Straight to the point

A programme developing radiology assistants to use their skills in practice contributed to a successful service redesign. Emma Forrest reports

With a shortage of radiologists and long waiting times affecting service delivery, the redesign of Royal West Sussex trust's radiology department focused on staff roles.

Though no single incident forced the change, there were a number of long-running issues in need of attention.

'There was a shortage of radiographers, which is a national problem. There were training issues around the professional development needs of longstanding staff, ' says Katherine Scannel, acting deputy director of human resources at the trust.

'This trust has a very good name for training and development and radiology's problems needed to be remedied.'

Although radiology is only a small department in the 500-bed hospital, many of its staff were long-standing and highly skilled but with no discernible career path.Meanwhile, those with qualifications had large parts of their clinical time taken up with routine procedures.

The trust's response began two years ago when then head of medical imaging Peter Ford joined up with the HR department to develop an action plan - Presenting a Clear Image.

Discussions took place with radiologists, radiographers and assistant-level radiographer helpers, as well as local Society of Radiography representatives. The report also received support from the local workforce development confederation.

Boosting the aspirations of current staff and improving the department's ability to recruit new staff was key. Support workers' roles needed extending and the roles of both assistant and advanced practitioners needed developing.

It was decided that nonqualified radiographer helpers should be trained to the point where, in the capacity of assistant practitioners, they could carry out basic x-rays.

In turn, this would free up radiologists, giving them more time to perform specialist work, make detailed examinations of more complex cases and work with those with more serious conditions.

'We could not see any reason why radiographers should not carry out simple procedures, providing the work was carried out under clinical protocols, ' says Ms Scannel, who oversees the human resources needs of the programme.

A six-month course at Portsmouth University developed with Mr Ford provided training for the radiography helpers. Previously they had been confined to the limited career paths offered to those without qualifications.

'The course gives helpers a chance to use their skills and experience. Some of them have been here a long time. They are, of course, financially rewarded, ' adds Ms Scannel.

She admits the scheme involved changing long-standing expectations in the department.

'It was quite a radical change and quite a culture shift too. It had never been done before. Staff now have clear paths for their education and development.'

Though some members of staff could not apply for the new assistant practitioner role, Ms Scannel describes them as enthusiastic about the project.

'There are varying levels of experience across the department and there were staff members who could not apply for one of the new positions. But measures will be put in place so they are in a position to develop their careers.'

Implementation of the new roles was done on a staggered timetable.

'Not all of what could be done was set in stone; it was more about integrating the new roles and skills bases, ' adds Ms Scannel.

With changes that have been made, she notes that substantial improvements have been achieved. Radiologists have more time to focus on hitting targets and improving patient care, while developing specialisms.

Preparations for the arrival of an MRI scanner in January have also been eased.

Patients have seen the benefits with reductions in CT scan waiting times from 15 to seven weeks and waiting times in radiography have fallen from 15 to four weeks. The reduction in waiting times, which contributed to the trust meeting the national two-week cancer wait target, also contributed to it being the overall winner at the excellence in strategic HR management awards jointly held by NHSP (formerly NHS Personnnel) and the Association of Healthcare Human Resource Management.

Crucial to training improvements was the appointment of a radiology consultant in diagnostic imaging, a post now held by Mr Ford.

'It was decided we needed someone who could support and run the initiative. The creation of this post has allowed a focus on professional education needs, ' says Ms Scannel. 'We believe other trusts are likely to use it as a benchmark.'

The trust's work with the Society of Radiographers means the scheme has gained a high profile among other radiology departments. The assistant practitioner course at Portsmouth is also likely to be used by other trusts to train unqualified staff. At Royal West Sussex advance practice forums - held trust-wide for all professionals - have been kept informed of the scheme's progress.

As Royal West Sussex's radiology department is currently being redeveloped, it is believed the new-look career path is aiding the recruitment problems blighting the radiography profession.

'It is now a more attractive department for any new recruit.

It is easier to recruit as we can show a clear career path, ' says Ms Scannel.

Work will now be ongoing to ensure the development of career progression in the department.

'With the consultant's position in place, there will be further opportunities for more radiography-based research and development. It should now progress further, ' adds Ms Scannel.