Supervision on the ground

By Julie Griffiths on 25 May 2018 Midwives Magazine Midwifery Education

This is the third and final in our series in which we take a closer look at the Question Time-style sessions from last year’s conference.

Since supervision was removed from legislation, the four UK countries have developed four different models. Six speakers shared their expertise of the models, at a Question Time-style session at the RCM annual conference 2017 in October. The speakers revealed that prior to any changes, the four countries had been asked to establish a taskforce to assess what midwives and women who used maternity services wanted in a new model.

NHS England regional maternity lead for London Jess Read outlined the resulting A-EQUIP model in NHS England. She revealed at the time that ‘employers are increasingly engaging with the A-EQUIP model,’ and that ‘by January 2018, there will be 112 trained professional midwifery advocates (PMAs) in London’. The implementation of the A-EQUIP model has progressed significantly since, with all maternity providers in England now having PMAs in practice. See the summary box, right, to learn the current status of A-EQUIP in England.

Deb Jackson, HoM and associate director of nursing at Aneurin Bevan University Health Board, went on to outline the model in Wales, explaining that it had been implemented from April 2017. While Karen Murray, senior professional officer at the Northen Ireland Practice and Education Council for Nursing and Midwifery, said that the value of supervision is recognised at senior levels in Northern Ireland. After outlining the model in Scotland, Professor Ann Holmes, chief midwifery advisor and associate nursing officer, Scottish Government, revealed that plans were on track for all boards to go live with it in 2018.

Delegates then heard about an A-EQUIP pilot site in Coventry and Warwickshire, with the then HoM Carmel McCalmont revealing that ‘being a pilot site was beneficial in developing the model, testing it and embedding it’. Sarah Dunn, Band 7 labour ward coordinator and SoM at Broomfield Hospital Maternity Unit, then presented her work at the Mid-Essex trust – despite not being a pilot site, the existing SoM team felt they had enough impetus and support for a new model of supervision to continue with the existing team and to incorporate the changes required for the A-EQUIP model. Read on to discover their set-ups and top lessons learned.

Coventry and Warwickshire

A-EQUIP pilot site

  • A multi-centre approach across practice and education
  • The A-EQUIP model was implemented across four organisations: University Hospitals Coventry and Warwickshire NHS Trust, George Eliot NHS Trust, Coventry University, and South Warwickshire NHS Foundation Trust
  • The pilot steering group started off with three HoMs, LME at Coventry University, matrons, clinical risk managers, a midwife research fellow and SoMs team. There were 10 PMAs initially across the area.
  • A lead PMA was hosted at one trust (funded by the three) to serve PMAs across all of the organisations
  • A short course delivered by Coventry University was designed to provide further PMAs

Outcomes

  • The pilot was very successful and led to the A-EQUIP model being adopted across the whole of Coventry and Warwickshire
  • It involves one full-time PMA and 23 sessional PMAs
  • A PMA (A-EQUIP) conference will take place in October 2018

Top lessons learned

  • Collaborative working across the organisations is vital
  • Leadership commitment in releasing dedicated time for PMAs to be trained, supported and undertake the role is required to embed the A-EQUIP model
  • A close relationship between the trusts and Coventry University was pivotal to developing a successful model and supporting the bridging programme at no financial cost to the trusts
  • PMA support for midwives external to their employing organisation brings transparency to the role

Broomfield, Mid-Essex

A-EQUIP site

  • Covering Chelmsford (consultant-led), Braintree and Maldon (midwifery-led)
  • Around November last year, produced a strategy for the trust, based on the A-EQUIP model
  • A daily on-call PMA was/is available 8am to 4pm via the switchboard or labour ward. Part of their role is to be a resource/sounding board, but also to allow each midwife space for personal growth, rather than just answer questions
  • The team concluded that more emphasis needed to be placed on the formative aspects of the model. This involved PMAs encouraging midwives to explore learning opportunities, and proactive management of midwives with identified needs for development and support
  • The team aim to keep a log of activities, and audit effectiveness as they progress. For example, a monthly tally is kept of individualised care plans for women requesting care outside of guidance

Outcomes

  • There are now eight PMAs, funded for 7.5 hours per month, to deliver PMA services
  • It’s taken around a year to find the right strategy (the service launched May 2018 with the strap line: ‘promote, protect and restore the physiology of birth’) to deliver an A-EQUIP service
  • There’s a good number of PMAs, but it’s still not certain if it’s exactly right – as there are differences between trusts

Top lessons learned

  • Flexibility is key
  • Keep going with the vision of what A-EQUIP can be and don’t give up
  • Start delivering the service and evaluate as you go along
  • Ensure governance links are in place from the beginning and encourage buy in and involvement at trust board level

Where we are now with a-equip?

Dr Yana Richens, deputy head of maternity services, offers an update from NHS England on the current status of A-EQUIP across the country.

Development of the new model of midwifery supervision for England has been an ambitious and worthwhile process. At the end of the first year (April 2018), there are nearly 800 PMAs in England. All maternity providers in England now have PMAs in practice.

This is in line with the NHS standard contract (NHS England, 2018) which states that the provider must ensure that arrangements are in place for all midwives to receive the new national model of midwifery supervision. In stark contrast to the previous model of midwifery supervision, this model is employer-led. Over the last year we have witnessed how midwives have come together to embrace the new model, some PMAs have gone one step further and formed regional PMA networks for support and to share good practice.

‘You said and we listened’ – a recent national survey by NHS England asked midwives if they were aware of the role of the PMA and A-EQUIP model. It revealed that 208 out of 245 clinical and non-clinical midwives, and students requested more information about the role of the PMA and the A-EQUIP model. NHS England is pleased to announce the launch of a second e-learning training module, which can be found at bit.ly/elearn_supervision

Read more about how to implement A-EQUIP.

Tell us what you think

What are your success stories in implementing A-EQUIP or other models of supervision? What barriers have you faced or overcome? Whatever your thoughts, contact us at [email protected]

References

NHS England. (2018) NHS Standard Contract 2017/18 and 2018/19 Technical Guidance. See: england.nhs.uk/wp-content/uploads/2018/01/7-contract-technical-guidance-v5.pdf (accessed 1 May 2018).

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