Advanced practice within imaging: A WELSH PERSPECTIVE · 9 out of 10 patients who attend hospital...
Transcript of Advanced practice within imaging: A WELSH PERSPECTIVE · 9 out of 10 patients who attend hospital...
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