An evaluation of the impact of implementation of consultant practitioners in clinical imaging

Abstract

Research to identify the scope of radiographic practice in 20081 recommended further work to evaluate the impact of implementation of the Career Progression Framework (CPF), and, in particular, the consultant practitioner role in clinical imaging. As a result the Society and College of Radiographers (SCoR) commissioned two exploratory case studies. These were undertaken at two NHS trusts where all four tiers of the CPF had been adopted (assistant practitioner, radiographer, advanced practitioner and consultant). One case study was undertaken in the south of England and the other in the north. The sites had consultants specialising in gasto-intestinal (GI) imaging, breast imaging and Emergency Department (ED) services. Interviews were undertaken with key personnel at each trust. Those participating consisted of consultant radiographers, service managers, a clinical manager (radiologist) and a consultant radiologist. Each trust viewed the adoption of the CPF as a means of modernising service development and addressing gaps in service delivery. At both sites, the consultant role had been instrumental in bringing about change to meet service needs. In planning prior to introduction of the CPF within the two trusts, the role requirements for the post (and the „four pillars‟ of the consultant role) had been contextualised to the specific needs and situation within the relevant departments. Key steps were consultation within and external to the trust and agreement of job descriptions. Gaining the support of radiologists within trusts had also been essential. The strengths of individuals viewed as likely candidates for the consultant roles once they were instituted were also taken into account during the design process. External recruitment to consultant posts had been challenging; they had been mainly filled through internal promotion. Interviewees were convinced that benefits and improvements in service delivery had been brought about by adoption of the CPF. Increased capacity and patient throughput. The changes brought about by introduction of the CPF, and in particular the consultant and advanced practitioner posts, had facilitated an increase in throughput of patients. Improved use of medical staff time. There was evidence that introduction of the consultant and advanced practitioner posts had led to radiologists‟ time and effort being used to greater effect. Interprofessional working. Inter-professional working had been improved, leading to service improvements. Cost containment. Where the consultant radiographer role had been introduced in place of a radiologist, the service expansion had been achieved at less cost than if a consultant radiologist had been appointed. Improved teamworking. Introduction of the consultant radiographer posts had had a beneficial impact on teamworking, both within the imaging service and across The impact of consultant practitioners in clinical imaging iv Report to the Society and College of Radiographers departments/professions. Improved departmental performance. Departmental performance had improved at both case study sites following introduction of the consultant radiographer posts. The consultant radiographers had been instrumental in redesigning patient pathways and services. Increased flexibility. Introduction of the consultant posts had led to more flexibility in responding to patients. More clinics were scheduled and appointments could be offered at a wider and more convenient range of times for patients. More fulfilled staff. Introduction of the four tier career progression framework had led to more fulfilled staff at all levels, with radiographers being able to utilise their full range of skills to the benefit of the patients. No change in errors or complaints. No increase in errors or complaints had been experienced since introduction of the consultant posts and their introduction had allowed service „gold standards‟ for double reporting to be achieved. Other benefits arising from the introduction of the consultant radiographer posts included gains through contributions to professional leadership, staff development and clinical governance. No negative impacts were reported but two issues were identified during the work. These were: Energy and effort. Introduction of the consultant posts takes a lot of time and effort. Ad hoc nature of developments. Introduction and design of the consultant posts remains an ad hoc process, driven either opportunistically, through highly talented individuals being in post and driving the development and approval process; or through service need, where the consultant grade is introduced in an attempt to resolve a service difficulty. This small-scale pilot study has pointed to many benefits arising from implementation of the CPF. There were no reports of negative outcomes for patients and many apparent benefits for patients. However, while interviewees could point to observed benefits, and in some cases could estimate the change to patient capacity that had arisen as a result of the service re-design, they did not believe that data existed that would enable cost/benefit calculations to be undertaken to demonstrate impact, and neither site had attempted to estimate the costs and benefits to date, other than pointing to savings made through not appointing more costly medical staff. Overall, the research captured data on issues relating to consultant appointment, impact on service operations and service improvement and hence their immediate impact on clinical imaging services at two NHS trusts. Based on the outcomes of the study recommendations are made for a larger study embracing clinical imaging and radiotherapy within the UK as a whole. The major focus of further work would be to explore the possibility of identifying and recording data to enable a thorough cost/benefit analysis to be undertaken