National pilot of innovative early years skill mix working in five Start for Life sites in England: study protocol

Journal article

Background: England’s Family Hubs and Start for Life (SfL) Programme Guidance recommends strengthening early years services by increasing workforce capacity and capability through innovative skill mix models. However, evidence regarding how different innovative early years skill mix workforce models operate, function, and influence outcomes remains limited. To address this gap, five local authorities in England that are existing SfL sites received funding from the Department of Health and Social Care (DHSC) to design and pilot innovative early years skill mix workforce models to enhance their Family Hub offers and better support families with children under two. Methods: The evaluation is guided by each site’s Theory of Change and uses a mixed-methods design. The study consists of five workstreams. First, pilot models will be mapped through documentary analysis, including content analysis of role descriptions and audits of workforce activities recorded in clinical diaries. Second, system-level mechanisms, facilitators, and barriers to implementation will be examined through reviews of service and management data and semi-structured interviews with key stakeholders. Third, relational structures underpinning effective practice will be explored using 75 family-level case studies and Social Network Analysis to assess professional networks and their influence on family and practitioner experiences. Fourth, impacts will be estimated using Synthetic Control Methods to assess effects on Healthy Child Programme outcomes, alongside cost and cost-benefit analyses. Finally, the broader application of skill mix working will be explored through semi-structured interviews and case studies across additional local authorities.

Authors: Barlow, J; Fanner, M; Sleed, M; Day, L; Conti, G

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Cambridge University Press
• Journal: Primary Health Care Research & Development
• Volume: 27
• Article number: e45
• Publication date: 2026-03-26
• Acceptance date: 2025-11-30
• DOI: 10.1017/s1463423626100966
• EISSN: 1477-1128
• ISSN: 1463-4236
• Language: English
• Keywords: health visiting; early years; infant mental health; staffing; skill-mix; healthcare workforce