A-EQUIP – one year on

Following the launch of A-EQUIP in April 2017, A-EQUIP one year on provides an implementation update and the Professional Midwifery Advocate (PMA) role.

It is of relevance to midwives, student midwives, members of the multi professional team, providers of maternity services, Clinical Commissioning Groups (CCGs), Higher Education Institutes (HEIs), The Care Quality Commission (CQC), Maternity Voices Partnership and Patient Advisory Groups.

A-EQUIP, an employer led model of midwifery supervision and the role of the PMA was co-produced with women who use maternity services, midwives, academics, nurse leaders and managers, commissioners, the Royal College of Midwives(RCM), Health Education England (HEE) and voluntary organisations, such as the National Childbirth Trust (NCT) and Birthrights.

Since April 2017, maternity providers and midwives have implemented A-EQUIP in different ways. Some organisations have supported the development of full time PMA or sessional PMA’s whilst others have developed regional PMA networks, which share and disseminate good practice.

Case studies

Case study 1 – Collaborative delivery of training of PMAs by two HEIs

The University of Manchester and University of Salford recognised that their close geographical locations and similar catchment areas would mean that they would be in competition with each other as course providers. This might mean that low numbers of applicants might render the course unviable. They therefore decided to provide one course, which meant that the education programme would be operable and sustainable for both Universities. Collaboratively, they developed the course content and agreed to alternate delivery of the course over the two Universities. This maximised all resources across the entire training programme, from inception to delivery.

The universities have also taken the opportunity to train their own staff on the more specialist facilitation of restorative clinical supervision. Eight lecturers are now trained to deliver this component. Future sustainability of the training remains central to both organisations. There is a clear understanding of demand from their maternity providers. As a collaborative they take a proactive role in keeping in touch with their providers and are flexible with delivery to meet this demand.

The University of Salford will continue to offer both bridging and long PMA courses whilst there is a requirement from service providers. They will collaborate with the University of Manchester and work together, to ensure sustainability across the geographical area.

Moving forward, as the changes in demand for PMA training fluctuate, The University of Salford are reviewing the delivery of future courses and are considering pragmatic solutions to make the delivery and access to training more accessible for midwives, these include;

  • Splitting the current 30 credit ‘long’ PMA training course into two 15 credit modules. The PMA element would first be completed. The midwife would be given the option to continue (then or at another time) with an established midwifery leadership module
  • Including a ‘Mentorship’ element to the PMA training course. This addition would make the skills transferrable to other areas of Nursing and Midwifery
  • Adopting a ‘blended’ learning approach with additional e-Learning training and reducing in face to face delivery in HEI, this would result in cost savings to NHS Trusts, midwives and HEIs.

Case study 2 – PMA Networks

The London Regional Maternity Team supported the initial launch of a PMA Support Network. The network is made up of PMAs from across London. The first session convened prior to the commencement of the first PMA training. At the first network event there was representation from all four HEIs in London, they came to discuss the A-EQUIP Operational Guidance, the course content and the requirements for PMA training.

Since the first meeting the support network have developed terms of reference and at subsequent meetings have shared and discussed how the PMA role and A-EQUIP has been implemented in their own organisations. The support network meet bi monthly with meetings hosted in a central location, with rotation to  in different maternity units in London.

The meetings provide an opportunity to:

  • Share good practice
  • Discuss any challenges
  • Discuss monitoring and evaluation of the PMA role and A-EQUIP

External speakers are also invited to the meetings to share national and local initiatives. To date speakers include members of NHS England national maternity team, and NHS Resolution’s Early Notification Scheme. Since the inception of the London group, other regions are looking at supporting similar networks either in a similar delivery format, or alternatively using online platforms to share good practice.

The London PMA group have also developed a WhatsApp group which offers on-going support and sharing of A-EQUIP initiatives too and membership has been opened to include PMAs from other regions too. The London PMA WhatsApp group is moderated by two London PMAs and is well supported.

Case Study 3 – the role of the PMA at Poole NHS Foundation Trust

The PMA role in Poole has been supported to develop over the past year with one full time PMA and a second PMA has been appointed which incorporates PMA activities into the Practice Education Midwife role. It has been given freedom to develop around the A-EQUIP model with a sense of creativity and reaction to local needs.

Activities include:

  • Organising public engagement events as part of planning for ‘Better Births’ using the ‘Whose shoes?’ board game
  • Development of a ‘Birth Afterthoughts’ service as an auditable service improvement project. The success of this service has been made possible by collaboration with colleagues in Patient Advice Liaison Services [PALs]; the maternity counselling service and midwives and was built on the model already in place in Southampton
  • Guided relaxation followed by – ‘work afterthoughts’ sessions are regularly offered as part of staff training. This is a forum for free exchange where staff can talk about the personal and emotional effects of being part of women’s birth experiences
  • Individualised support for staff referred by line managers or by self-referral – for facilitation of reflection and/or support in relationship building (formerly known as ‘conflict resolution’) or for support during absence due to ill-health
  • Organisation of motivational interviewing training (90 midwives; Maternity Support Workers [MSWs] and clerical staff supported to train this year). This is a communication tool which has a double positive effect on both service-users and practitioners’ health and well-being
  • Member of the multi-disciplinary ‘Schwartz Round’ team which provides an opportunity for staff from all disciplines to reflect on the emotional aspects of their work
  • In response to service-user feedback, PMA support for an MSW – led project to improve the experience of women and partners during stays on ANW (particularly around induction of labour). This is an example of the PMA supporting all staff to become service improvers
  • An additional member of the SHIP (Southampton; Hampshire; Isle of Wight and Portsmouth) PMA group – PMAs along the South Coast who meet quarterly to share best practice and provide feedback from site visits to each other’s workplaces and staff groups.

Find out more about how A-EQUIP has been implemented  by watching two short videos:

Support & Quality Improvement within A-EQUIP – ‘One Year On’

Educating for and Collaboration within A-EQUIP – ‘One Year On’