WHAT IS THE SIGNIFICANCE OF THIS? The whole technology issue is an article on its own, but in précis we now have a scenario where many decisions or processes are no longer in the hands of equipment operators, where computer assisted diagnosis is a reality and where emerging technologies, such as molecular imaging, may change the face of radiology12
. Without wishing to be too
contentious, it may be argued that some imaging and oncology practices have already been deskilled by the intervention of modern equipment. What does this mean then to the scope and emphasis of radiographic practice and, in that context, how does education align with this change? Does a radiographer really need a degree in order to carry out many aspects of routine radiography? Or to put it another way, when assistant practitioners are evidently capable of carrying out much of the routine work, do radiographers still need to be taught the same skills set, or should the emphasis lie in areas where they can effectively exercise the clinical judgements associated with graduate level practice? The evolution of radiographic practice is also linked to the wider environment, health policy priorities and, of course, professional aspiration.
approvals undertaken by the College of Radiographers indicate that the UK’s entry level education is not dramatically different14
to that of many other developed countries. It
can be legitimately argued that this is because role extensions are post-registration skills, taught usually at postgraduate level, but when does an evolving practice become a mainstream skill or, indeed, can it? And in that context, from a skill mix perspective, when does the practice of assistant practitioners influence the entry level training of radiographers?
The NHS Plan2 and the recent white paper ‘Liberating the NHS’4 , set out to change the
face of healthcare in significant ways. Among other things they advocate skill mix, the shifting of services to the primary sector, and increased involvement of the independent sector in delivery. These features encourage the evolution that is already underway, so what do radiographers need to look like in the future if they are to deliver effectively in this environment? Specifically, how do they need to be trained and developed in order for this to happen?
there is politiCal will to build the band 4 workforCe
HEALTH POLICY AND THE HEALTH SERVICE The healthcare landscape is influenced by changing demographics, clinical research outcomes and political priorities. Alongside this, clinical practice evolves. In radiography, the most familiar phrases of recent years have surely been ‘skill mix’ and ‘role extension/development’ alongside, for slightly different reasons, continuing professional development (CPD) and advanced/consultant practice. All terms associated, quite explicitly, with modifying or evolving the roles of radiographers. Developed roles such as diagnostic image reporting, portal image evaluation, and an extensive range of others, have become widely regarded as completely acceptable - to the radiographic community at least - and are supported by robust research evidence to underline their credibility.
Like all evolution however, the correct circumstances must exist for it to occur and the unique structure and demands of the UK’s National Health Service (NHS) have provided this. Witness the fact that radiographic reporting, for example, has hardly scraped the surface in most other countries globally13
, making it apparent that the UK is a bit of a rarefied environment. It is interesting to note then that recent international course
EDUCATING THE FUTURE WORKFORCE The business, for that is what it is, of training and educating the radiographic workforce has conflicting demands. In order to deal with significant development and lead-in times, particularly for undergraduate programmes, the HE sector must have a very clear perspective on the health policy agenda, effective linkage with the clinical sector, and with those who commission training in whatever form; the market! How much the HE sector can push the practice agenda and how much it must follow is, of course, influenced by resources and, frankly, by market forces. In respect of post-registration education in particular, it is evident that despite the College of Radiographers’ clear viewpoint on the radiographic scope of practice15
, there is limited commonality of view at ground
level. In fact, there is considerable variation in the implementation of skill mix initiatives across the United Kingdom, often because of regional workforce priorities and/or local professional opposition16
. The localisation of professional development priorities is further
encouraged by the implementation of Agenda for Change requirements in respect of staff development through the NHS Knowledge and Skills Framework (KSF), meaning that clinical environments may have very specific demands for CPD provision, often unaligned with the traditional forms of post-registration programmes on offer.
51 2011
IMAGING & ONCOLOGY
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