Improving maternity and neonatal care in England: a formative evaluation of the implementation of the Core Competency Framework to improve multi-professional practice.

Research question: How has implementation of the Core Competency Framework (CCF) impacted organisational, team and individual competence in England’s maternity and neonatal units; and how can the adaption and adoption of the CCF improve maternal and neonatal outcomes in different contexts?

Background: According to the CQC, maternity remains an area of specific concern. CQC ratings suggest a worsening of maternity services quality over the last 12 months, with 49% of NHS services rated as inadequate or requires improvement. A Health and Social Care Committee report examining how best to ‘Support Maternity Services and Staff to Deliver Safe Maternity Care’ found not all training was equal, effective and that multi-professional training was not always occurring.

The Maternity Transformation Programme (NHS England) has led the development of the CCF to reduce variation in competency through training (rollout v1 December 2020 and v2 December 2023). The implementation of the CCF and its impact on performance in different contexts has not been evaluated. The role of the CCF to improve maternity care, in particular for those who are at greatest risk of the poorest outcomes, has not been investigated.

Aims: To explore and enhance the implementation and impact of the CCF in England as it seeks to reduce variation in maternity and neonatal care.

• Investigate the fidelity, adaption and adoption of the CCF and explore the determinants associated with its implementation.

• Explore the role of the CCF in reducing variation in a. organisational, team and individual competence and b. maternal and neonatal health inequalities.

• Gather stakeholders’ views on the key findings from the research and to translate these into a toolkit to support the development and implementation of the CCFv3.

Methods: Mixed-method study underpinned by implementation science comprising four work packages (WP). WP1: national survey investigating the implementation of the CCF in England. WP2: ethnographic research exploring local implementation of the CCFv2 in six purposively sampled units, including six local panel discussions with service users most at risk of poor outcomes.

WP3: secondary analysis of routinely collected outcome data related to training to inform understanding of the framework’s impact on practice variation. WP4: Joint Interpretive Forums (JIFs) to inform development of the CCFv3 implementation toolkit (2027). Normalisation Process Theory will guide our analysis.

We will integrate our findings using the Consolidated Framework For Implementation Research which will inform our development of the CCFv3 logic model and implementation toolkit.

Timelines: Months1-3: Obtain ethical approval and design the national online survey. Months4-6: Online survey of English maternity and neonatal units. Months6-17: Ethnographic data collection visits. Months 18-19: Local JIFs and National Survey2. Month20: National JIF. Months21-24: National JIF analysis and integration of study findings, complete CCFV3 Implementation Toolkit.

Anticipated impact and dissemination: The CCFv3 logic model and Implementation Toolkit will enable maternity and neonatal unit to improve implementation of competency training (CCFv3). The study will ensure CCFv3 meets the needs of service users and reduces inequalities. Dissemination (codeveloped with NHS England) includes national presentations and distribution of the Toolkit. We will publish at least two high-impact papers.