Gillibrand Stephanie, Parkyn Kate, Hall Charlotte, Kletter Maartje, Harkness Elaine, Munford Luke Aaron, Wilson Paul, Dumville Jo
The University of Manchester, Manchester, UK
NHS England, London, UK.
BMJ Open. 2025 Jul 28;15(7):e095509. doi: 10.1136/bmjopen-2024-095509.
The enhanced midwifery continuity of carer (eMCoC) pilot programme provided additional resource (funding) to midwifery teams operating in the 10% most deprived areas in England. The eMCoC programme aims to provide additional support to those at greatest risk of poor maternal health outcomes. We conducted a rapid formative evaluation aiming to explore the implementation of the pilot programme to (1) generate timely insights to inform ongoing service delivery; (2) generate a logical framework of the eMCoC service and; (3) inform the design of a longer-term summative evaluation.
Rapid evaluation using mixed-methods.
We explored implementation of the eMCoC service in 58 funded local midwifery teams across 23 Local Maternity and Neonatal Systems (LMNS). We undertook qualitative data collection in 10 case study sites across England, focusing on the implementation in 17 teams.
We purposively sampled 34 service users who received care from enhanced teams, and 38 staff working in enhanced teams. Inclusion criteria for the service user interviews included women who had received care from enhanced teams during our evaluation period and were more than 28 weeks pregnant. Exclusion criteria included women who had not received care from our target teams. We undertook descriptive analysis using the Maternity Services Dataset to compare the characteristics of service users in enhanced teams with service users receiving other midwifery service models.
Many of the 58 teams funded were unable to implement eMCoC during the evaluation period because of institutional and organisational barriers. The barriers identified here are indicative of the barriers associated with implementing midwifery continuity of carer. Largely, the eMCoC service successfully targeted women living in the most deprived areas and a focus on reaching women living in these areas was valued by enhanced teams. Equally, enhanced teams strived to broaden the targeted characteristics (i.e. more broadly than on the basis of deprivation) to include a wider and more diverse set of social risk factors and vulnerabilities, based on local needs and priorities. Service users reported being well supported by the enhanced teams, including receiving relational and well-being support and personalised one-to-one public health education, information and support. Service users emphasised that enhanced teams went 'above and beyond in their care'.
Funding for eMCoC has been well received by both staff and service users. The implementation of the enhanced roles was perceived to have supported delivery of team-based care, facilitating successful release of midwifery capacity and the delivery of additional public health activities. Supporting a team-focused ethos seems an important feature of eMCoC services. This was consistent across sites and from both staff and service user perspectives. There appears to be many routes (i.e. different service delivery types) to delivering enhanced care, and the multiplicity of service delivery types found in this evaluation suggests no tightly prescribed way of meeting eMCoC's objectives. The flexibility of the initial funding specification guidance from NHS England has been a key driver of local ownership and permitted eMCoC services to be organically built 'from the ground up'. Our conclusions point to the value of autonomy afforded to local areas to use eMCoC funding as they deem necessary to best suit the needs of their staff and specific service user groups. Attention should be placed on the barriers to implementation and sustainability issues which can be addressed, namely: delays in releasing funding from LMNS and Integrated Care Boards to providers, and protecting maternity support worker and midwifery time to their allocated teams.
强化助产士连续性照护者（eMCoC）试点项目为在英格兰10%最贫困地区工作的助产士团队提供了额外资源（资金）。eMCoC项目旨在为那些孕产妇健康结局不良风险最高的人群提供额外支持。我们开展了一项快速形成性评估，旨在探索试点项目的实施情况，以（1）及时获取见解，为正在进行的服务提供提供信息；（2）生成eMCoC服务的逻辑框架；（3）为长期总结性评估的设计提供信息。
采用混合方法进行快速评估。
我们在23个地方孕产妇和新生儿系统（LMNS）中的58个获得资助的地方助产士团队中探索了eMCoC服务的实施情况。我们在英格兰的10个案例研究地点进行了定性数据收集，重点关注17个团队的实施情况。
我们有目的地抽取了34名接受强化团队护理的服务使用者和38名在强化团队工作的工作人员。服务使用者访谈的纳入标准包括在我们评估期间接受强化团队护理且怀孕超过28周的女性。排除标准包括未接受我们目标团队护理的女性。我们使用孕产妇服务数据集进行描述性分析，以比较强化团队中的服务使用者与接受其他助产服务模式的服务使用者的特征。
在评估期间，58个获得资助的团队中有许多因机构和组织障碍而无法实施eMCoC。这里确定的障碍表明了与实施助产士连续性照护相关的障碍。总体而言，eMCoC服务成功地将目标对准了生活在最贫困地区的女性，强化团队重视关注生活在这些地区的女性。同样，强化团队努力扩大目标特征（即比基于贫困更广泛），以根据当地需求和优先事项纳入更广泛、更多样化的社会风险因素和脆弱性。服务使用者报告说，强化团队给予了他们很好的支持，包括获得关系和福祉支持以及个性化的一对一公共卫生教育、信息和支持。服务使用者强调强化团队“在护理方面做得非常出色”。
工作人员和服务使用者都对eMCoC的资金表示欢迎。强化角色的实施被认为有助于提供基于团队的护理，促进助产士能力的成功释放以及开展额外的公共卫生活动。支持以团队为中心的理念似乎是eMCoC服务的一个重要特征。这在各个地点以及工作人员和服务使用者的角度都是一致的。似乎有许多途径（即不同的服务提供类型）来提供强化护理，本次评估中发现的多种服务提供类型表明，实现eMCoC目标没有严格规定的方式。英格兰国民保健服务体系最初的资金规范指南的灵活性是地方自主权的关键驱动力，并允许eMCoC服务“从基层”有机地构建起来。我们的结论指出了给予地方自主权以根据其认为最适合其工作人员和特定服务使用者群体需求的方式使用eMCoC资金的价值。应关注实施障碍和可持续性问题，并加以解决，即：从LMNS和综合护理委员会向提供者发放资金的延迟，以及保护产妇支持人员和助产士分配到其团队的时间。
