Improving maternity and neonatal care in England: a survey to evaluate the implementation of the core competency framework to improve multi-professional practice.

BACKGROUND: The NHS England-led Core Competency Framework (CCF) aims to address significant safety concerns and national variations in maternity practice. The CCF defines minimum safety training requirements for all maternity and neonatal services in England. It emphasises the importance of service user involvement, local incident learning, multi-disciplinary team training and network learning. Successful national implementation may reduce variation in training and competency assessment across England, but the CCF has not been subject to evaluation.

AIMS: To explore CCF implementation in maternity and neonatal units in England including factors affecting implementation and investigate staff views regarding the acceptability, appropriateness and feasibility of implementing the CCF.

METHODS: A national online survey of organisational leads responsible for planning, delivering and implementing the CCF across NHS Trusts in England. Survey questions were informed using the TIDieR framework and acceptability, appropriateness and feasibility of the CCF were measured using the Weiner validated scale. Proportions were calculated for each response by individual and by Trust with corresponding confidence intervals using Stata version 19 and open text responses were analysed using thematic analysis.

RESULTS: The survey contained 82 completed responses covering 66 (54.7%) NHS Trusts across England. Survey respondents considered the CCF acceptable 4.4/5, appropriate 4.2/5, but feasibility scored just 3.7/5 with lack of resources cited as a common implementation barrier. Multi-professional Education Teams were reportedly in place at 68.2% of Trusts (55.8-78.4%, 95% CI), although responsibility for the development and planning of training was mostly undertaken by midwives. Respondents reported delivering multi-professional maternity and neonatal training, however, there was variation in the number of days training that each professional group received. The survey found 54.5% (42.3-66.3 95% CI) of Trusts provided midwives 3-4 days and 31.8% (21.6-44.2 95% CI) 5-6 days. Whilst 47.0% (35.1 - 59.2 95% CI) of obstetricians, 45.5% (33.7-57.7 95% CI) of neonatologists and 87.9% (77.3- 93.9 95% CI) of anaesthetists were provided only one to two days of CCF training. Maternity service user involvement was reported at 68.2% (55.8-78.4 95% CI) of Trusts, whilst neonatal service user involvement was reported in 39.4% (28.2 -51.8 95% CI) of Trusts. Involvement consists mainly of routine feedback rather than encouraging active user engagement.

CONCLUSION: Whilst the CCF is generally considered to be acceptable and appropriate it is reportedly less feasible. There remains variation in the implementation of Multi-Professional Education Teams, the number of days of training available to professionals and involvement of service users across represented NHS Trusts. Insufficient resources and staffing impacted on the delivery of the framework.