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Version 2

Workforce Summary – Diagnostic Radiographers

July 2008 – England only


Summary of findings

Imaging services provide support to a wide range of care areas and are affected by
numerous policy drivers including 18 weeks, the Darzi review, the National Stroke Strategy,
abdominal aortic aneurysm screening and the Cancer Reform Strategy. These policy areas,
alongside a year-on-year increase in requests for imaging, are leading to increased
demands on the service. NHS Workforce Review Team (WRT) analysis has identified
evidenced room for workforce growth within the profession to meet this rising demand.

High training course attrition rates remain - up to 35% in some higher education institutes
(HEIs) - although training institutions and the Society and College of Radiographers (SCoR)
continue to seek improvements in the situation. In tandem with lowering course attrition
rates, to improve the flow of newly qualified staff there is an ongoing need to ensure that
continued professional development (CPD) and career development is available to all
radiography staff to maximise recruitment and retention within the NHS.

Analysis

1. Brief specialty description and pattern of training

Diagnostic radiographers are responsible for providing safe and accurate imaging
examinations in a wide range of clinical environments, using a variety of imaging modalities
and techniques so that appropriate management and treatment of patients and clients can
proceed. The identification, evaluation and monitoring of systemic diseases, skeletal and soft
tissue abnormalities and trauma are the major focus of diagnostic radiography.
Radiographers often work alone or in inter-professional care teams. Hence, they need to be
prepared to deal with medical emergencies which may arise during examination and
treatment.

Diagnostic radiographers are concerned with both non-invasive and interventional


procedures, radiation treatments, health surveillance screening and research, with additional
involvement in occupational and forensic medicine. They use their professional judgment to
decide how best to achieve a diagnostic outcome. This includes deciding which examination
is required and how best to execute the procedure. Increasingly, radiographers report on the
images they produce and hence play a vital role in the diagnosis and management of
disease and trauma. A developmental role is the ongoing referral or discharge of selected
patients.

A key aspect of the radiographer’s role is the management of complex interpersonal


dynamics in what is sometimes a short episode of care. During that period, diagnostic
radiographers take responsibility for the physical and psychological well being of the patient.

Pattern of training
Pre-registration education:
The minimum requirement for working as a radiographer in the NHS is an honours degree in
radiography (or equivalent). Pre-registration courses in diagnostic and therapeutic
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This document and the information within it are for use within the NHS for discussion and planning purposes only. The data
and commentary have been supplied by external sources and while the Workforce Review Team has made every attempt to
validate the information WRT cannot guarantee the accuracy of all data and information. This document does not necessarily
reflect the views of the Department of Health.
Version 2 Diagnostic Radiographers

radiography are currently taught in 23 HEIs evenly spread across the UK, 17 of which are in
England. Of the 17 English HEIs, ten offer courses in both disciplines and seven offer
diagnostic courses only; all are three year BSc honours courses. Extended clinical
placements are major elements of all the courses, and expansion of the number of pre-
registration training places is constrained by the availability of trainers and clinical
placements. Greater use of technology-based learning methods is being considered, for
example e-learning/internet-based training. In the medium-term this move will improve
access to training and make it more accessible to a wider audience. Pre-registration
postgraduate courses are offered for graduates from other disciplines (most often, though
not exclusively, science based) who wish to become radiographers, e.g. a competency-
based assistant practitioner programme for which a registration process is being set up.

Post-registration education:
The post-registration postgraduate courses offer more specialised content, providing
qualified radiographers with a pathway for entry into specialised areas such as nuclear
medicine, ultrasound and MRI. Postgraduate courses are also a route for continued
professional development.
• There are now only two nuclear medicine postgraduate programmes.
• There is a shortage of ultrasound training places.
• Supporting the development of academic/clinical roles is thought to be positive.
• Staff retention would be helped by improving access to MSc and PhD further study.

2. Current Workforce

The NHS Information Centre (IC) census September 2006 recorded 12,934 headcount
(11,008 FTE) qualified diagnostic radiographers, and 3,472 diagnostic radiography support
staff (2,852 FTE). The Health Professions Council (HPC) report in October 2007 that the
number of radiographers (including diagnostic and therapeutic) registered with them is
24,707. The Society and College of Radiographers records @15,400 active diagnostic
radiographer members employed in England in August 2008. Additionally it is believed that
there are approximately 400 Assistant Practitioners in the diagnostic workforce who
undertake a limited range of diagnostic imaging procedures under supervision.

Figure 1, based on NHS Information Centre (IC) census findings, demonstrates that
diagnostic radiographers work across all age groups, with a slight bias towards the numbers
in the 40+ age group. SCoR reports that 55% of diagnostic radiographers are over 40.

The current workforce of qualified diagnostic radiographers is approximately 82% female


and 18% male, and the diagnostic radiography support workforce is approximately 83%
female and 17% male (IC data).

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This document and the information within it are for use within the NHS for discussion and planning purposes only. The data
and commentary have been supplied by external sources and while the Workforce Review Team has made every attempt to
validate the information WRT cannot guarantee the accuracy of all data and information. This document does not necessarily
reflect the views of the Department of Health.
Version 2 Diagnostic Radiographers

Radiography (diagnostic)
500

450

400

350

300
HC/FTE

Headcount
250
FTE
200

150

100

50

0
0
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Age

Figure 1: Diagnostic Radiographer Workforce Age Profile (NHS 2007)

3. Demand drivers and estimates

Imaging services provide support to a wide range of care areas and many of these areas are
generating a year-on-year growth in imaging referrals leading to a rising demand for the
workforce. The workload of the profession is also being increased by numerous policy
drivers including 18 weeks, the Darzi review, the National Stroke Strategy, abdominal aortic
aneurysm screening and the Cancer Reform Strategy.

Evidence suggests that 18 week waits have been achieved across the service with the
possible exception of non-obstetric ultrasound. There is an expectation that the targets for
waiting times will further reduce substantially. Strategies for the recruitment, education and
training of sonographers are now required, not only to meet current targets but also the
demands of new screening programmes using ultrasound as the imaging modality of choice.

Extension of the NHS Breast Screening Programme to include the routine screening of
women between the ages of 47 and 70 will require an increase in the radiography workforce.
The previous extension, which was achieved in 2003, saw the introduction of the Assistant
Practitioner to assist in image acquisition and consultant radiographers to undertake the
reporting of images and to conduct further investigations. The establishment of a clear
career progression pathway for assistant practitioners is required to ensure good retention of
this component of the workforce. There is also evidence to suggest that radiographers in this
particular section of the diagnostic service have an age profile that is greatly skewed towards
retirement age.

The recently introduced bowel cancer screening programme may result in an increased
demand for colonography, colonoscopy and endoscopy. For some time, radiographers have
undertaken colonography (barium enema examinations) in place of radiologists. Some are
also being trained to undertake endoscopic examinations of the sigmoid colon. The move
towards a “one-stop shop” approach will require more radiographers to extend their practice.
In addition, the use of virtual colonoscopy (computerized tomography (CT) colonography) is
growing as an alternative to colonoscopy for people who are unable to, or unlikely to be able
to tolerate colonoscopy.
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This document and the information within it are for use within the NHS for discussion and planning purposes only. The data
and commentary have been supplied by external sources and while the Workforce Review Team has made every attempt to
validate the information WRT cannot guarantee the accuracy of all data and information. This document does not necessarily
reflect the views of the Department of Health.
Version 2 Diagnostic Radiographers

The impact of the policy for the provision of positron emission tomography/computerized
tomography (PET-CT) services has not been fully assessed. Ideally, practitioners
undertaking this form of imaging require the knowledge and skills involved in both CT
imaging (diagnostic radiography) and nuclear medicine imaging (medical technologists).
While some “hybrid imaging” courses have been developed there is still a considerable
requirement for additional training to ensure a competent workforce to deliver this service.

The DH has announced the introduction of two screening programmes that will have a major
impact on ultrasound services. The first is the fetal anomaly screening programme where an
additional assessment, nuchal screening, is made of the development of the fetus in early
pregnancy. This is a technically demanding examination that requires a highly skilled and
experienced workforce.

The second is the abdominal aortic aneurysm screening programme that is to be offered, by
2010, to all men over the age of 65 years. The programme is to be delivered by 60 centres
that will need to identify a suitable workforce to undertake this role. It has been proposed
that this may be an opportunity to develop the assistant healthcare workforce, working in
supervised environments to deliver this service.

The review of health service provision that proposes to increase local access to services
including diagnostics may result in the development of local diagnostic imaging services. At
this stage it is not known whether this will provide increased capacity in order to sustain low
waiting times and rapid access or whether it will lead to a transition of services from the
acute sector to primary care. In either scenario there is an anticipated increase in the
demand for diagnostic radiography staff either because of increased capacity or due to the
reluctance of staff to transfer to local units. The extension of GP contract hours may lead to
an increased demand for diagnostics to be provided “out of hours”. There is evidence that
there are already changes in working practices towards a 24 hour, 7 day service provision
through the increased use of shift patterns of working inevitably lead to an increase in
headcount. These changes in service, as exemplified by implementation of the “Stroke
Strategy” require not only additional capacity but also investment in staff training in image
reporting to support service delivery.

4. Workforce Supply

Radiographers are usually recruited through NHS Jobs or Radiography Members’ magazine.

The WRT radiographer supply model predicts the number of radiographers entering the NHS
workforce between 2006 and 2015 to be 7,840, with the anticipated number of retirements
over the same period being 2,985: a net growth of 4855.

The NHS IC three month vacancy survey (March 2007) recorded a vacancy rate of 0.7% (74
posts) (in 2006 – 1.6% (170 posts)), however, it should be noted the IC survey only counts
advertised vacancies that have been vacant for three months or more.

Overseas recruits have to be registered with the Health Professions Council (HPC) in order
to work in the UK. All radiographers are assessed individually as to what further training
they may require as not many programmes internationally have equivalence with the UK.
However, Australian, New Zealand & Canadian trained radiographers generally require little
or no further training. During 2004, 641 radiographers registered through the international
route, with 390 additional applications subsequently being withdrawn. In addition to this 50
applications were rejected. No information is currently available on the split between
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This document and the information within it are for use within the NHS for discussion and planning purposes only. The data
and commentary have been supplied by external sources and while the Workforce Review Team has made every attempt to
validate the information WRT cannot guarantee the accuracy of all data and information. This document does not necessarily
reflect the views of the Department of Health.
Version 2 Diagnostic Radiographers

diagnostic and therapeutic radiographers. All qualified diagnostic radiographers were on the
Home Office Shortage Occupation List (HOSOL) issued in July 2007.

At present, overseas recruitment is mainly from the southern hemisphere – only a very small
portion of recruits come from North America. However, overseas membership of the SCoR
has increased lately with increasing numbers of UK radiographers going to work abroad. The
most common destinations are Australia, New Zealand, South East Asia and South Africa,
where the qualifications required are similar to those in the UK.

5. Summary of issues

A number of policy drivers including 18 weeks, the Darzi review, the national stroke strategy,
abdominal aortic aneurysm screening and the cancer reform strategy, alongside annual
increases in imaging referrals are leading to increased demands on the service. WRT has
identified that there is evidenced room for workforce growth within the profession to meet
this increased workload.

There are ongoing concerns over student attrition rates, which are too high, and that there is
a need for continued efforts to retain students more effectively.

Attendees at the 2007 WRT diagnostic radiographers review meeting suggested that the two
or three major causes of attrition are:
• Finance difficulties for students
• It is reported that clinical placements could be more supportive in their structure.
There is a role for virtual learning environments (VLEs) such as in Teeside or Hull
for radiotherapy. VLEs are more common in Europe and the USA than in England.
• Perceived lack of career progression. In some areas, advanced and consultant
roles are not well established. Clinical Leadership is thought to be critical.
It was predicted that attrition is unlikely to fall below 20% in the next few years.

Concerns were expressed at review meetings that staff retention difficulties are due to lack
of career structure. In 2006, 28 departments had frozen posts. Many departments say that
they are too understaffed (particularly in bands 6 and 7) to be able to run the system, but
that they do have funding for recruitment.

Introduction of a four tier workforce is expected to not only establish a clear career pathway
for diagnostic radiographers but also improve retention within the workforce. Tier 1 will
consist of assistants/assistant practitioners (APs), tier 2 will consist of practitioners (qualified
radiographers), tier 3 will be advanced practitioners and tier 4 will be the consultant
practitioner.

The competences required for each level are set down under the benchmarking and
occupational standards, but it is unclear at this stage how many departments are taking this
on board and providing the necessary training required for individuals to move up to the next
level. Courses for training assistant practitioners have been developed at several HEIs with
more to follow, although reportedly the AP workforce is not yet increasing by much.

At present it is not clear how participation rates will change in the future although it is likely
that specialists will work part time more often than at present and that current full time
specialists will not work as long hours as at present. This is due to generational changes in
attitude to work, increasing numbers of female trainees and the Working Time Directive.

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This document and the information within it are for use within the NHS for discussion and planning purposes only. The data
and commentary have been supplied by external sources and while the Workforce Review Team has made every attempt to
validate the information WRT cannot guarantee the accuracy of all data and information. This document does not necessarily
reflect the views of the Department of Health.
Version 2 Diagnostic Radiographers

Overseas recruitment is a viable route for recruiting diagnostic radiographers. The staff
group remains on the national shortage occupation list (NSOL). Presence of a staff group on
NSOL increases the ease with which an employer can acquire a work permit for an overseas
employee.

6. Bibliography

Department of Health, Our Health, Our Care Our Say available at


http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceAr
ticle/fs/en?CONTENT_ID=4127602&chk=esRlSL [cited October 2006]

Department of Health, Commissioning a patient led NHS available at


http://www.dh.gov.uk/PublicationsAndStatistics/LettersAndCirculars/DearColleagueLetters/DearColleagueLettersArticle/fs/en?C
ONTENT_ID=4118534&chk=41zYSo [cited October 2006]

Department of Health, The NHS in England: the operating framework for 2006/7 available at
http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceAr
ticle/fs/en?CONTENT_ID=4127117&chk=BgslVK [cited October 2006]

National service frameworks available at


http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/HealthAndSocialCareArticle/fs/en?CONTENT_ID=4070
951&chk=W3ar/W [cited October 2006]

Healthcare commission available at http://www.healthcarecommission.org.uk [cited October 2006]

Delivery of the 18 Week Patient Pathway and Beyond: A Strategy for Imaging Workforce,
March 2007, available at
http://www.18weeks.nhs.uk/cms/ArticleFiles/xv4u5y45d2q5v345nzgu2zet06092006111022/Files/imagingstrategyfinalNIB.doc

Society and College of Radiographers, Radiography - The Scope of Practice, 2003 available
at http://www.sor.org/public/document-library/sor_scope_practice_2003.pdf [cited September 2008]

Home Office Shortage Occupation List (HOSOL) Face to face interview transcript, Society
and College of Radiographers, June 2007

Update to ‘A Review of National Healthcare Labour Markets to Update the Additionality List’,
September 2007

N:\WRT\Workforce Summaries\AHP's\Radiographers\Diagnostic\080730-Diagnostic Radiographer Workforce Summary 2008-RH

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This document and the information within it are for use within the NHS for discussion and planning purposes only. The data
and commentary have been supplied by external sources and while the Workforce Review Team has made every attempt to
validate the information WRT cannot guarantee the accuracy of all data and information. This document does not necessarily
reflect the views of the Department of Health.