Local Supervising Authority
Practice Programme
Name
Local Supervising Authority
Practice Programme
Midwife’s name:
Signature :
Midwife PIN:
LSA Representative:
Programme Lead Supervisor of Midwives’ name :
Signature
Named Supervisor of Midwives’ name:
Signature
Academic Mentor’s name:
Signature
Clinical Mentor’s name:
Signature
Clinical Mentor’s name :
Signature
Programme start date:
Planned date of completion:
Actual date of completion:
Hours Completed:
2
Contents
The aim of the Local supervising authority (LSA) practice programme........................5
Overall objectives of this Local supervisory authority practice programme...................5
Programme specification ............................................................................................. 5
Assessment................................................................................................................. 6
Assessment of clinical competence ............................................................................ 6
Assessment of theory, when required for the programme?......................................... 6
Standards of presentation of written work ................................................................... 6
Successful programme ............................................................................................... 7
Unsuccessful or incomplete programme..................................................................... 7
Clinical Proficiency Assessment Criteria (adapted from Harrison 2001) ...................... 8
Investigation recommendations and proficiencies from supervisory investigation
report. (Please copy and paste the findings from the supervisory investigation) ......... 9
Check list prior to commencement of the programme................................................ 10
Health assessment .................................................................................................... 11
Employment issues ................................................................................................... 11
The role of those involved in this Local supervisory authority practice programme .... 11
Role of the Local Supervising Authority Midwifery Officer (LSAMO) ......................... 11
Programme Lead Supervisor of Midwives ................................................................ 12
Named supervisor of midwives ................................................................................. 12
Role of clinical mentor(s) .......................................................................................... 13
Role of the Academic Mentor when required (Midwife with a Teaching Qualification)13
Role of the Head of Midwifery (HOM)/ Director of Midwifery (DOM) ......................... 14
Orientation to practice following an absence of six months or more .......................... 14
Agreement on content and length of programme ....................................................... 16
Midwife agreement ................................................................................................... 16
Proficiency: Accountability ......................................................................................... 17
London Local Supervising Authority Practice Programme 2013
3
Proficiency: Administration and Care of women in labour with an epidural. ............... 28
Proficiency: Neonatal Resuscitation .......................................................................... 33
Proficiency: The use and interpretation of Cardiotocograph (CTG). ........................... 36
Proficiency: Documentation and Record Keeping ...................................................... 40
Proficiency: The use of intravenous syntocinon in labour to initiate or augment uterine
contractions. .............................................................................................................. 43
Proficiency: Medicines management ......................................................................... 48
Proficiency: Professional Behaviour .......................................................................... 53
Proficiency: Demonstrate the ability to provide intrapartum care for a woman with a
previous history of caesarean section (LSCS) ........................................................... 59
Agreement on conclusion of the programme ............................................................. 63
Appendix one ............................................................................................................ 64
References ................................................................................................................ 64
Clinical Proficiency Assessment Criteria adapted from: ............................................. 64
Appendix Two - Example........................................................................................... 65
Appendix Three - Example ........................................................................................ 66
Reading log ............................................................................................................... 67
Local Supervising Authority Practice Programme will replace
supervised practices programmes in accordance with the new
Midwives rules and standards 2012 comes into force 1 January 2013
(NMC 2012).
London Local Supervising Authority Practice Programme 2013
4
The aim of the Local supervising authority (LSA)
practice programme
The aim of the practice programme is to provide a formal process that develops and
assesses the midwife’s competence in order for her to practice midwifery safely.
Overall objectives of this Local supervisory authority practice
programme

To provide a positive and encouraging learning experience for the midwife that will
facilitate him/her to gain the required experience and knowledge in order to
achieve the agreed outcomes.

To facilitate the midwife to achieve the level of competence necessary to practise
midwifery safely.

To facilitate a supportive environment, which enables the midwife to reflect on
practice and become a confident, competent practitioner of contemporary practice.
Programme specification

London LSA will agree the programme before the midwife starts the programme

The midwife should be supernumerary during the course of the programme. This
means that the midwife will have the opportunity to discuss ongoing clinical care
and decision making with her/his clinical mentor

During the period of Local supervisory authority practice programme, the midwife
must not be involved in the teaching or mentoring of students.

To ensure that all concerned have a clear focus on the requirements of this
programme it should be ensured that the programme has measurable objectives
and clear outcomes, with the midwife and the mentor providing clear evidence of
achievement.

The objectives and learning outcomes will relate to the specified needs and
proficiencies identified within the supervisory investigation as being of concern,
and from the NMC Domains and ‘Essential skills clusters’ (NMC Standards for preregistration midwifery education 2009).

The midwife should have input into the design and content of the programme in
relation to the learning outcomes, which should be directly related to the identified
practice needs and documented within the specific Local supervisory authority
practice programme.

The midwife will need to pass all the elements of the programme.
London Local Supervising Authority Practice Programme 2013
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Assessment
Assessment of clinical competence
Clinical midwifery practice is assessed by clinical mentor
The midwife must demonstrate ability and competence to the standard of a newly
qualified midwife (Level 3) to be deemed competent and fit to practise as a midwife;
this is different to an employer’s requirement to be fit for role. Any aspects of
extension of role or employment status will be determined by employers.
It is expected that the minimum standard (level 3) is acceptable to complete a
programme of Local supervisory authority practice programme.
Marking criteria – Assessment Criteria for clinical practice
Level 3 Pass The midwife can demonstrate competence in the areas of midwifery
practice assessed by this programme.
Level 2 and below Fail The midwife has not demonstrated competence (attitude,
knowledge, skills abilities) in the areas assessed by this programme (Student /
Maternity Care Assistant).
Stage 1 Developmental period
The clinical mentor will be available to the midwife in a teaching capacity.
Stage 2 Assessment of competence
The clinical mentor will be available to the midwife and assessing the midwife’s
proficiency in the clinical environment.
Assessment of theory (as required)
Theoretical midwifery knowledge assessed by academic link
There should be a discussion facilitated with the academic link to agree to the most
appropriate means to assess level of insight (reflection) and critical thinking. An
academic marking grid can be used (see Appendices 2 and 3) to demonstrate fair
means of assessment. Assessment will be based on a 40% pass rate.
Midwives without a midwifery degree will be assessed at level 2 and all degree trained
midwives will be assessed at level 3.
A system of moderation should be utilised in line with University regulations.
Standards of presentation of written work
Any written work presented for the assessment should

Be typed

Be referenced

Demonstrate the appropriate and agreed level of critical thinking

Formative and summative work should be submitted by the dates agreed at
the first meeting
London Local Supervising Authority Practice Programme 2013
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Successful programme
Following the successful completion of the Local supervisory authority practice
programme, the midwife will continue to receive ongoing support and guidance from
her named supervisor who will also continue to review her practice as appropriate.
The midwife will be encouraged to meet with her line manager and named SoM before
her/his return to normal working environment to ensure this is an appropriate working
environment following the programme completion.
Unsuccessful or incomplete programme
London LSA should be kept informed of progress throughout the programme and
should also be involved in the decision of the final outcome.
The LSAMO must become involved if the midwife is having difficulty in meeting the
proficiencies/learning objectives at this stage, the LSAMO, in conjunction with the
midwife, and the Investigating/programme lead supervisor of midwives should review
the midwife’s progress on the programme.
Where a midwife fails to meet the objectives set within the programme, and has been
given every reasonable opportunity and support to do so, the LSAMO will consider
referral of the midwife to the NMC, and the employing Head of Midwifery should be
informed.
Where the Local supervisory authority practice programme is linked to a Trust
capability procedure, the midwife should understand from the outset that failure to
meet the required competence might result in further disciplinary action. The Trust,
where applicable, should be informed of the outcome of the programme.
If a midwife is unwilling to undertake a Local supervisory authority practice programme
the supervisor of midwives must then refer the case to the LSAMO. The midwife
should understand that this may result in a referral to the NMC, and the employing
Head of Midwifery will be informed.
.
London Local Supervising Authority Practice Programme 2013
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Clinical Proficiency Assessment Criteria (adapted from Harrison 2001)
Status
Level of achievement
Assessment Level
No clinical experience
Cannot perform this activity satisfactorily to participate within the clinical environment.
0
Student,
Can perform this activity, but not without constant supervision, assistance and/or guidance. (Novice)
1
Can perform this activity satisfactorily, but requires some supervision and assistance and/or minimal
guidance. Developing knowledge base & skills. (Advanced beginner)
2
Midwife at point of
registration
Can perform this activity satisfactorily without supervision, assistance and/or guidance; with
acceptable speed and quality of work with understanding and appropriate application Identify the
problem, relevant information and uncertainties. (Competent and able to account for their actions)
3
Midwife (post preceptor
period)
Can, independently perform this activity satisfactorily, with more than acceptable speed, quality and
with initiative and adaptability to specific problems as and when they arise. Explore interpretations
and connections, with junior midwives and learners, etc. (Proficient and therefore fully
accountable)
4
Experienced midwife
Can perform this activity satisfactorily with more than acceptable speed and quality and with initiative
and adaptability. Can lead/instruct/assess other practitioners in performing this activity. Can prioritise
alternatives and implement conclusions. Can explore interpretations and connections and
advise/assist others to do so. (Specialist)
5
Experienced midwife
with ongoing postdegree education.
Utilises Research and development activity to inform the evolution of evidence based practice.
Envisions and directs strategic innovation. (Consultant, expert)
6
Maternity care assistant
Student
Maternity care assistant
The NMC uses the term “standards of proficiency” to describe the skills and ability required to practice safely and effectively without the need
for direct supervision.
London Local Supervising Authority Practice Programme 2013
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Investigation recommendations and proficiencies
from supervisory investigation report. (Please copy
and paste the findings from the supervisory
investigation)
The Programme –length xxx hours to include:
 List competencies
London Local Supervising Authority Practice Programme 2013
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Check list prior to commencement of the programme
Task
Date
completed
Signature
Investigation report sent to LSAMO for approval
Following approval from London LSA:
Feedback to midwife in presence of her named supervisor
RCM/ Recognised Union Representative or work place
colleague may be present for support
Copy of investigation report to Registrant
Recommendation for Local supervisory authority practice
programme entered onto database
Investigation outcome summary report to Head of
Midwifery
Head of Midwifery support for the programme in writing
Academic mentor identified when required
Clinical mentors identified
LSA Practice Programme compiled with input from the
midwife and a copy given to midwife
Ensure that the midwife has a copy of NMC ‘The Code’
and ‘Midwives rules and standards’ 2012
London Local Supervising Authority Practice Programme 2013
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Health assessment
Before the programme commences the midwife may need to be assessed by
Occupational Health. The Supervisor facilitating the programme can consider making
the appropriate referral to Occupational Health.
Everyone involved in the Local supervisory authority practice programme should be
aware that the health of the midwife can be assessed at any time during the
programme, if the midwife displays signs or symptoms of health problems.
Employment issues
Whilst on Local supervisory authority practice programme the midwife is strongly
advised not to practise as a midwife anywhere else including any work outside the
LSA (this includes working as an agency midwife or on the midwifery bank).
If the Local supervisory authority practice programme is to take place outside the
midwife’s usual place of employment, the rationale for this should be discussed with
the midwife, the LSAMO and the current employer.
An honorary contract, CRB and occupational health clearance is required if working
in another practice setting.
The role of those involved in this Local supervisory
authority practice programme
Role of the Local Supervising Authority Midwifery Officer (LSAMO)
The LSAMO exercises the function of the London Local Supervising Authority (LSA).
An investigating supervisor of midwives will have investigated the incident and will
have made a recommendation to the LSA for the next course of action.
The LSAMO:

Agrees the recommendation required for the LSA practice programme

Explores any concerns raised by the midwife about the decision for LSA practice
programme, the programme and the final outcome.
The Assistant LSAMO or LSA support Midwives:

Provides the supervisors of midwives, clinical and academic mentors with
support and guidance.

Can commence and sign off the programme on behalf of London LSA.
London Local Supervising Authority Practice Programme 2013
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Programme Lead Supervisor of Midwives
The Programme Lead Supervisor of Midwives will normally be the investigating
supervisor of midwives. They will:

Plan with the midwife, named supervisor and academic mentor an individual
Local supervisory authority practice programme which is structured and includes
objectives that are individual to the midwife concerned, are based on NMC
requirements for competence and practice and are related to the incident(s) that
occurred

Act as an advocate for the midwife on the programme in facilitating her learning
needs and will be responsible for ensuring that the content of the programme will
support the learning outcomes.

The supervisor of midwives will take responsibility for reviewing progress and will
act as overall verifier of the programme outcomes.

Should issues arise during the programme the supervisor of midwives will assist
in resolving them.

This facilitating supervisor will negotiate with the Head of Midwifery to ensure the
Local supervisory authority practice programme period and supernumerary
status is supported by the Trust. If the midwife is recommended to work outside
her/his usual Trust and requires an external LSA practice programme, the
LSAMO will be consulted to assist in that negotiation with the relevant Head of
midwifery.

Facilitate review meetings.
Named supervisor of midwives
The named supervisor of midwives will provide confidential support during the
programme.

The midwife may contact her to discuss in confidence, her progress and any
areas of concern. The named supervisor is also responsible for retaining this
Local supervisory authority practice programme record within the midwife’s
supervisory records and transferring as appropriate if the named supervisor
changes. The record must be retained for 25 years and noted on the LSA
database.

This supervisor should be involved in the decision making in relation to the
achievement of the programme.

The named supervisor should always be present at progress meetings even if the
midwife requiring this Local supervisory authority practice programme chooses
not to engage or utilise her as a support person. This serves as advocacy and
further support.
London Local Supervising Authority Practice Programme 2013
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Role of clinical mentor(s)
The clinical mentor(s) should be experienced in the area of practice relating to the
programme objectives and be on the register of midwife mentors as a sign off
mentor. The clinical mentor does not have to be a supervisor of midwives. The
clinical mentor(s) is/are not responsible for further mistakes or omissions made by
the midwife whilst on Local supervisory authority practice programme.
The clinical mentor(s) will:

Help to ensure that the midwife remains supernumerary for the duration of the
programme, and that the midwife also can make decisions under the support and
guidance of a clinical practice mentor for the proficiencies identified.

Will be available to work with the midwife as required in the clinical environment
to provide clinical advice and guidance to the midwife.

Identify learning opportunities, clinical cases, clinical forums, etc., appropriate to
facilitating the learning outcomes.

Be responsible for teaching the midwife during the developmental stage of the
programme and subsequently be responsible for assessing the clinical
competence of the midwife against the learning outcomes set in the programme.

Provide formal and informal feedback on clinical care given by the midwife
highlighting areas of competent practice and also areas that need development.

Identify with the midwife any additional learning needs that become apparent
during the programme and liaise with the facilitating supervisor of midwives

Inform the facilitating supervisor of midwives if any additional incidents of unsafe
practice occur during the programme.

Provide a verbal report to the facilitating supervisor of midwives at an interim
point and a written report at the final review meeting. This report will provide clear
evidence from the clinical perspective of where the midwife has or has not
demonstrated competence.
Role of the Academic Mentor when required (Midwife with a Teaching
Qualification)
The role of the academic mentor is to:
Generate, with the Programme Lead Supervisor, a contract/plan of academic
support including learning resources required, the amount of dedicated study
time required, providing guidance on accessing and updating their learning skills
to inform their understanding and academic ability

Mark the assessment to the determined criteria

Utilise a system of moderation to support fair judgement

Provide formative and summative feedback on the work to the midwife and
programme lead supervisor throughout the programme.
London Local Supervising Authority Practice Programme 2013
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Role of the Head of Midwifery (HOM)/ Director of Midwifery (DOM)
If the midwife is employed the Head/ Director of Midwifery (HOM/ DOM) needs to
agree to the Local supervisory authority practice programme and should be informed
of the programme objectives. This is because there are planning and cost
implications for the service. The HOM/DOM should be informed about the outcome of
the programme.
Orientation to practice following an absence of six
months or more
Following a period of absence of six months or more or if undertaking Local
supervisory authority practice programme in another unit, an agreed period of
orientation of not less than 75 hours should precede the Local supervisory authority
practice programme.
During this time the midwife must be supernumerary
Local supervisory authority practice programme
details

The midwife must work in a supernumerary capacity at all times during
this Local supervisory authority practice programme

Throughout any Local supervisory authority practice programme the
midwife remains accountable for her actions

The period of Local supervisory authority practice programme should
not be less than 150 hours and not greater than 450 hours, not
including annual leave.

Local supervisory authority practice programme programmes must
aim to be completed within 6 months of the programme commencing.

In the instance where a portfolio development, academic work, and
attendance at study sessions, time allocated on this programme is 1
day a week pro-rota (7 ½ hours a week if full time).

A single extension of 150 hours can be made at the discretion of the
LSAMO.
London Local Supervising Authority Practice Programme 2013
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
This programme may be extended if there is sickness or other
absence during the programme (programme extension to be agreed
with the LSAMO and negotiated with the Head of Midwifery).
Formal review of programme
A formal review of the programme will take place regularly at the following intervals
and should be attended by the midwife, the programme lead supervisor of midwives,
named supervisor, academic mentor and clinical mentors as needed. This will be in
addition to the informal meetings which will take place between the midwife, the
supervisors of midwives, academic mentor and clinical mentors.
Initial meeting date:
150 hour review date:
300 hour review date:
Final review date:
All of the formal meetings will have notes of the meeting taken which should
be signed by the midwife. Additional meetings will be arranged as necessary.
London Local Supervising Authority Practice Programme 2013
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Agreement on content and length of programme
We the undersigned agree that the content and length of programme meet with
the objectives set for this Local supervisory authority practice programme.
Name
LSAMO/ Ass. LSAMO / LSA Support Midwife
Signed
Name
DATE
Programme Lead Supervisor of Midwives
Signed
Name
DATE
Academic Mentor
Signed
Name
DATE
Named Supervisor of Midwives
Signed
DATE
Midwife agreement
I agree to undertake the programme as set out within this document
Name
Midwife
Signed
Date
London Local Supervising Authority Practice Programme 2013
16
Proficiency: Accountability
Proficiency Outcome as a practising midwife: ‘As a professional you are personally accountable for your actions and omissions in your
practice and must always be able to justify your decisions’ (NMC The Code: Standards of conduct, performance and ethics for nurses and
midwives 2008).
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
1
A practising midwife is responsible for
providing midwifery care to a woman and
baby during the antenatal, intranatal and
postnatal periods, in accordance with such
standards as the NMC may specify from
time to time. Therefore a midwife must be
familiar with:


2
The NMC The Code: Standards of
conduct, performance and ethics for
nurses and midwives (NMC 2008).

Documented discussion
and structured
questioning with named
supervisor.

Demonstrate
understanding in
reflective essay.

Testimony of mentors.

Undertake a
presentation to named
supervisor and mentors
of the key points in these
2 documents.

Attend NMC Fitness to
practice hearing.

Write a reflection on the
visit.

Demonstrate
understanding in
reflective essay.
The NMC Midwives rules and standards
(NMC 2004).
You are accountable for your own practice
and you cannot have that accountability
taken from you by another registered
practitioner, nor can you give that
accountability to another registered
practitioner.
Neither you nor your employing authority
should arrange for anyone to act as a
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
17
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
substitute for you other than another
practising midwife or a registered medical
practitioner.
If you are supervising a student, you remain
professionally accountable for what they do,
including the consequences of their actions
and omissions. (Rule 6, Midwives Rules and
Standards (NMC, 2004).
3
A midwife must be able to clearly
differentiate between the meaning of
accountability towards:

women and their families in their care

their employer

the NMC

themselves

working within a legal framework

Testimony of mentors.

Testimony of other
professionals.

Attend a mentor update
session.

Documented discussion
and structured
questioning with named
supervisor.

Demonstrate
understanding in
reflective essay.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
18
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
4
5
The midwife must always be able to justify
actions taken.
Where possible the decisions made by the
midwife must be evidence based.

Documented discussion
and structured
questioning with named
supervisor.

Demonstrate
understanding in
reflective essay.

Testimony of mentors.

Testimony of other
professionals.

Evidence of justification
of actions taken, by
including 5 anonymised
copies of care records.

Testimony of mentors.

Testimony of other
professionals.

Undertake the review of
an existing guideline and
benchmark against
National guidance and if
necessary update
applying new research
findings relevant to the
guideline.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
19
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
6
Ensure that women are given every
opportunity to give informed consent of their
own free will.

Provide copies of 5 sets
of anonymised records
demonstrating evidenced
based practice.

Evidence of facilitating
informed consent by
including 5 anonymised
copies of care records.

Demonstrate
understanding in
reflective essay.

Testimony of mentors.

Testimony of other
professionals.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
20
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
7
The midwife must always be able to
demonstrate on-going education and
practice experience (fulfilling PREP
requirements) to maintain accountability.

Midwife must state
identified learning needs
and develop action plans
to achieve required
learning outcomes.

Documented discussion
and structured
questioning relating to
PREP with named
supervisor.

Present an individual
learning plan to named
supervisor detailing
learning needs and
action plans on how
these will be achieved
for the next year.
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
If Evidence, for example a study day, or attendance at a particular activity has not yet happened by either the 150 or 300 hour review please enter NYF (Not Yet Facilitated).
At each of these reviews, if particular activities have not yet been facilitated , reassurance will be sought that, for example dates, times, venues, etc,, have been arranged to
ensure evidence is completed and in place for the final 450 hour end review. At the final 450 hour review, if level 3 is not achieved, reasons for the failure must be clearly
evidenced to justify the failure of the Local supervisory authority practice programme.
The named supervisor can provide all the information in one document if appropriate.
You may use the same five sets of records if they provide all the evidence required
You are only expected to prepare one presentation for student midwives ensuring that all areas identified are covered
London Local Supervising Authority Practice Programme 2013
21
Proficiency: Effective Communication
Proficiency Outcome: The practitioner must be effective in communicating appropriately to optimise the outcomes for mothers, babies and
their families under her care.
Clinical Level Achieved
(minimum level is 3)
No Benchmark Statements
Evidence
150 hr
Review
1
2
Be able to define normality and be
competent to work within the sphere of
practice as defined within the Midwives
Rules and The Code of Conduct (NMC,
2008).
Be able to recognise deviation from normal
and /or when the mother’s needs fall outside
the scope of midwifery practice and make
appropriate referral to a practitioner best
deemed to deal with the situation with the
appropriate skills and knowledge.

Documented discussion
and structured
questioning with named
supervisor.

Demonstrate
understanding in
reflective work.

Testimony of mentors.

Demonstrate to mentors
how to use an obstetric
early warning system to
aid referral to an
appropriate practitioner.

Testimony of mentor and
other professionals.

Evidence of justification
of referrals made by
including 5 anonymised
copies of care records.

Attend unit update days.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Signature
Achieved of Mentor
22
Clinical Level Achieved
(minimum level is 3)
No Benchmark Statements
Evidence
150 hr
Review
3
4
Be familiar with Trust’s/ Health Board’s
procedures, protocols, guidelines and
proficiencies pertaining to the need for
referral when the clinical need arises.
Recognise the working of the multiprofessional team and contribute to care
within the framework of care delivery.

Include copies of these
with a summary of main
points for each
document.

Documented discussion
and structured
questioning with named
supervisor.

Testimony of mentors.

Evidence of justification
of referrals made by
including 5 anonymised
copies of care records.

Documented observation
by mentors in daily diary.

Evidence of multiprofessional team care
planning by including 5
anonymised copies of
care records.

Demonstrate ability to do
this in reflective work.

Attend 2 multiprofessional meetings.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Signature
Achieved of Mentor
23
Clinical Level Achieved
(minimum level is 3)
No Benchmark Statements
Evidence
150 hr
Review
5
Team working in the best interests of
individual women.

Testimony of mentor.
6
Communicate with women throughout their
pregnancy, labour and the period following
birth.

Documented observation
by mentors.

Documented discussion
and structured
questioning with named
supervisor.

Testimony of others.

Evidence of multiprofessional team care
planning by including 5
anonymised copies of
care records.

Documented observation
by mentors.

Testimony of others.
7
7.1
7.2
Listen to women, jointly identifying their
feelings and anxieties about their
pregnancies, the birth and the related
changes to themselves and their lives
within the context of their culture and
personal beliefs.
300 hr
Review
450 hr End
Review
Date
Signature
Achieved of Mentor
Enable women to think through their
feelings and make informed choices,
based on the best available evidence
about their own health, the health of
their babies and families, and how they
can be improved.
London Local Supervising Authority Practice Programme 2013
24
Clinical Level Achieved
(minimum level is 3)
No Benchmark Statements
Evidence
150 hr
Review
8
9
7.3
Document discussions within notes,
thus enabling planning of needs to be
understood by all professionals
contributing to care.
7.4
Continue to communicate and provide
support to women when their
pregnancies are in difficulty.
Be able to discuss and/or negotiate with
other professionals about further
interventions which are appropriate for
individual women, considering their wishes,
context and culture.
Draw on the skills of others to optimise
health outcomes and resource use.

Through discussion and
structured questioning
by named supervisor.

Documented observation
by mentors and named
supervisor.

Demonstrate ability to do
this in reflective work.

Testimony of others.

Through discussion and
structured questioning
by named supervisor.

Documented observation
by mentors and named
supervisor.

Demonstrate ability to do
this in reflective work.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Signature
Achieved of Mentor
25
Clinical Level Achieved
(minimum level is 3)
No Benchmark Statements
Evidence
150 hr
Review

Testimony of others.
10
Consistently document accurately and legibly
full details behind the reasoning of all actions
taken and referrals made.

Evidence of referral to
multi-professional team
and reasons for doing so
by including anonymised
copies of care records.
11
Ensure the confidentiality and security of
written and verbal information acquired within
professional capacity.

Documented discussion
with named supervisor
on the NMC standards
for record keeping.
Midwife to present key
points.
12
Disclose information about individuals and
organisations only to those who have a right
and need to know it once proof of identity
and right to disclosure has been obtained.

Documented discussion
with named supervisor
on the NMC standards
for confidentiality.
Midwife to present key
points.
13
Be able to represent the midwife’s own
considered views and experiences within the
context of broader health and social care
policies in the interests of women, babies
and their families.

Through discussion and
structured questioning
by named supervisor.

Documented observation
by mentors and named
supervisor.

Demonstrate ability to do
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Signature
Achieved of Mentor
26
Clinical Level Achieved
(minimum level is 3)
No Benchmark Statements
Evidence
150 hr
Review
300 hr
Review
450 hr End
Review
Date
Signature
Achieved of Mentor
this in reflective work.
14
Make effective use of the framework for
statutory supervision of midwives.

Testimony of others.

Documented discussion
with named supervisor.

Testimony of named
supervisor.
15
Gain feedback from women, their families,
colleagues and other professionals and
appropriately applying this to practice.

Documented observation
by named supervisor
and mentors.
16
Keep up to date with evidence and apply
evidence to practice and alert others to the
evidence to apply to their own practice.

Undertake the review of
an existing guideline and
benchmark against
national guidance if
necessary update
applying new research
findings relevant to the
guideline.
If Evidence, for example a study day, or attendance at a particular activity has not yet happened by either the 150 or 300 hour review please enter NYF (Not Yet Facilitated). At
each of these reviews, if particular activities have not yet been facilitated , reassurance will be sought that, for example dates, times, venues, etc,, have been arranged to
ensure evidence is completed and in place for the final 450 hour end review. At the final 450 hour review, if level 3 is not achieved, reasons for the failure must be clearly
evidenced to justify the failure of the Local supervisory authority practice programme.
The named supervisor can provide all the information in one document if appropriate.
You may use the same five sets of records if they provide all the evidence required
You are only expected to prepare one presentation for student midwives ensuring that all areas identified are covered
London Local Supervising Authority Practice Programme 2013
27
Proficiency: Administration and Care of women in labour with an epidural.
Proficiency Outcomes: The practitioner will be able to care for a woman safely and competently with an epidural for the management of pain
relief in labour
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
1
Discuss Trust/ Health Board policies and
procedures relating to epidural.

Discussion with mentor.
2
Attend relevant training session.

Provide evidence of
attendance.

Assessment of
competency against a
Trust/ Health Board
approved proficiency
document.
Have knowledge of the anatomy of the
spinal column and neurological tissues and
be able to describe the principles of
epidural anaesthesia.

Discussion with mentor.

Include in reflective
essay.
Identify rationale for epidural anaesthetic in
relation to individual patient circumstances
such as maternal request.

Mentor to witness
interaction and
discussion with women
on at least 5 occasions.

Provide 5 anonymised
case records for
portfolio.
3
4
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
28
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review

Discussion with mentor.

Demonstrate in clinical
practice.

Provide 5 anonymised
case records for
portfolio.

Discussion with mentor.
Be able to inform the anaesthetist of the
need for epidural and be able to describe
individual details relating specifically to
each case.

Demonstrate in clinical
practice.

Discussion with mentor.
Be aware of the clinical situations in which
an epidural anaesthetic is not appropriate
or the situations where specific screening is
required prior to its setting up.

Discussion with mentor.

Include in reflective
essay.
8
Be able to assemble the necessary
equipment and items to carry out the
procedure including intravenous fluid
administration.

Demonstrate in clinical
practice on at least 5
occasions.
9
Be able to correctly and comfortably
position the woman and assist the
anaesthetist in the insertion of the epidural
cannulae.

Demonstrate in clinical
practice on at least 5
occasions.
5
6
7
Explain procedure and rationale to the
woman demonstrating awareness of the
need for gaining her informed consent.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
29
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
10
Assist the anaesthetist to ensure that the
epidural cannula is secured safely with the
appropriate material according to the
woman’s need.

Demonstrate in clinical
practice on at least 5
occasions.
11
Maintain asepsis throughout the whole
procedure and be able to dispose of used
equipment in a safe and appropriate way.

Discuss Trust/ Health
Board policy with mentor
for:
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
Disposal of sharps.
Sharps injuries.
12.1 12.1 Have an in-depth knowledge of the
drugs administered via the epidural
catheter, including dosage, action and
side effects.
12.2 Be able to follow the anaesthetist’s
prescription instructions and query
any problems as appropriate.

Demonstrate in clinical
practice.

Attendance at an
epidural update.

Demonstrate a working
knowledge of local policy
including the Medicines
policy.

Demonstrate in clinical
practice on at least 5
occasions.

Demonstrate knowledge
of emergency
procedures and use of
resuscitation equipment.
London Local Supervising Authority Practice Programme 2013
30
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review

Include in reflective
essay.
13
Maintain dignity and privacy of the woman
before, during and after procedure

Demonstration in clinical
practice on at least 5
occasions.
14
14.1 Be able to monitor the woman
appropriately and record all
observations and actions accordingly

Demonstrate knowledge
to mentor of Trust/
Health Board guidance
14.2 Maintain accurate records and
document any actions / concerns as
appropriate.

Discuss recognition of a
deviation from the
normal with mentor

Describe appropriate
action/ referral

Demonstrate in practice
by maintaining accurate
and contemporaneous
records.

Case note review (5 sets
of own records)

Demonstrate in practice
by maintaining accurate
and contemporaneous
records.

Case note review (5 sets
15
15.1 Provide a plan of care for the woman
having an epidural anaesthetic,
including a record of observations.
15.2 Assess the pressure areas, record
findings, evaluate and modify care as
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
31
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
required.
16
Recognise possible side effects and
instigate correct interventions as
appropriate.
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
of own records).

Be able to identify to
mentor signs of side
effects to mother and
baby.

Be able to take timely
and appropriate
action/referral.

Discussion with mentor
and record in daily diary.
If Evidence, for example a study day, or attendance at a particular activity has not yet happened by either the 150 or 300 hour review please enter NYF (Not Yet Facilitated). At
each of these reviews, if particular activities have not yet been facilitated , reassurance will be sought that, for example dates, times, venues, etc,, have been arranged to
ensure evidence is completed and in place for the final 450 hour end review. At the final 450 hour review, if level 3 is not achieved, reasons for the failure must be clearly
evidenced to justify the failure of the Local supervisory authority practice programme.
The named supervisor can provide all the information in one document if appropriate.
You may use the same five sets of records if they provide all the evidence required
You are only expected to prepare one presentation for student midwives ensuring that all areas identified are covered
London Local Supervising Authority Practice Programme 2013
32
Proficiency: Neonatal Resuscitation
Proficiency Outcome: The practitioner will be competent to perform evaluation and initial resuscitation of the newborn infant.
Clinical Level Achieved
(minimum level is 3)
No Benchmark Statements
Evidence
150 hr
Review
1
2
3
4

Discuss in reflective
essay local Trust/ Health
Board guideline on
neonatal resuscitation.

Compare this with
guidance from
Resuscitation Council
and discuss in reflective
essay.
Midwives must be fully aware of the
implications on practice as defined by the
rules set out in the NMC's Midwives rules
and standards (2004) and The Code (NMC
2008).

Discuss within reflective
essay.

Discussion with named
supervisor of midwives.
Have an awareness of predisposing factors,
which may identify babies needing active
resuscitation.

Prepare a short
presentation for senior
student midwives
ensuring that these
issues are covered.

Discussion with mentor.

Provide evidence of
Trust/ Health Board
guidance on daily
Discuss Trust/ Health Board guidelines
relating to neonatal resuscitation.
Be able to check and ensure the resuscitaire
is clean, stocked and in full working order.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
33
Clinical Level Achieved
(minimum level is 3)
No Benchmark Statements
Evidence
150 hr
Review
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
maintenance of
resuscitaire.
5
6
Be able to identify babies needing active
resuscitation.
6.1
Be able to correctly position the head
to maximize air entry.
6.2
Know the rate and pressures required
for effective inflation breaths and
ventilation breaths.
6.3
Be able to recognize successful lung
inflation and the action to take if
unsuccessful.
6.4
Be able to confirm heart rate by a
recognized method and what action is

Evidence that this has
been completed
successfully on ten
occasions.

Demonstrate from five
sets of records
assessment.

Discuss within daily
journal evidence of five
babies where
resuscitation was
anticipated (if possible).

Discussion with mentor.

Working with Practice
Development Midwife/
Labour Ward
Coordinator/Advanced
Neonatal Practitioner
undertakes at least five
‘mock’ resuscitations
and Senior Practitioner
write a testimony to your
proficiency.

Attend an in house
London Local Supervising Authority Practice Programme 2013
34
Clinical Level Achieved
(minimum level is 3)
No Benchmark Statements
Evidence
150 hr
Review
required.
7
8
6.5
Be able to perform effective chest
compressions when appropriate.
6.6
Be aware of the drugs required for
resuscitation including doses and
where they can be found.
Demonstrate clear evidence that assessment
and planned care is discussed with the
mother and documented within the records.
Maintain accurate records and document any
actions taken as appropriate.
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
training session on
neonatal resuscitation.

Demonstrate from five
sets of records.

Discussion with mentor

Provide evidence from at
least five sets of records.

Review of records with
mentor.
If Evidence, for example a study day, or attendance at a particular activity has not yet happened by either the 150 or 300 hour review please enter NYF (Not Yet Facilitated). At
each of these reviews, if particular activities have not yet been facilitated , reassurance will be sought that, for example dates, times, venues, etc,, have been arranged to
ensure evidence is completed and in place for the final 450 hour end review. At the final 450 hour review, if level 3 is not achieved, reasons for the failure must be clearly
evidenced to justify the failure of the Local supervisory authority practice programme.
The named supervisor can provide all the information in one document if appropriate.
You may use the same five sets of records if they provide all the evidence required
You are only expected to prepare one presentation for student midwives ensuring that all areas identified are covered
London Local Supervising Authority Practice Programme 2013
35
Proficiency: The use and interpretation of Cardiotocograph (CTG).
Proficiency Outcome: The practitioner must be able to identify the relevant clinical situations in which to record a CTG. The practitioner must
be able to appropriately and correctly apply the CTG equipment. Be able to interpret and document their findings and make referrals to the
appropriate practitioner when findings are abnormal and/or difficult to interpret.
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
1
1.1
1.2
2
Practitioners must be fully aware of
the implications for practice as
defined by the rules set out in the
NMC guidance.
Practitioners must be familiar with all
Trust/ Health Board protocols and
procedures relating to CTG recording
and interpretation.
Practitioners must have knowledge of the
anatomy and physiology of the fetal and
placental cardiovascular circulation and be
able to relate this to the observable
components of the CTG.

Discussion with
Supervisor of Midwives.

Demonstrate knowledge
on local fetal monitoring
guidelines and under
pinning NICE guidance.

Demonstrate knowledge
of any related guidelines.

Prepare a short
presentation for student
midwives relating to use
of CTG and link to NICE
guidance.

Evidence of completion
of K2 CTG training
package or equivalent.

Discussion with mentor.

Include as part of
presentation.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
36
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
3
Practitioners must be adequately trained to
set up and use the CTG machine.

300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
Demonstrate knowledge
of the use of CTG
machines within the unit
to include:
Cleaning and storage
Loading of paper
Changing settings e.g.
time clock
4
5
Practitioners must be able to define clinical
situations both antenatally and during the
intrapartum periods when the use of CTG
recording is required.

Discussion with mentor.

Demonstrate in practice.

Include as part of
presentation.
5.1
Practitioners must know how to label
the CTG appropriately.

Discussion with mentor.

Demonstrate in practice.
5.2
Practitioners must be able to perform
an abdominal palpation and record
their findings including auscultation of
the fetal heart rate prior to the
application of the CTG.

Review of 10 sets of
case notes including
CTG with mentor.
5.3
Practitioners must be able to explain
the rationale for regularly recording
maternal pulse and verification of the
fetal heart rate by auscultation upon
the CTG tracing contemporaneously.
London Local Supervising Authority Practice Programme 2013
37
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
6
Practitioners must be able to clearly define
and accurately record the parameters of the
observable components of the CTG that
enable an assessment of normality to be
obtained.

Discussion with mentor.

Demonstrate in practice.

Review of 10 sets of
case notes including
CTG using a recognised
framework.
Demonstrate the use of recognised
antenatal and labour categorisations.
7
8
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
e.g. DR C BRAVADO
NICE
Practitioners must be able to recognise any
deviation from normal, record their actions
and to whom they have referred the CTG
for further assessment.

Discussion with mentor.

Demonstrate in practice.

Discuss referral process
with mentor.
Practitioners must explain the rationale of
documenting all external influences and/or
interventions that may affect the CTG, or
enact a change in the parameters observed
upon the trace as they occur
contemporaneously.

Discussion with mentor.

Demonstrate in practice.

Discuss referral process
with mentor.
London Local Supervising Authority Practice Programme 2013
38
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
9
Practitioners must be able to verify the

strength of contractions through abdominal
assessment as the CTG can only show the
frequency and length of contractions. This is 
of particular importance in the use of
syntocinon to induce/augment uterine
contractions.
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
Demonstration in
practice.
Discussion with mentor.
If Evidence, for example a study day, or attendance at a particular activity has not yet happened by either the 150 or 300 hour review please enter NYF (Not Yet Facilitated). At
each of these reviews, if particular activities have not yet been facilitated , reassurance will be sought that, for example dates, times, venues, etc,, have been arranged to
ensure evidence is completed and in place for the final 450 hour end review. At the final 450 hour review, if level 3 is not achieved, reasons for the failure must be clearly
evidenced to justify the failure of the Local supervisory authority practice programme.
The named supervisor can provide all the information in one document if appropriate.
You may use the same five sets of records if they provide all the evidence required
You are only expected to prepare one presentation for student midwives ensuring that all areas identified are covered
London Local Supervising Authority Practice Programme 2013
39
Proficiency: Documentation and Record Keeping
Proficiency Outcome: The practitioner must be able to document an accurate, contemporaneous and detailed record of all their actions
relating to all aspects of care delivery.
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
1
1.1
1.2
2
3
Can demonstrate the ability to
recognise accurate record keeping as
required by Record keeping: Guidance
for nurses and midwives (NMC 2009).







Discussion with named
Supervisor.

Demonstrate knowledge
of NMC guidance
Record keeping:
Guidance for nurses and
midwives in reflective
essay.

Discussion with mentor.

Include in reflective
essay.

Complete an audit of
case notes using
recognised Trust/ Health
Board audit tool
Can demonstrate knowledge of the
Data Protection Act 1998 and the
application of health records and
understands the implications and
actions arising from them.
Can identify rationale for maintaining
accurate records.
3.1

Can identify and produce evidence of
records that show all key entries
required
date
timed using 24hr clock
signed (name printed)
designation
untrained entries are countersigned
able to photocopy
alterations – dated, signed, single cross

300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
5 sets containing own
records
5 sets of randomly
selected completed case
notes
Discuss audit findings
London Local Supervising Authority Practice Programme 2013
40
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
through
 allergies marked and recorded
3.2 Can identify and produce evidence that
all documentation has all identifiers of
the patient:
3.3
 name
 date of birth
 hospital number
 ward
Can produce evidence of records that
are factual, accurate and detailed
information on the care, treatment and
condition of the mother and/or baby.
3.4
Can demonstrate a working knowledge
of local abbreviations that have been
approved for use within their speciality.
3.5
The practitioner can produce a full
record of assessment, planning and
action required to address identified
problems.
3.6
Can demonstrate clear evidence that
assessment and planned care is
discussed with the mother and
documented within the records.
3.7
Can demonstrate how to document
omissions or errors in the provision of
planned care.
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
with mentor and write a
short report.

Produce a short
presentation to
demonstrate knowledge
about the importance of
accurate documentation
and record keeping.

Provide 5 sets of your
anonymised case
records demonstrating a
high standard of record
keeping.
London Local Supervising Authority Practice Programme 2013
41
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
4
Can demonstrate an understanding of why
any deviations from guidelines should be
documented including why and who has
authorised such changes.

Discuss reasons and
give examples of why
this may happen.

Demonstrate knowledge
of the local agreements
and process.
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
If Evidence, for example a study day, or attendance at a particular activity has not yet happened by either the 150 or 300 hour review please enter NYF (Not Yet Facilitated). At
each of these reviews, if particular activities have not yet been facilitated , reassurance will be sought that, for example dates, times, venues, etc,, have been arranged to
ensure evidence is completed and in place for the final 450 hour end review. At the final 450 hour review, if level 3 is not achieved, reasons for the failure must be clearly
evidenced to justify the failure of the Local supervisory authority practice programme.
The named supervisor can provide all the information in one document if appropriate.
You may use the same five sets of records if they provide all the evidence required
You are only expected to prepare one presentation for student midwives ensuring that all areas identified are covered
London Local Supervising Authority Practice Programme 2013
42
Proficiency: The use of intravenous syntocinon in labour to initiate or augment uterine
contractions.
Proficiency outcome: The practitioner demonstrates that they are proficient to care for women with a syntocinon infusion.
Practitioners must be familiar and competent in the following defined proficiencies:

Intravenous drug administration

Effective communication

Documentation and record keeping

The use and interpretation of the cardiotocograph (CTG)
Clinical Level Achieved (minimum
level is 3) *
No Benchmark Statements
Evidence
150 hr
Review
1
2
Practitioners must have knowledge of
uterine anatomy and physiology and the
pharmacology of the action of syntocinon.
Midwives must be fully aware of the
implications on practice as defined by the
rules set out in the NMC's Midwives rules
and code of practice.

Discuss the
pharmacological action of
syntocinon with mentor.

Within essay include
information on normal
uterine anatomy and
physiology and the action
of syntocinon.

Discuss within reflective
essay.

Discussion with your
named supervisor of
midwives.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
43
Clinical Level Achieved (minimum
level is 3) *
No Benchmark Statements
Evidence
150 hr
Review
3
4
5
6

Provide evidence of Trust/
Health Board guideline on
syntocinon use.

Bench mark this against
NICE guidance.

Discussion with mentor.

Provide evidence from the
case notes of five women
you have cared for which
demonstrates why
syntocinon was used
during labour.

Discussion with mentor.
Be able to explain the process to the
woman including possible side effects to
enable woman‘s consent to be given with
understanding.

Demonstrated in practice.

Provide evidence from the
case notes of five women
you have cared for which
demonstrate evidence of
the discussion and
involvement of the
woman.
Practitioners must be able to appropriately
prepare and use the correct equipment for
the administration of syntocinon.

Provide evidence of five
occasions where infusion
has been commenced.
Practitioners must be familiar with all Trust/
Health Board guidelines and procedures
relating to the use of syntocinon in the
initiation and augmentation of uterine
contractions.
Practitioners must be able to define clinical
situations and changes within the clinical
situation in the intrapartum period when the
use of syntocinon is indicated.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
44
Clinical Level Achieved (minimum
level is 3) *
No Benchmark Statements
Evidence
150 hr
Review
7
8
Prior to the administration of syntocinon the
fetal condition must be assessed by the use
of CTG. This must be continued until birth
of the baby is achieved.
Practitioners must be able to define the
different guideline parameters used for the
initiation and augmentation of uterine
contractions in primiparous and multiparous
women and women undergoing a vaginal
birth after caesarean section.

Discuss with mentor
importance of accurate
preparation and
administration and
document this within daily
journal.

Prepare a short
presentation for senior
student midwives ensuring
that these issues are
covered.

Provide evidence from five
sets of women’s records
of use of CTG and
syntocinon infusion.

Discuss with mentor.

Prepare a short
presentation for senior
student midwives ensuring
that these issues are
covered.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
45
Clinical Level Achieved (minimum
level is 3) *
No Benchmark Statements
Evidence
150 hr
Review
9
10
11
12
Practitioners must be able to describe and
recognize the side effects and
complications of the use of syntocinon to
initiate and augment uterine contractions
and act appropriately.

Discussion with mentor.

Prepare a short
presentation for senior
student midwives ensuring
that these issues are
covered.
Practitioners must be able to recognize
when the optimal use of Syntocinon is
achieved and act appropriately to ensure
this continues.

Provide evidence from five
sets of women’s records
to demonstrate this.

Discussion with mentor.
Practitioners must be able to explain the
rationale for the use of the partogram whilst
syntocinon is being used during labour. The
importance of accurate fluid balance
recording must also be demonstrated.

Provide evidence from five
sets of clients’ case notes.

Discussion with mentor.
Practitioners must be able to verify the
strength of contractions through abdominal
assessment as the CTG can only show the
frequency and length of contractions. This
is of particular importance in the use of
syntocinon to initiate and augment uterine
contractions.

Demonstrate in practice.

Provide evidence from five
sets of women’s records.

Discussion with mentor.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
46
Clinical Level Achieved (minimum
level is 3) *
No Benchmark Statements
Evidence
150 hr
Review
13
Administration of syntocinon must be
clearly documented in the records, with
commencement, changes in dosage clearly
recorded on CTG and partogram.

Demonstrate in practice.

Provide evidence from five
sets of women’s records.

Discussion with mentor.
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
If Evidence, for example a study day, or attendance at a particular activity has not yet happened by either the 150 or 300 hour review please enter NYF (Not Yet Facilitated). At
each of these reviews, if particular activities have not yet been facilitated , reassurance will be sought that, for example dates, times, venues, etc,, have been arranged to
ensure evidence is completed and in place for the final 450 hour end review. At the final 450 hour review, if level 3 is not achieved, reasons for the failure must be clearly
evidenced to justify the failure of the Local supervisory authority practice programme.
The named supervisor can provide all the information in one document if appropriate.
You may use the same five sets of records if they provide all the evidence required
You are only expected to prepare one presentation for student midwives ensuring that all areas identified are covered
London Local Supervising Authority Practice Programme 2013
47
Proficiency: Medicines management
Proficiency Outcome: The practitioner will be able to select, acquire and administer safely, a range of permitted drugs consistent with
legislation, applying knowledge and skills to the situation which pertain at the time.
Clinical Level Achieved
(minimum level is 3)
No Benchmark Statements
Evidence
150 hr
Review
1
2
Can demonstrate a working knowledge of
Trusts/ Health Boards & NMC medicine
policies and procedures.
2.1
Be able to identify the correct
woman/baby for which medication is
prescribed (ID band and verbal
check, or case of baby,
administration with maternal

Discussion with mentor.

Ensure has a copy of
NMC guidelines for
administration of
medicines.

Demonstrate knowledge of
NMC guidelines for
administration of
medicines in reflective
essay.

Observation when
undertaking 6 medicine
rounds.

Access and discuss Trust/
Health Board guidelines
with mentor.

Be observed undertaking
the medicine round with
mentor x 6 occasions.

Write a short reflection on
the 6 medicine rounds.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
48
Clinical Level Achieved
(minimum level is 3)
No Benchmark Statements
Evidence
150 hr
Review
consent).
2.2
Read the individual’s drug chart
correctly (mother/baby’s details,
including hospital number and
weight).
2.3
Check individual for sensitivities/
allergies, and post drug
incompatibilities/ interactions.
2.4
Can discuss the reason(s) why the
woman/baby is prescribed the
drug(s)
2.5
Can state the correct dosage range
for all drugs administered
2.6
Can explain the possible side effects
of drugs administered.
2.7
Initiate correct actions in the event of
an individual experiencing a drug
reaction
2.8
Be able to demonstrate that consent
for administrations is gained.
2.9
Prepare medicines appropriately
(timing, route and dosage).

Undertake correct
documentation regarding
drug administration.

Discussion with mentor
showing an
understanding.
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
2.10 Demonstrate the ability to give
appropriate information to the woman
regarding all aspects of drugs, such
London Local Supervising Authority Practice Programme 2013
49
Clinical Level Achieved
(minimum level is 3)
No Benchmark Statements
Evidence
150 hr
Review
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
as action, side effects and specific
care planning relating to the drug i.e.
avoiding constipation
2.11 Correctly demonstrate accurate
record keeping in relation to all
aspects of drug administration.
2.12 Take appropriate actions if
prescription is not
correct/clear/accurate
3
Demonstrate appropriate action taken in
the event of a drug error.

Discuss with your mentor
the actions to be taken in
the event of discovering a
drug error.
4
Can state what constitutes a drug error

Demonstrate an
understanding of the
policy relating to drug
errors by discussion with
your mentor.
5
5.1
Can discuss the pharmacist’s role
within the ward setting.

Discussion with mentor.

5.2
Can explain how to order all drug
types and how to obtain drugs ‘outof-hours’.
Find out the local process
for ordering drugs
including out of hours.

5.3
Can explain how to order all drug
types and how to obtain drugs ‘out-
Find out the process of
ordering controlled drugs.
 Demonstrate knowledge of
London Local Supervising Authority Practice Programme 2013
50
Clinical Level Achieved
(minimum level is 3)
No Benchmark Statements
Evidence
150 hr
Review
of-hours’.
5.4
6
7
Aware of Patient Group Directions
(PGDs) and what may be
administered under these directions.
Can demonstrate knowledge and
application of drugs that a midwife can
legally supply and/or administer under
midwives exemptions.
7.1
7.2
Can state how to assess the
woman’s competence for selfadministration of medication and/or
the administration of medicines to her
baby.
Demonstrate knowledge and
application regarding drug use in the
antenatal, intrapartum and postnatal
period including affects on breastfeeding.
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
local PGD through
discussion with mentor.

Meet with ward pharmacist
to discuss their role.

Read the Medicines Act
1968 relating to midwives
exemptions.

Discuss the drugs that a
midwife can legally supply
and/or administer under
midwives exemptions.

Write a short article
considering the
implications of medicines
for a woman during her
pregnancy, labour and
postnatal period. Highlight
the most common drugs
that are contraindicated if
the woman is
breastfeeding.
London Local Supervising Authority Practice Programme 2013
51
Clinical Level Achieved
(minimum level is 3)
No Benchmark Statements
Evidence
150 hr
Review

300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
Discuss self administration
of drugs for a mother and
her baby with the woman
in the presence of your
mentor.
If Evidence, for example a study day, or attendance at a particular activity has not yet happened by either the 150 or 300 hour review please enter NYF (Not Yet Facilitated). At
each of these reviews, if particular activities have not yet been facilitated , reassurance will be sought that, for example dates, times, venues, etc,, have been arranged to
ensure evidence is completed and in place for the final 450 hour end review. At the final 450 hour review, if level 3 is not achieved, reasons for the failure must be clearly
evidenced to justify the failure of the Local supervisory authority practice programme.
The named supervisor can provide all the information in one document if appropriate.
You may use the same five sets of records if they provide all the evidence required
You are only expected to prepare one presentation for student midwives ensuring that all areas identified are covered
London Local Supervising Authority Practice Programme 2013
52
Proficiency: Professional Behaviour
Proficiency Outcome: The midwife will be competent to practise to the standard of professional conduct required of them in the exercise of
their professional accountability and practice. (NMC 2004)
Clinical Level Achieved
(minimum level is 3
No
Benchmark Statements
Evidence
150 hr
Review
1
2
3
To demonstrate an understanding of the
content of the Code: Standards of conduct,
performance and ethics for nurses and
midwives (NMC 2008) Midwives rules and
standards (NMC 2004)
Practise in accordance with The Code:
Standards of conduct, performance and
ethics for nurses and midwives (NMC
2008), within limitations of the individual’s
own competence, knowledge and sphere
of professional practice, consistent with the
legislation relating to midwifery practice.
Be aware of the processes involved in

Documented discussion
and structured questioning
with named supervisor.

Demonstrate
understanding in reflective
work.

Undertake a presentation
to named supervisor and a
student midwife
demonstrating the key
points in these 2
documents.

Documented observation
by mentors in diary.

Midwife must state
identified learning needs
and develop action plans
to achieve required
learning outcomes.

Demonstrate
understanding in reflective
work.

Documented observation
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
53
Clinical Level Achieved
(minimum level is 3
No
Benchmark Statements
Evidence
150 hr
Review
consulting other healthcare professionals
when the woman and baby’s needs fall
outside the scope of midwifery practice
(refer to proficiency on effective
communication).
4
5
6
450 hr End
Review
Signature
of Mentor
by mentors in diary.

Documented discussion
and structured questioning
with named supervisor.

Evidence of referrals by
including 5 anonymised
copies of care records.

Demonstrate ability to do
this in reflective work.

Testimony of other
healthcare professionals.

Documented observation
by mentors in diary.

Demonstrate ability to do
this in reflective work.
Practise in accordance with relevant
legislation. This will include demonstrating
knowledge of legislation relating to human
rights, equal opportunities and access to
patient records.

Documented discussion
and structured questioning
with named supervisor.

Review of local, regional
and national legislation
and guidelines.
Maintain confidentiality of information. This
will include ensuring the confidentiality and
security of written and verbal information

Documented observation
by mentors in diary.
Work collaboratively with other
practitioners and agencies in ways which
enable them to participate effectively in the
care of woman, babies and their families.
For example child protection.
300 hr
Review
Date
Achieved
London Local Supervising Authority Practice Programme 2013
54
Clinical Level Achieved
(minimum level is 3
No
Benchmark Statements
Evidence
150 hr
Review
7
8
acquired in a professional capacity.

Documented discussion
and structured questioning
with named supervisor.
Practise in a way which respects,
promotes and supports individual rights,
interests, preferences, beliefs and cultures.

Documented observation
by mentors in diary.

Documented discussion
and structured questioning
with named supervisor.

Testimony of others.

Review of local, regional
and national legislation
and guidelines.

Demonstrate an
understanding of health
and safety legislation
through discussion and
structured questioning by
named supervisor.

Documented observation
by mentors in diary.
Support the creation and maintenance of
environments that promote the health,
safety and wellbeing of women, babies and
other family members.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
55
Clinical Level Achieved
(minimum level is 3
No
Benchmark Statements
Evidence
150 hr
Review
9
10
Provide seamless care and, where
appropriate, interventions in partnership
with woman and other care providers
during the antenatal, intrapartum and
postnatal periods.
Be able to plan and provide appropriate
care for women during the intrapartum
period demonstrating the ability to identify
and manage appropriately any risks
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
Through discussion and
structured questioning by
named supervisor

Demonstrate an
understanding of reviewing
previous history.

Undertake further
assessment of needs.

Care planning and referral.

Evaluate care.

Keep women informed,
facilitating choice, gaining
consent and keeping them
updated on progress.

Demonstrate ability to do
this in reflective work.

Testimony of others.

Demonstrate an
understanding of
intrapartum care through
discussion and structured
questioning by named
supervisor.

Documented observation
by mentors in diary.
London Local Supervising Authority Practice Programme 2013
56
Clinical Level Achieved
(minimum level is 3
No
Benchmark Statements
Evidence
150 hr
Review
11
Be able to demonstrate the ability to work
as a team member:


12
13
supporting junior midwives and care
assistants
communicating effectively with shift
coordinators, the medical team, health
visitors, specialist practitioners,
physiotherapists, social workers, etc.
Demonstrate the ability to handle situations
in a professional and confidential manner.
Be able to manage and prioritise demands

Demonstrate ability to do
this in reflective work.

Testimony of others.

Review of local, regional
and national legislation
and guidelines.

Through discussion and
structured questioning by
named supervisor.

Documented observation
by mentors in diary.

Demonstrate ability to do
this in reflective work.

Testimony of others

Through discussion and
structured questioning by
named supervisor.

Documented observation
by mentors in diary.

Demonstrate ability to do
this in reflective work.

Testimony of others.

Through discussion and
structured questioning by
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
57
Clinical Level Achieved
(minimum level is 3
No
Benchmark Statements
Evidence
150 hr
Review
and workload.
14
15
Demonstrate a positive attitude and remain
calm under pressure.
Be able to communicate in a professional
manner at all times, using appropriate
language.
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
named supervisor.

Documented observation
by mentors in diary.

Demonstrate ability to do
this in reflective work.

Testimony of others

Documented observation
by mentors in diary.

Demonstrate ability to do
this in reflective work.

Testimony of others

Documented observation
by mentors and named
supervisor.

Demonstrate ability to do
this in reflective work.

Testimony of others.
If Evidence, for example a study day, or attendance at a particular activity has not yet happened by either the 150 or 300 hour review please enter NYF (Not Yet Facilitated). At
each of these reviews, if particular activities have not yet been facilitated , reassurance will be sought that, for example dates, times, venues, etc,, have been arranged to
ensure evidence is completed and in place for the final 450 hour end review. At the final 450 hour review, if level 3 is not achieved, reasons for the failure must be clearly
evidenced to justify the failure of the Local supervisory authority practice programme.
The named supervisor can provide all the information in one document if appropriate.
You may use the same five sets of records if they provide all the evidence required
You are only expected to prepare one presentation for student midwives ensuring that all areas identified are covered
London Local Supervising Authority Practice Programme 2013
58
Proficiency: Demonstrate the ability to provide intrapartum care for a woman with a
previous history of caesarean section (LSCS).
Proficiency Outcome: The practitioner must be able to care for a woman who has chosen to undergo Vaginal Birth after Caesarean Section
(VBAC) safely and effectively.
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
1
2
3

Discussion with
Supervisor of Midwives.

Reflection on situation
resulting in need for LSA
practice programme

Review evidence used to
support guideline.

Attend high risk antenatal
clinic and reflect on
session.
.Be able to plan care on an individual basis
within the multi-disciplinary team.

Record keeping from
episode of care of a
women with VBAC (please
anonymise).
Consider care for a woman for when
VBAC is not advisable but the woman
expresses a wish for VBAC despite the
risks discussed.

Discussion with
Supervisor of Midwives.

Reflection on discussions
with mothers.
Understand the risks associated with
VBAC for both the mother and baby.

Record keeping from
episode of care of a
women with VBAC (please
Understand and follow the Trust/ Health
Board’s guideline on VBAC.
London Local Supervising Authority Practice Programme 2013
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
59
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
300 hr
Review
450 hr End
Review
Date
Achieved
Signature
of Mentor
anonymise).
4
Recognise and be able to respond
appropriately to the complications
associated with VBAC

Discussion with
Supervisor of Midwives.

Reflection on situation
resulting in need for LSA
practice programme.

Attend LSCS review
meeting.

Record keeping from
episode of care of a
women with VBAC (please
anonymise.

Discussion with
Supervisor of Midwives.

Reflection on situation
resulting in need for LSA
practice programme.

Attend LSCS review
meeting.
If Evidence, for example a study day, or attendance at a particular activity has not yet happened by either the 150 or 300 hour review please enter NYF (Not Yet Facilitated). At
each of these reviews, if particular activities have not yet been facilitated , reassurance will be sought that, for example dates, times, venues, etc,, have been arranged to
ensure evidence is completed and in place for the final 450 hour end review. At the final 450 hour review, if level 3 is not achieved, reasons for the failure must be clearly
evidenced to justify the failure of the Local supervisory authority practice programme.
The named supervisor can provide all the information in one document if appropriate.
You may use the same five sets of records if they provide all the evidence required
You are only expected to prepare one presentation for student midwives ensuring that all areas identified are covered
London Local Supervising Authority Practice Programme 2013
60
Proficiency: Be able to recognise acute maternal physical deterioration and make the
appropriate interventions and referrals.
Proficiency Outcome: The practitioner must be able to recognise acute physical deterioration in a woman and act appropriately.
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
1
Attend ALERT course.

Place booked for ……

Discussion with named
Supervisor (SOM).

Reflection on learning and
how this will be
incorporated into your
practice.
2
Be able to undertake all physical
observations effectively.

Observation and
discussion with
mentor/SOM.
3
3.1
Be able to document all observations
accurately

3.2
Be able to use the MEOWS chart as
a means of assessment
Examples of charts used,
care plans and records
(please anonymise).

Observation and
discussion with
mentor/SOM.

Discussion with named
SOM.

Examples of charts used,
care plans and records
4
Be able to refer appropriately and in timely
manner to any sudden physical
deterioration.
London Local Supervising Authority Practice Programme 2013
300 hr
review
450 hr End
Review
Date
Achieved
Signature
of Mentor
61
Clinical Level Achieved
(minimum level is 3)
No
Benchmark Statements
Evidence
150 hr
Review
300 hr
review
450 hr End
Review
Date
Achieved
Signature
of Mentor
(please anonymise).
5
6
Be able to care for women with complex
obstetric and/or medical conditions as per
Trust/ Health Board guidelines.
Review the latest “Saving Mothers’ Lives”
report.

Record in daily dairy.

Observation and
discussion with
mentor/SOM.

Discussion with named
SOM.

Examples of charts used,
care plans and records
(please anonymise).

Discussion with named
SOM.

Reflection on learning and
how this will be
incorporated into your
practice.
If Evidence, for example a study day, or attendance at a particular activity has not yet happened by either the 150 or 300 hour review please enter NYF (Not Yet Facilitated). At
each of these reviews, if particular activities have not yet been facilitated , reassurance will be sought that, for example dates, times, venues, etc,, have been arranged to
ensure evidence is completed and in place for the final 450 hour end review. At the final 450 hour review, if level 3 is not achieved, reasons for the failure must be clearly
evidenced to justify the failure of the Local supervisory authority practice programme.
The named supervisor can provide all the information in one document if appropriate.
You may use the same five sets of records if they provide all the evidence required
You are only expected to prepare one presentation for student midwives ensuring that all areas identified are covered
London Local Supervising Authority Practice Programme 2013
62
Agreement on conclusion of the programme
Please complete the names and print out this page before the final meeting to allow all parties to sign
the agreed plan
We the undersigned agree to the conclusion of this Local supervisory authority practice
programme.
Name
Programme Lead Supervisor of Midwives
Signed
Name
DATE
Academic Mentor
Signed
Name
DATE
Named Supervisor of Midwives
Signed
Name
DATE
LSAMO/ Ass. LSAMO / LSA Support Midwife
Signed
DATE
Midwife
I have been notified of the outcome of the programme as set out within this document
Signed
DATE
Name
Midwife
Local Supervising Authority Practice Programme 2013
63
Appendix one
Sources of Benchmark statements
Midwives Rules and Standards (NMC 2012)
The Code: Standards of conduct, performance and ethics for nurses and midwives (2008)
Standards for medicines management (NMC 2008)
Records keeping: Guidance for nurses and midwives (NMC 2009)
Midwifery standards of proficiency
(Adapted from Standards of Proficiency for Pre-Registration Midwifery Education (NMC 2009)
The NMC uses the term standards of proficiency to describe the skills and ability to practice safely and
effectively without the need for direct supervision.
References
Clinical Proficiency Assessment Criteria adapted from:
Harrison, A. (2001) Competence is the key to safe supervision and delegation, The pharmaceutical
journal (267) pp 89-91
Local Supervising Authority Practice Programme will replace
supervised practices programmes in accordance with the new
Midwives rules and standards 2012 comes into force 1 January 2013
(NMC 2012).
Do not disclose this report without permission from the LSA
Local Supervising Authority Practice Programme 2013
64
Appendix Two - Example
Local Supervising Authority Practice Programme 2013
65
Appendix Three - Example
Local Supervising Authority Practice Programme 2013
66
Reading log
Consider these questions:

Why did you read these particular articles?

How do they relate to your learning needs?

Were they interesting or useful?

What criticisms would you make of them?
For relevant articles please write a report on how they have enabled you to meet this objective and cross reference to the relevant benchmarking
statement.
Title of Article/ Book.
Author(s)
Name of Journal or
Publisher.
Date/ volume
number.
Comments.
Discussion with
Supervisor.
Date / Signatures
Local Supervising Authority Practice Programme 2013
67
Title of Article/ Book.
Author(s)
Name of Journal or
Publisher.
Date/ volume
number.
Comments.
Discussion with
Supervisor.
Date / Signatures
Local Supervising Authority Practice Programme 2013
68