How to... implement A-EQUIP
A-EQUIP is a supportive framework for midwives in England, intended to replace the former system of statutory supervision. Carmel McCalmont shares how the programme works in practice.
As everyone knows, statutory supervision of midwifery ceased on 31 March 2017. It has been replaced by the A-EQUIP model – Advocating for Education and Quality Improvement – which is led by professional midwifery advocates (PMAs). To develop the new system, seven pilot sites were selected to test its process and principles and to create a group of PMAs across the country. The pilot sites developed different models of A-EQUIP; in Coventry and Warwickshire, where I worked, we explored a model that is delivered across a local maternity system (LMS).
Unusually, our pilot brought together staff from four different organisations with the aim of developing a cross-county model: George Eliot Hospital, South Warwickshire NHS Foundation Trust, University Hospitals Coventry and Warwickshire NHS Trust and Coventry University.
It was tested with Band 5 midwives who had no previous experience of statutory supervision, with the aim that PMAs would support staff outside their employing trust. To be chosen as a pilot site was timely as LMSs were under development and relationships across the system had developed well. This assisted collaborative working, not only as an A-EQUIP pilot, but also as an LMS.
Lessons learned on implementing A-EQUIP
One of the first lessons was in the importance of giving midwives the time for support and restorative clinical supervision. To ensure this, decision-makers need to be on board with the project.
In our area, the potential PMAs self-selected and 10 of them stepped forward. The three HoMs from across the area, as well as the lead midwife for education (LME), committed to ensuring that all 10 were given appropriate time and resources to successfully complete the pilot. Without additional funding to develop and implement the model, the commitment from the HoMs and LME was essential.
A second lesson for successful implementation of A-EQUIP is collaborative working, and we took several steps to ensure this became the norm. We had 24 PMAs in post by December 2017. During the pilot, the team decided to merge all of the ex-supervisors’ meetings into one county-wide meeting per month, rotating the sites and venue. This was really helpful in breaking down barriers and for collaborative working, and it led to some good practice sharing.
Having collaborative working as a pivotal part of implementing A-EQUIP dovetails with the third important lesson. By putting women and families at the centre of everything in the pilot, collaborative working became much easier. We were better able to help one another out in new ways: for example, where capacity was filled at one site, one of the other trusts helped out by offering women care. Induction of labour is a good illustration of this new way of working – instead of delaying the process, trusts offered women an alternative place for induction and birth, providing the women were willing and neighbouring trusts had capacity.
Keeping an open mind
The fourth lesson was to commit to the trial, but taking a flexible approach. We found it was important to be prepared to revisit any or all of the elements involved in the model. The primary concern for the trainee PMAs during the pilot was developing the skills to deliver restorative clinical supervision. This required training and practice to allow their confidence and competence to develop. Midwives found that this worked best if they had a PMA who was not their line manager; it meant there was no conflict of interest, and they could focus on their learning and development.
Another example was the support of the HoMs for an away day for the PMAs and trainee PMAs in December 2017. At this meeting, the team identified that it would be useful to appoint a lead PMA across the LMS. The three HoMs agreed to fund this and a full-time lead PMA has been appointed; they currently lead A-EQUIP across Coventry and Warwickshire. The 23 remaining PMAs are sessional and the organisations have supported this model, which continues to develop.
A fifth lesson was to recognise the importance of listening to all viewpoints. We took the view that no opinion was silly or not worth hearing. Those involved have a specific insight into how A-EQUIP might work and evolve.
Set up for success
As the pilot progressed, the PMAs developed a plan around how full implementation could be rolled out. At the beginning of the pilot, many of the ex-statutory supervisors were unsure if they wanted to undertake the bridging programme needed to become a PMA and implement the A-EQUIP model. However, by the end of the pilot they could see the benefit to the role and felt they could be much more proactive especially when, unlike the old model, PMAs have no requirement to investigate practice.
This has been a really successful employer-led A-EQUIP model. What is unique is that four organisations came together to work collaboratively for women and midwives. A-EQUIP is part of the NHS standard contract but how it is enacted is decided by the employer. The model described here is just one way of implementing this and, as with all new projects, there are always lessons to be learned. We continue to develop and evolve to find the best way of working for midwives, women and families.
Carmel McCalmont is director of midwifery for Birmingham and Solihull LMS
A model that works
Carmel’s top tips for developing a successful A-EQUIP model:
- Listen to all views – no opinion is silly
- Commit to trialling a project and be prepared to revisit all of the elements
- Take time, there is no rush
- Collaborative working is essential
- Ensure decision-makers are on board with the project
- Make women and babies the central focus
- Give midwives time for support and restorative clinical supervision
- Support and value midwives to give safe and compassionate care
- Listen to women and their families
- Celebrate the success
An e-learning training model on A-EQUIP is available at bit.ly/elearn_supervision