The SIMCA Study Protocol: Factors influencing the implementation of the Midwifery Continuity of Carer (MCoC) model of care in NHS maternity care in England: A mixed methods cross case analysis involving clinicians, women and policy makers

Background: During pregnancy, labour and early motherhood, most women in the UK receive care from different midwives. NHS policy change in England sought to introduce a model of care whereby each woman is cared for by the same midwife throughout antenatal, intrapartum and postnatal periods, supported by a small team of midwives to cover off-duty periods. This model is called the Midwifery Continuity of Carer (MCoC). This study proposes to evaluate the implementation and delivery of MCoC across England, aiming to better understand the factors that result in different rates of progress with MCoC implementation. Aim: To identify the local, regional and national factors which contribute to variable progress with implementation of MCoC in the NHS in England? Methods: A sequential mixed-methods study, informed by implementation science frameworks will be delivered over three work packages. Following a literature review of the challenges and successes of previous attempts to implement MCoC (work package 1), six case studies in NHS Trusts will be undertaken to better understand different rates of progress with MCoC implementation and people's experiences of MCoC implementation through: interview and questionnaire (maternity services staff); interviews (service-users); observation of relevant implementation meetings and organisational documentation collection (work package 2). Interviews will be undertaken with national and regional stakeholders relevant to MCoC implementation (work package 2). Data analysis will be conducted both inductively and deductively, informed by implementation science constructs (work package 3). Dissemination: Study findings will be disseminated through peer-reviewed journals, conferences and events. Results will be of interest to the public, clinical and policy stakeholders in the UK and will be disseminated accordingly.