ADVANCED PRACTICE WITHIN IMAGING: A

WELSH PERSPECTIVE

Gareth Thomas

Lecturer

Cardiff University

President Society & College of Radiographers

NHS WALES/GIG CYMRU

➤ Provides emergency services and a range of primary and

secondary services and specialist tertiary services.

➤ District general hospitals provide outpatient, inpatient, and

accident & emergency services and there is a network of

community hospitals run by GPs.

➤ Specialist hospitals provide services such as burns units

and plastic and cardiac surgery.

CROSS BORDER ISSUES

➤ The geography of Wales means that there are areas where cross-

border arrangements are necessary

➤ The population of north Wales is too small to support specialist

units, so patients travel to Liverpool and Manchester.

➤ There are no large hospitals in Mid Wales at all. More than 31,000

Welsh patients were treated in English hospitals in 2013/4

POLITICAL CONTEXT

➤ Welsh Government proved that targets for timely treatment of cancer were the same in

Wales as in England, for example that 98% not on the urgent pathway should start

definitive treatment within the target time of 31 days.

➤ Wales has a specific waiting time target for diagnostic tests, different from England –

the maximum wait for access to specified diagnostic tests is 8 weeks.

➤ In August 2014 24,107 patients were waiting more than 8 weeks for diagnostic tests in

Wales; 70% receive their tests within the target time.

➤ In February 2016 the Organisation for Economic Co-operation and Development

published a review which concluded that performance of the NHS in Wales was little

different from that in the rest of the UK. They described performance across the UK as

"fairly mediocre" saying that great policies were not being translated into great

practices. They suggested that GPs should be more involved in health boards and that

resources should be shifted out of hospitals.

RADIOGRAPHER REPORTING CONTEXT

➤ 9 out of 10 patients who attend hospital will be seen by a radiographer for diagnosis or

treatment.

➤ Reporting Radiographers are reporting 21.1% of studies.

➤ The Scope of Practice for diagnostic radiographers continues to expand; and with

increasing numbers in advanced and consultant practice roles e.g. reporting images,

interventional procedures e.g biopsies

➤ Opportunity – reporting Gaps – 82% of Health Boards / Trusts Outsourcing reporting.

Outsourcing spend trebled in Wales over last 4 years. Consultant Radiologist vacancies

- 1 in 6.5 vacant in 2015/16

➤ Wales workforce – highest level of radiologist vacancies.

0 8 15 23 30 38

CT

Fluroscopy

General radiography

Interventional procedures

MRI

Nuclear medicine

Paediatrics

Ultrasound

Paediatric Adult

SCOPE OF PRACTICE 1

– Providers with Advanced Radiographic practitioner roles by specialties

SCOPE OF PRACTICE

RADIOGRAPHER ADVANCED PRACTICE AIMS

➤ Advanced Clinical Practice (ACP) across the multi-

professional workforce can be used via the New Allied Health

Professionals Post-Graduate framework

➤ To effectively enhance capacity and capability within teams

➤ To provide safe, accessible and high quality care for patients

➤ To help to close the gap of workforce shortages and meet

patient need

➤ To work differently in providing care delivery

➤ Funding available via the framework

NATIONAL IMAGING ACADEMY / WORKFORCE NIB

➤ Planned for S Wales in 2017

➤ Phase 1 - Radiologists

➤ Phase 2 - Radiographers and

Other roles

➤ Workforce Workstream – National

Imaging Board – Workforce paper for

submission includes extended

Radiographer roles and Advanced

practice. Evidence to CEOs and

Health Secretary.

NATIONAL IMAGING BOARD

WORKFORCE REVIEW

➤ It is recognised that radiographers

are fully capable of assisting in

service delivery by undertaking tasks

historically associated with the role

of the radiologist, allowing them to

concentrate on the more complex

imaging.

➤ Although the number of non-medical

consultant practitioners in Wales is

low compared with England and

Scotland, it has been recognised as

part of the ‘four tier radiographic

structure’ for many years.

EXTENDED ROLES➤ Videofluoroscopy swallow and proctogram are also undertaken in one organisation

by radiographers with the appropriate skills

➤ HSG: Undertaken in 5 organisations by radiographers and nurses

➤ TRUS biopsy: Performed by a radiographer in one organisation. It had been

undertaken in another organisation until urologists introduced ‘one stop’ facilities.

➤ MSK Ultrasound: This is an increasingly important area of role extension currently

undertaken by sonographers in three organisations.

➤ Joint injection / arthrogram: Currently undertaken by radiographers in one

organisation.

➤ Breast biopsy: Only currently undertaken by radiographers in Breast Test Wales

where 8.5 WTE radiographers perform this task.

UNUSED EXTENDED ROLES

➤ Nuclear medicine reporting

➤ CT head reporting

➤ MR reporting

AREAS THOUGHT APPROPRIATE FOR

FURTHER ROLE EXTENSION

➤ CT & MR REPORTING

➤ RADIOGRAPHER LED TRIAGE

➤ CT COLONOGRAPHY

➤ GENERAL REPORTING

➤ U/S FNAS

➤ CARDIAC STRESSING FOR MPI SCANS

➤ LINE INSERTIONS

➤ CLINICAL EXAMINATION IN BREAST TEST WALES.

KEY ENABLERS FOR

ROLE EXTENSION

➤ SHORTAGE OF RADIOLOGISTS

➤ INCREASED COSTS OF EXTERNAL REPORTING

➤ CAPABLE AND WILLING STAFF

➤ WELSH GOVERNMENT STRATEGY BASED ON EVIDENCE

BASED PRACTICE AND SERVICE NEED.

CONSTRAINTS

➤ FUNDING

➤ DISPARITY OF CONSULTANT VIEWS

➤ COST OF TRAINING AND BACKFILL

➤ ACCEPTANCE BY ORGANISATIONS

CONSULTANT RADIOGRAPHERS

IN WALES?➤ EVOLVING IN BREAST IMAGING

➤ Reporting of mammograms

➤ Performing and reporting on breast US

➤ Running clinics

➤ US and stereotactic guided core biopsies and wire localisations

➤ Presenting own cases at MDTs

➤ Acting as lead radiographer within Breast Centre (Llandough)

➤ Undertaking and publishing research and other articles

➤ Teaching

THE FUTURE

➤ Opportunity plus Ambition equals development – aim for 90%

of plain film to be radiographer reported

➤ Consultant / Advanced Practice Radiographers leading

radiographer reporting development

➤ Diolch Yn Fawr