Radiography (2010) 16, 5e7

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GUEST EDITORIAL

Consultant radiographers e Does the professionwant them?

The concept of consultancy in the non-medical professionsis becoming established and within radiography around 45posts have been appointed since 2003.1 In additiona number of posts have been advertised but not appointed,and subsequently lost.2 Factors in this may be lack ofevidence of the success of the roles or limited achieve-ments of existing appointees, but it could also be a lack ofimagination in the context of post creation and under-standing of the roles by candidates for posts.

Paterson has always been a strong advocate of theconcept of consultant practitioners3 and in her articleConsultant radiographers e The point of no return4 shestated that in her view the answer to questions around thelong term future of the role is a ‘‘resounding yes’’.However, she added the caution that ‘‘it is too early to besure’’ and felt it was up to the existing consultants todemonstrate commitment to research, education, accred-itation, leadership and interprofessional relationships.

Price et al.5 agreed, but also stated that setting priori-ties for individual consultants within the core areas ofconsultant practice would seem to be an issue that needs tobe resolved urgently. While existing postholders need todemonstrate success in their roles, establishment of theconcept on a broad basis can only be achieved through thecreation of posts with innovative clinical focus anddifferent ways of working, and with the active support oftheir managers. This requires the profession to understandthat the non-medical consultant concept is more thanexpert clinical practice. The support of peers and managersis needed for them to rise to the challenge of breakingtraditional professional and cultural boundaries, andexploit opportunities to create different improved ways ofservice provision for the benefit of patients.

The reasons for the relatively low numbers of existingposts are multifactorial but must include resource issues,opposition from both within and outside the profession,expectations, and the limited number of suitable appli-cants.6 Should/can anything be done to change this?

So far posts have been created in areas of clinicalpractice that follow the established routes of radiographer

1078-8174/$ - see front matter ª 2009 The College of Radiographers. Pdoi:10.1016/j.radi.2009.10.016

development e oncology, mammography, conventionalimaging in emergency and primary care, fluoroscopy,ultrasound and MRI. Other posts include some researchbased, and in endovascular services and in nuclear medi-cine.7 It is to be expected that early posts would be createdwhere high clinical skills already exist within the radio-graphic workforce, although interestingly there are noneyet based around CT practice.

By their nature roles are rooted in clinical practice andexisting appointees demonstrate a high level of exper-tise.8,9 Dean10 argued that consultant radiographers havea ‘‘similar role and clinical level of responsibility as that ofthe medical breast specialist’’. Is this emphasis on clinicalworking one of the reasons for the low numbers, withinsufficient understanding on the breadth of the role?

While there is a natural concentration on the clinicalskills which provide the descriptor for posts, this was notthe only reason for their original creation. The officialguidance sets out that all posts must consist of 4 domains ofpractice11 and initial research supports this.6 The domainsare as follows.

� Expert clinical practice� Professional leadership and consultancy� Practice and service development� Education training and development

The non-clinical domains of practice, which shouldoccupy 50% of the individual’s time, were key in the originalthinking. They are about creating change and innovation,using teaching, leadership and research to facilitate thisbut founded on expert clinical practice skills. Is this wheremisunderstandings occur? When I have spoken to advancedpractitioner radiographers working for their Masters degreeabout the consultant role they have said they are notinterested in a post with only a 50% expert practiceelement. Similarly I have been told by more than oneradiologist that they would not support a role with onlya 50% clinical content. Talking to two consultant colleaguestheir experience has been similar to mine when assessing at

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6 Guest Editorial

interview panels for consultant posts. We have not beenable to appoint some posts because, while candidates haveshown strong clinical skills, they have not shown anunderstanding of the other domains of practice.

The Society and College of Radiographers understands theconcept. It has embraced the development of consultantpractitioners12 within the four-tier system13 and has issueda number of guidance documents such as the curriculumframework14 which included consultancy. There are paperson the society website7 which emphasise the need for a wideservice perspective and a broad remit if these posts are tomake fundamental changes to improve services.

Despite this there is little evidence that individualradiographers have grasped the full implications of theleadership and vision needed for these roles. Interviewpanels find they have few candidates applying for adver-tised posts,6 and many come ill prepared to demonstratea broad portfolio of achievements. Relying on expert clin-ical skills alone shows a lack of comprehension of what isneeded to make these posts a success.

Support is mixed within the senior levels of imagingservices. Some radiologists are strong advocates andsupporters, as evidenced in Trusts where posts have beenestablished, but strong opposition remains. The joint paperby the Royal College of Radiologists and Society and Collegeof Radiographers15 on team working was disappointing tomany. It failed to acknowledge the very substantial role forindividuals within radiography not only to support theclinical services currently predominantly provided by radi-ologists but also the leadership element which has been soactively adopted by non medical consultants in nursing andother allied health professions.16,17 The wider lack ofunderstanding the possibilities for team working andservice leadership was perhaps encapsulated in the recentRoyal College of Radiologists survey of member’s views18

which appeared to show a lack of support for existing aswell as further radiographer role extension.

The concept of a post with only 50% clinical work isanathemas to some radiologists who fail to understand thebroader remit, the need for greater clinical leadershipwithin radiography from within the radiography professionto support ‘‘the crucial responsibilities of consultant clin-ical radiologists’’.19 Consultants in other specialties appearto recognise the role of consultancy within radiography andhave been very supportive.6

Existing appointees may be best known for the clinicalaspects of their work which they have presented atspecialist clinical study days and conferences such as Gas-tro Intestinal Radiographers Special Interest Group Sympo-sium Mammographicum and the Radiotherapy Weekend.These attract a specialist radiographer audience in aninteractive environment. However, excellent examples ofleadership and service development have been published orpresented at less specialist forums.

� Radiographer discharge of patients.20

� Coordinating a regional gynaecology referral system.21

� Changes to image reporting system to enhance theservice provided to the Accident and EmergencyDepartment.22

� Radiographer led nasogastric intubation service.23

Improved efficiency within the NHS is a perpetual annualgoal required not only by the Department of Health but alsowithin individual Trusts for both financial reasons and theimprovement of services to patients. A key tool in this is thecreation of LEAN working systems based on work in theJapanese motor industry.24 This involves the elimination ofwaste by refining all processes to remove delays, balanceworking practices, and improve organisational efficiency.Experience has shown that successful efficiency gains canbe achieved with LEAN working in the NHS25 but it requiresprofessional leadership. The consultant radiographer role iswell placed to provide this.

If this is the case why do service managers seem reluc-tance to understand or embrace the roles, as evidenced bythe limited number and lack of innovation in many of theexisting posts. The NHS continues to evolve with a greateremphasis on direct patient care in the community.26 Thisrequires changes in the secondary sector, where mostimaging services are currently based. Consultant posts offerthe opportunity to broaden access to patient services and tochange traditional lines of service provision in keeping withthe work of Lord Darzi.27 Is this lack of innovation purely dueto financial pressures and the inability to emerge from therelentless pressures of service delivery, or is there anelement of professional jealousy and lack of vision?

Few would disagree that research and doctoral qualifica-tions are important aspects of the role.28 However, Manningand Bentley29 in their argument that consultant radiogra-phers must have doctoral degrees may have done a disserviceby emphasising the need for this high academic qualification.Their argument is well founded professionally but it may havecreated a feeling that posts are too academic to managersand potential candidates. New research is important but ithas been coherently argued that leadership and vision are theessential qualities needed in these posts.30

Finance and support for such high profile positions willalways be mixed, and the predicted forthcoming severefinancial restraints31 will force service changes. To gainsupport for new posts opportunities must be created tochallenge existing service delivery, to develop new andimproved ways of working, and create new professionalleadership to support senior managers to improve patientcare. It is no longer about continuing the existing pattern ofservice provision but creating new approaches and puttingpatients more central to services. No longer should it beabout replacing aspects of the role of a radiologist buttaking the lead in creating new approaches; such asdeveloping the principles of LEAN efficiency, closer workingwith the community, and providing changes to services forgroups of patients who sometimes fall between the gaps inthe existing system. Consultant radiographer posts providethe opportunity to tackle such challenges.

The Society and College of Radiographers has been verysupportive of the consultant practitioner concept. If theprofession as a whole wants consultant radiographers,service managers must establish more posts, and theseshould to be innovative and exciting not just stop gaps to fillshortages of radiologists. To fill these jobs advanced prac-tice radiographers need to be worthy candidates. Theymust move beyond expert clinical practice and develop thevision and leadership skills required to embrace all fourdomains.

Guest Editorial 7

The management structure being developed in one Trustconsists of a triumvirate of consultant radiologist as clinicallead, a radiographer as business lead and a consultantradiographer as professional lead. Is it time for all membersof the profession to show they are working towards a similarmodel for the future?

References

1. Database started by the author and now shared with theSociety of Radiographers.

2. Information collected by the author from fellow consultantsfollowing unsuccessful panel interviews for nationally adver-tised posts.

3. Price R, Paterson A. Consultant practitioners in radiography e

a discussion paper. Radiography 2002;8(2):97e106.4. Paterson A. Consultant radiographers e the point of no return?

Radiography 2009;15(1):2e5.5. Price R, Vosper M, Miller L, Heasman F, Edwards H. The scope of

radiographic practice 2008. University of Hertfordshire; 2009.6. Ford P. The role of the consultant radiographer: the experience

of appointees. Thesis submitted as partial fulfilment ofa Professional Doctorate University of Portsmouth; 2008.

7. Society of Radiographers. Consultant Radiographer GroupNetwork. Available from: http://www.sor.org; 2009 [accessed14.07.09].

8. Kelly J, Hogg P. Role of a consultant radiographer. A reflectiveaccount. Available from: http://www.isrrt.org/images/isrrt;2008 [accessed 14.07.09].

9. Lawson S. Consultant radiographer-led ultrasound-guidedvacuum assisted excision biopsy. Ultrasound 2008;16(4):234e7.

10. Dean E. Workforce issues in breast imaging: the consultantradiographer’s perspective. Bournemouth: Symposium Mam-mographicum; 2006. 1 p.

11. Department of Health. Advance Letter PAM (PTA) 2/2001.Arrangements for consultant posts e for staff covered by theprofessions allied to medicine PT ‘‘A’’ Whitley Council. Lon-don: The Stationary Office; 2001.

12. College of Radiographers. A strategy for the education andprofessional development of radiographers. London: Collegeof Radiographers; 2002.

13. Department of Health. Radiography skills mix: a report on thefour-tier service delivery model. London: The StationaryOffice; 2003.

14. College of Radiographers. A curriculum framework for radi-ography. London: College of Radiographers; 2003.

15. The Royal College of Radiologists and The Society and Collegeof Radiographers. Team working within clinical imaging e

a contemporary view of skill mix. The Royal College of Radi-ologists and The Society and College of Radiographers; 2007.

16. Guest D, Peccei R, Rosenthal P, Redfern S, Wilson-Barnett J, Dewe P, et al. An evaluation of the impact ofnurse, midwife and health visitor consultants [online]. Areport to the Department of Health by a team from King’sCollege London and Birkbeck College. King’s College Lon-don. Available from: http://www.kcl.ac.uk/nursing/nru/nurseconreport.html; 2004 [accessed 21:07:05].

17. Turnpenney J. Consultant AHP 360 assessment. Leeds: NHSModernisation Agency Leadership Centre; 2003.

18. Royal College of Radiologists. Skills mix survey. Royal Collegeof Radiologists; 2008.

19. Price R. A compromised view of skill mix? Imaging andOncology; 2007:61e2.

20. Snaith BA. Radiographer led discharge in accident and emer-gency e the results of a pilot project. Radiography 2007;13(1):13e7.

21. Punt L. So you want to do service improvement? Presentationat UKRC 2009. British Institute of Radiology; 2009.

22. Keane D. Consultancy not just another job, a commitment.Available from: http://www.dhsspsni.gov.uk/ahp_dorothy_keane.pdf [accessed 14.07.09].

23. Law R. Problematic fine bore nasogastric intubation: a radiog-rapher led service development. Radiography 2008;14(1):82e4.

24. Wano D. Lean working: the aggressive elimination of waste inmedical product outsourcing 2006. Available from: http://www.mpo-mag.com/articles [accessed 9.09.09].

25. Vosper R C. Beating the odds e Hinchingbrooke’s challenge.Presentation at UKRC 2009. British Institute of Radiology.

26. Department of Health. Our health our care our say: a newdirection for community service. London: The StationaryOffice; 2006.

27. Department of Health. High quality care for all the NHS nextstage final report. London: The Stationary Office; 2008.

28. Reeves PJ. Research in medical imaging and the role of theconsultant radiographer. A discussion. Radiography 2008;14(1):e61e4.

29. Manning D, Bentley HB. The consultant radiographer anda Doctorate degree. Radiography 2003;9(1):3e5.

30. Price R, Edwards H. Harnessing competence and confidence:dimensions in education and development for advanced andconsultant practice. Radiography 2008;14:e65e70.

31. Appleby J, Crawford R, Emmerson C. How cold will it be? Pros-pects for NHS funding: 2011e2017. London: Kings Fund; 2009.

Peter FordWestern Sussex Hospitals NHS Trust, St Richards Hospital,

Chichester, West Sussex PO19 6SE, UKE-mail address: peter.ford@wsth.nhs.uk

27 July 2009

Available online 9 December 2009