Category: Scheme best supporting New Ways of Working and Training
Name: Jacqui Smith
Job Title: Acting DGM, Imaging and Oncology
Organisation: United Lincolnshire Hospitals NHS Trust
Email: jacqui.smith@ulh.nhs.uk
Telephone: 01476 565232 ext 4657
Key team: Jacqui Smith - Acting Directorate General Manager, Nicky Cornelius - Consultant Radiographer, Dr Elisabeth Murray - Clinical Director
Title: Radiotherapy modernisation and the role of a consultant radiographer
The Lincolnshire Department of Clinical Oncology relocated to a new facility in 2001. The advent of this new technology demanded radical new working practices. The concurrent external targets detailed in the NHS plan, reinforced the need for traditional roles and boundaries to be redefined, to develop new ways of working. In addition therapy radiographers were now the shortage profession and morale, recruitment and retention were at an all time low. Patient waiting times were one of the longest in the country at 20 weeks. Following a successful project to introduce a flexible workforce where roles were competency based rather than profession and grade led, the Lincoln radiotherapy department was selected to become a DoH pilot site to introduce a new 4 tier staffing structure for allied health professionals.
This paper will outline the project strategy, which culminated in Lincoln being the only site nationally to introduce all 4 tiers including recruitment of the first Consultant Radiographer in June 2003.
The aim of the project was to reduce waiting lists and improve recruitment and retention specifically.
The following benefits were realised:
- Patient benefits (for example, reduction of waiting list from 20 weeks to a maximum of 6 weeks)
- Patient choice (for example, greater range of appointments available)
- Staff benefits (improved recruitment and retention)
- Improved partnership working between clinicians and managers.
- Financial benefits
These were achieved by:
- Recruitment of a Consultant Radiographer to improve access for patients with lung cancer
- Introducing advanced practice for radiographers. Work based learning units accredited at Masters level were developed to provide academic underpinning and a competence based assessment system introduced. As these were developed, marked and moderated in-house there was little financial investment required.
- Introducing assistant practitioners. With the advent of new technology it was recognised that many of the traditional radiographic duties could be undertaken by assistants and this new role was introduced (the 1st of the 4 tiers).
Although led by radiotherapy there was a multi-professional and multi-agency approach.
To deliver the in-house training required for the assistants many other professionals contributed to the course and agreed to pilot clinical placements for them within their departments.
For the advanced practice training collaboration was sought with Sheffield Hallam University, in particular Angie Eddy as course leader. Again many professionals contributed to the in-house lectures, for example, dieticians, pharmacists etc.
Achievement was measured in a variety of ways:
- Patient satisfaction, Staff satisfaction, Oncologist satisfaction, reduction in waiting times, improved recruitment and retention, etc.
Main challenges were professional territory issues both from radiographers delegating to assistants and oncologists delegating to radiographers. This was overcome with clear leadership, analysis of benefit realisation and demonstrating clear evidence of training and fit to practice using competency assessments.
Wide consultation was undertaken with all stakeholders to ensure acceptance and support
It was originally expected that the new 4 tiers would be cost neutral - savings made by introducing a lower tier would be offset by the increase in salaries for the advanced and consultant practitioners. However once the whole structure was in place and a reassessment made of the skill mix, savings in the order of £50k recurrently were realised.
The next steps are to widen the role of the radiographer to incorporate other areas of the service, for example, to train radiographers to undertake skin radiotherapy. In addition we are also planning to develop a Consultant Radiographer for breast cancer.
Within ULHT there are also plans to implement the 4-tier structure within radiology and a project plan is currently under development.
To build on this successful project requires cross boundary working, and the “celebrating success in Trent” workshop will be a useful forum to disseminate and share best practice to maximise the benefits to patients.
Lincoln is now a reference site for the 4 tier staffing structure both nationally and internationally. Jacqui Smith, project lead, is working in collaboration with the Canadian radiation technologist association to implement this structure across Ontario.
Both Jacqui Smith and Nicky Cornelius have been asked to present this project at many national and international conferences.
