labour and the first month of her baby’s life.
  • Performed a national and international function as a resource for all those interested in this type of innovative midwifery practice.

From the start we have collected our data in order to perform an ongoing audit of the midwives’ practice. We set up an advisory group composed of 50% users of the service and 50% professionals with relevant expertise, including heads of midwifery and consultant obstetricians from the local hospitals. During the following three years funding proved to be an ongoing problem, necessitating continuing negotiations with a succession of different representatives from the Health Authority. The SELMGP model of care, however, quickly proved to be very popular with the women, and our work soon became both nationally and internationally acclaimed as ground-breaking.

Towards the end of 1996, despite its success, SELMGP was under serious threat. The Health Authority, although clear in its desire to see the project continue, had incurred a massive budgetary overspend, and it became apparent that funds would no longer be available to support SELMGP after the end of the financial year. We began to explore ideas for moving forward with the project; with satisfied customers and excellent clinical outcomes we felt it was unthinkable to give up at this point. It was obvious that a different route for funding would be necessary. In the light of SELMGP’s excellent outcomes, predicted cost-effectiveness and health gain within the local population, both the midwives and the health authority were hopeful about making the SELMGP model of care more mainstream. We approached the Director of Midwifery of a neighboring healthcare trust, Cathy Warwick, who had been a very supportive member of the advisory group for the SELMGP. She agreed to work with us and the health authority to negotiate a sub-contract with Kings Healthcare Trust, and although this would mean relocating and losing the innovative shop-front premises, it was an opportunity for secure funding and thus the survival of the model.

We signed our first contract on 1st April 1997, and the SELMGP was renamed the Albany Midwifery Practice, after the Albany Community Centre, where we had first set up as the SELMGP three years previously. In this unique contract we were able to maintain our self-employed and self-managed status, which we saw as fundamental to the principle of an autonomous midwifery model. We were very keen to continue auditing practice outcomes and felt that the caseload should be either geographically based or generated by local general practitioners (GPs), thereby ensuring equity of access to the service. This would address any criticism that self-selection may affect outcomes. The group, now consisting of six whole caseload equivalent midwives, would take on the care of 216 women per year. It was agreed that the caseload would be generated by three GP practices located on a housing estate in Peckham, an area of South East London recognised as having high levels of social deprivation. A budget was agreed, to be paid directly to the Practice in quarterly instalments. This funding came directly from the hospital Trust, who planned to use available finances from midwifery vacancies, with the Health Authority making an initial contribution in recognition of the value of this arrangement. The Trust agreed to indemnify the midwives in accordance with clinical protocols and Trust policies, and Cathy Warwick agreed to manage the contract. Initially the practice was based in a condemned building which housed the GPs. However, we felt strongly that working from a community base in a non-medical environment was crucial to our model of care, and the following year we moved to a newly-built local Health and Leisure Centre, the Peckham Pulse, with an office and access to other rooms for antenatal visits and ante- and postnatal groups. The centre has swimming pools, a gym, a children’s play area, meeting rooms and a café, as well as a health suite for complementary practitioners, and is well used by local women and their families.

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