The increasing pressure to deliver high quality services at a low cost will present challenges but, says one services manager, new ways of working can offer value for money.
Speaking at the Annual Radiotherapy Weekend, Christine Richards, radiotherapy services manager at Kent Oncology Centre, described her experiences implementing the four tier structure and the positive impact it has had on service delivery.
“We have had assistant and advanced practitioners in post for the past five years and the full tier system in place for three years and we haven’t looked back,” she said.
“It has had a dramatic effect on reducing our waiting times, we have fewer complaints, incidents and errors and our recruitment and retention is greatly improved.”
Christine manages over 90 staff members across two sites in Maidstone and Canterbury. Radiographers at the centre undertake a range of advanced practice, including weekly on treatment reviews, follow up of patients, treatment verification evaluation and referral, informed consent for radiotherapy treatment, breast and palliative radiographer-led simulation, brachytherapy insertions and some radiotherapy prescribing.
“With the introduction of both the advanced and consultant roles, the consultant oncologists now have additional time to manage the more complex cases,” explained Christine. “Having radiographers in these extended roles certainly makes economic sense, but it also has a really positive impact on waiting times and service delivery.”
Introducing new roles
Christine’s key message to managers unsure of how to go about introducing these roles, is that full implementation of the four tier model is vital.
Her approach to staffing the lower tiers is unique but effective. She operates a system in which some student radiographers are employed by the Trust for the duration of their pre-graduate training.
“This enables me to utilise them as trainee assistant practitioners and later as assistant practitioners, linking their clinical skills with the academic course,” she explained.
“On completion of their undergraduate training there are potential band 5 radiographers who can be accelerated through the career pathway.”
The consultant radiographer post was filled after Christine approached the Trust with a proposal to recruit someone to work across both sites, providing one stop assessment and treatment.
“A number of vacancies at the time made it possible to fund the position within my budget,” she explained. “Macmillan was keen to adopt the post so the training costs were picked up by them.”
The consultant radiographer now manages the palliative patient pathway enabling patients to be fast tracked through the system. “His appointment has effectively streamlined and improved the service for this group of patients,” said Christine.
Recruitment and retention
Recruitment of band 6 and 7 radiographers remains a problem and Christine says that the lack of parity of roles and grading across the country has exacerbated this. (Click here to read about the SoR's newly launched advanced accreditation scheme.)
“Staff coming in at band 7 are expected to work as advanced practitioners here and need to evidence their ability,” she said. “On the plus side, our staff retention has improved because we are able to offer a wide scope of career development opportunities.”
There is no doubt that implementation of the four tier system is a huge undertaking and Christine says that it would not have been possible without the support of a practice development radiographer who helped guide staff through the process.
"It is not easy, particularly in the current economic climate when many services are already under immense pressure," she concluded."But if we are going to deliver on existing and future healthcare strategies, we have no choice but to embrace these new and innovative ways of working.”
