Improving maternity and neonatal care in England: protocol for a formative evaluation of the implementation of the core competency framework to enhance multi-professional practice

Abstract Background Concern exists about the variation in maternity services across England, highlighted by various high-profile investigations into care failures. In response, NHS England developed the Core Competency Framework (CCF) to standardise training and reduce unwarranted discrepancies in maternity and neonatal care. The current version of the framework (CCFv2) outlines minimum training requirements, targets key areas of harm, and supports multi-professional education while allowing local adaptation. This study aims to explore and enhance the rollout and impact of the CCFv2 and to strengthen its implementation and impact across England. Methods We will conduct a mixed-methods formative evaluation across four work packages. WP1: a national survey of maternity units to assess adoption and variation in CCFv2 implementation. WP2: ethnographic research in seven purposively selected maternity units to explore variations in local implementation. WP3: retrospective analysis of routinely collected outcome data from these sites to assess effects on practice and patient safety. WP4: Joint Interpretive Forums with stakeholders at each study site and nationally to support shared understanding and inform the development of an implementation toolkit for CCFv3. Discussion This study will generate practical insights into how the CCF is embedded across diverse settings. Through a collaborative, multi-disciplinary design - including input from service users, NHS staff, and academics - it will identify enablers and barriers to implementation and inform future improvements. Findings will guide the development of CCFv3 and support national efforts to improve care quality and reduce variation, particularly for vulnerable populations.