the unique nature of continuity of care midwifery and thus the lack of or international market the unique gendered nature of the workforce and clients and the opportunity for inherent bias to build up over time through institutional and personal discrimination the systemic undervaluation of services in existing methodologies. In order to establish fair and reasonable remuneration the co-design group used multiple methodologies to establish the likely range within which remuneration should sit. This approach was reviewed and approved by State Services Commission and the Ministry of Health Steering Group in September 2017. The purpose of this report is to present the results of these methodologies to assist the Ministry of Health to develop a Budget 2018 bid for additional funding for the Primary Maternity Appropriation to recognise cost and service pressures. The document sets out the following components: The work of a community midwife Description of work Significant scope changes since the creation of the role Employment context – costs and benefits Pricing methodologies Historic pricing adjusted for inflation and significant scope change Pricing of comparable jobs Expert statement on strengths and limitations of methodologies in this context. Calculation of 1 Full Time Equivalent Best practice/evidence based practice time allocation Actual time spent by workforce currently Proposed methodology of recognising caseload variance. Calculation of costs of providing community midwifery Pricing of operating costs Pricing on-call expectations Pricing of a national locum service. The work of a community midwife in 2017 Description of work Community LMC midwifery is a complex and demanding occupation. It requires equivalent to a four year degree to achieve the starting qualification (plus an Intern Year encompassing the First Year of Practice), and a further 4-5 years of clinical practice and continuing professional education and mentoring to gain full proficiency.
On call and business operating have not been allowed for in these calculations or any scope of work adjustment. Comparator Similarities Differences Price range Employed resident medical officer, 45-50 hours per week, midpoint of experience band (6 years). Responsible for complete care for a number of patients at once. Similar risk of exposure to hazards. Works as part of a multidisciplinary team. Similar years of on the job experience. Similar expectations in use of technology & maintaining clinical records. Does not work autonomously (reports to Senior Medical Officer). Managed predictable rostered hours only, and less time on call. Ability to access comprehensive administration support. No travel, hospital setting only. Two additional of formal education. Broader scope of practice. Not expected to concurrently run a business. Professional registration and indemnity insurance costs are paid by employer. $118,910– to $121,839 + 11 days statutory or statutory pay + 30 days annual leave, and up to 30 accumulating days sick leave +Tools of trade and multiple related expenses and allowances + Significant additional call out and on call including telephone contact + 6 weeks education leave, up to $6,500 conference attendance + travel expenses/mileage if appropriate + 6% Kiwisaver employer contribution Employed General Practitioner, 40+ hours per week Responsible for complete care for a number of patients at once. Works autonomously to deliver primary care. Works as part of a multidisciplinary team. Similar years of on the job experience. Similar expectations in use of More variance in range of patient needs (wider than maternal/infant). Fewer urgent and emergency situations. No on call. Predictable hours. Two additional years of formal education. Not expected to concurrently run a business. Less $171,000 - $180,000 + 6% Kiwisaver employer contribution + statutory leave or statutory pay
technology & maintaining clinical records. requirement to perform clinical procedures on a regular basis. + 30 days annual leave, minimum of 9 days sick leave Contractor General Practitioner, 40+ hours per week Responsible for complete care for a number of patients at once. autonomously to deliver primary care. Works as part of a multidisciplinary team. Similar years of on the job experience. Similar expectations in use of technology & maintaining clinical records. Similar self- employment context. More variance in of patient needs (wider than maternal/infant). Fewer urgent and emergency situations. No on call. Predictable hours. Two additional years of formal education. Less requirement to perform clinical procedures on a regular basis. $190,000 - $203,000 Self-employed General Practitioner (practice partner), 40+ hours per week (2016 summary workforce survey – insert reference) Responsible for complete care for a number of patients at once. autonomously to deliver primary care. Works as part of a multidisciplinary team. Similar years of on the job experience. Similar expectations in use of technology & maintaining clinical records. Similar context (owner operator). More variance in of patient needs (wider than maternal/infant). Fewer urgent and emergency situations. No on call. Predictable hours. Two additional years of formal education. Less requirement to perform clinical procedures on a regular basis. Employed community case loading midwife in a rural DHB (actual price required to attract a midwife to this position) Same community and home-based antenatal and postnatal services. Same education and experience. Rostered time off. Statutory, sick and study leave. No labour and birth attendance. Not expected to concurrently run a business. Professional registration and indemnity insurance costs are paid by employer. Supported by organisational systems and processes $160,000 + 6% Kiwisaver employer contribution + statutory leave or statutory pay + 30 days annual minimum of 9 days sick leave Employed community case loading midwife (Multi-Employer Same community & home based postnatal services. Same Rostered time off call. Statutory, sick, study leave. All equipment and consumables $89,000 Inherent undervaluation of
long term is unsustainable Adjusted total $31,115 Core Midwives Defined under the current MECA (note in process of being On call is rostered, managed and limited to ensure standard hours on average per week of 40 hours $4.04 per hour on call plus 1.5 for statutory days $6.06 per hour plus hours in lieu to 1.5/2.0 times Use $4.22 weighted average rate Currently under review as part of 2017 MECA negotiations 100% Total Hours per annum 8760 hours less actual hours where unable to respond Estimated at 25 days per at 24 hours = 600 hours On call availability 8160 Total 8160 hours @ $4.22 $34,435 ACC Contracts with Prime Practices Injury related responses Call out attendance fee $183.11 per hour plus travel at $.73 per km Unknown Unknown Registered Medical Officers On call is rostered, managed and limited to ensure reasonable standard hours per week in line with contract Call Back includes time from home to place of providing care plus travel On Call availability allowances from $4 up to $25 per hour Minimum call back and payment 4 hours Logged telephone conversation 1 hour minimum payment Emergency on call back up roster $50 per hour Unknown Unknown Co-design Recommendation The Co Design team propose that $30,000 per per full time equivalent paid evenly during the course of the year.
Registration with results providers Some DHBS require health professional to pay a monthly fee of over $40 per month for the ability to receive results electronically. This does not vary with Caseload and is the same regardless of the number of results received. Some midwives are choosing not to subscribe to this service because of the cost and then must time on the phone to track down and receive results in a timely manner. Accountant, lawyer and advisors Accountant costs are the most typical costs in this category This does not vary with Caseload. Bank Fees and Interest Section 88 payments do suffer from a delay in payments. This does not vary with Caseload. GST Cost (If not registered) In NZ business are not required to register for GST until they have turnover of more than $60,000 per annum. This may have an impact for midwives with a smaller caseload but is avoided if they register for GST. Calculated at 72% of 15% of all costs that are inclusive of GST Professional Costs NZ Midwifery Council APC Fee Compulsory Practicing Certificate from the NZ Midwifery Council, $400 per annum incl GST This does not vary with Caseload. All these professional costs are covered by DHBS for employed midwives - except NZCOM Membership NZCOM Membership incl Prof Indemnity NZCOM Membership is not compulsory but offers the cheapest for LMC midwives to obtain Professional Indemnity at $695 per annum incl GST A 25% discount for low income earners exists The College have not changed these fees in over 15 years have established robust quality assurance procedures and a unique relationship with QBE Insurance in order to provide this service to members. Individual indemnity insurance would cost well in excess of $2,000 per annum Midwifery Standards Review Reviews are compulsory every three years with some midwives requested to return earlier if required. $396.25 incl GST This does not vary with Caseload. This does allow for travel for rural midwives.
Continuing Professional Development Professional Development requirements are set by the NZ Midwifery Council and include 3-5 days per year of education time This does not vary with Caseload. This does allow for travel for rural midwives. This cost solely covers the attendance fee and acknowledges additional travel for rural midwives. Other Costs Other Costs See Co-Design Survey for examples of other costs Locum Support Payments Made Covered elsewhere Fixed Assets Depreciation Vehicle A vehicle is required to offer midwifery services. It is in business use at all times when a midwife is on-call. As a and often urgent service is expected The vehicle must be reliable. This does not vary with Caseload. Office Equipment Includes a computer and office furniture or office equipment. This does not vary with Caseload. Medical Equipment Includes fetal monitoring equipment and resuscitation equipment This does not vary with Caseload. and Homebirth midwives may require a higher standard of equipment. Midwives currently are not purchasing the highest quality equipment instead looking for ways to save money by buying second hand or cheaper imports. In some this can include reliable communication devices, setup costs and educational text books.