Study to explore midwifery continuity of carer policy for NHS and parents

New research will explore how recent important policy changes made to midwifery care in England are being introduced in NHS hospitals, and whether it’s improving the experience of pregnancy and birth.

Many women and birthing people see lots of different midwives and doctors during their pregnancy, birth, and early parenthood. But new policies aim to introduce ‘continuity of carer’: where care is provided to each pregnant person by an individual midwife or small number of midwives. 

The SIMCA (Studying the Implementation of Midwifery Continuity of Carer) project will evaluate the factors which shape how these important changes are being brought into practice across England, and how they’re improving the safety and quality of care. 

Midwifery continuity of carer - also known as MCoC - is a major policy shift for NHS England. It was developed because of evidence suggesting that seeing different midwives at different stages of pregnancy could lead to gaps in care that result in poorer outcomes and experiences for women or birthing people and their babies. 

SIMCA, led by the University of Plymouth with funding from the NIHR, will explore whether this new care model is being implemented well, and where its introduction is creating challenges. 

Kate Davies, our Head of Policy, Research and Information at Tommy’s, is the project’s patient involvement lead, which means she’s responsible for bringing women and birthing people with recent experience into the project so their voices can be heard. 

Kate says:

“At Tommy’s, we believe everyone deserves the very safest and highest quality maternity care – and of course we want to see measures implemented in care that help deliver this. We’re delighted to be contributing to this project which will investigate the current model for Continuity of Carer so that there is a better understanding of what is working and what isn’t.  

"We hear time and time again that Continuity of Carer means so much to women and birthing people and can help address inequity. We also know that for some midwives, when the right resources are there, this is their preferred way to deliver care. We’re excited to be part of a project that will find evidence to improve practice in this area.   

‘"As PPI Lead, we will ensure that we bring the voices of women and birthing people to the project; helping the team take a broader look at the context of maternity services, to understand the wider system of healthcare, how systems reflect the needs of the community and how these might impact on Continuity of Carer.” 

SIMCO involves partners from across the UK – including Cardiff University, University of Birmingham, Imperial College London, Imperial College Healthcare NHS Trust, and The Mosaic Community Trust. 

Aled Jones, Professor of Patient Safety and Healthcare Quality and Head of the University of Plymouth’s School of Nursing and Midwifery, is the project’s chief investigator. He said:  

“Midwives invariably deliver first-rate care for women and their babies. However, several reports into safety failures in England and internationally have demonstrated where that isn’t always the case.  

“The Midwifery Continuity of Carer model offers an approach that may enhance the safety and quality of care for all women, in addition to improving job satisfaction for midwives. However, there are also significant uncertainties about its implementation. Better understanding of how implementation of MCoC works best and what factors influence implementation is imperative, and by the end of this study we plan to deliver that.” 

Researchers will be interviewing people involved in developing MCoC, and looking at 9 NHS trusts – in rural and urban areas with different levels of social and economic deprivation – as case studies, to better understand the local, regional and national factors which contribute to different rates of progress with fully implementing MCoC. 

The research will then be used to shape future improvements within midwifery services, and will directly influence how current and future midwifery students and registered midwives implement and lead change in the NHS and internationally.