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Appendix A

Outline therapeutic radiotherapy workforce profiles based on the situation as of March 2016, for a range of differing radiotherapy service models and sizes.

It is beyond the scope of this guidance to be prescriptive about local workforce requirements for an entire radiotherapy service as configurations will be dependent upon a variety of factors and will need to vary to meet local circumstances.

This information has been provided to assist radiotherapy managers make informed decisions about their local therapeutic radiography workforce staffing requirements. All information provided in this appendix is based upon data collated from a recent SCoR survey22 conducted by the SCoR Radiotherapy Advisory Sub-Group (RASG). Seventeen radiotherapy centres were surveyed during March 2016 to profile their multi-disciplinary radiotherapy workforce establishments, radiotherapy activity (level and specialities), equipment and working hours.

The SCoR Radiotherapy Advisory Sub-Group advises that the information provided in this appendix must not be taken in isolation. It should be considered in the context of the Principles of Therapeutic Radiographer Staffing criteria (a) to (g) within Achieving World Class Outcomes: The Vision for Therapeutic Radiography. It is the view of this expert group (RASG) that the following outlines the current therapeutic radiography staffing requirements for a variety of models and sizes of service provider.

Managerial and supervisory radiographer posts

o   Head of radiotherapy (Radiotherapy Service Manager) who is an HCPC registered therapeutic radiographer with deputy/deputies who is/are the identified leads in the event of absences.

o   Service area specific leads (eg pre-treatment and treatment lead) for each working area within the main centre and each satellite.

Registered practitioners: consultant, advanced and practitioner levels
Therapeutic radiographers play a pivotal role in caring for patients with cancer across the entire radiotherapy pathway. They are critical in the delivery of patient centred care and, as such, they are required to care for patients prior to and during radiotherapy delivery, and into patients’ survivorship phase of their management pathway.

The current data has highlighted the need for therapeutic radiographers to operate both pre-treatment imaging units and treatment units, and undertake a range of other associated activities all of which are critical to ensure a safe, efficient and effective radiotherapy service. These include the following:

  • MDT meeting attendance and decision making
  • pre-treatment patient information and patient consent
  • role of therapeutic radiographer as key worker
  • supplementary and independent prescribing
  • dosimetry and mould room services
  • professional education
  • clinical governance, quality management and audit
  • data management
  • clinical trials, research and development
  • brachytherapy
  • molecular radiotherapy
  • radiographer led on treatment clinic reviews, follow up clinics, survivorship clinics and community liaison
  • radiographer- led information, support and counselling services.

The variable nature of the data acquired during the recent survey22  supports the principle that many of these associated activities are not always exclusively undertaken by therapeutic radiographers, but are often carried out in conjunction with professional colleagues; clinical oncologists, medical physicists and nurses. As a consequence, it has not been possible to identify definitive therapeutic radiographer staffing requirements for each of these essential associated activities. A multi-professional approach will be required by the service manager to determine the overall radiotherapy staffing requirements as they will be influenced by local service requirements and arrangements.

It will be for each individual radiotherapy centre to implement the number, range and mix of therapeutic radiographers required at consultant, advanced and practitioner levels, according to local circumstances based on a number of factors to include: specialist patient needs, case load, availability of Specialist Registrars and succession planning.

Consultant and advanced practitioners
The number of consultant and advanced practitioners will be dependent on local circumstances.
Job descriptions and job plans include the requirement to fulfil the four domains of practice1 in accordance with SCoR guidance.7 They are only allocated as part of ‘core’ treatment or planning delivery team for a small proportion of their job plan.

The current data highlighted that radiotherapy centres support the following:

a)     up to two consultant practitioners regardless of model or size of radiotherapy centre

b)     the number of advanced practitioners vary according to radiotherapy centre model and size, as follows:

  • multi-site centres support between 3 - 7 WTEs
  • large centres (8-10 linacs) support between 0 - 5 WTEs
  • medium centres (4-6 linacs) support between 0 - 7.5 WTEs
  • small centres (2-3 linacs) support between 0 – 7 WTEs.

Details about the range and number of specialist radiographer posts in employment in radiotherapy centres across the UK have been published by the Society and College of Radiographers.20,21 These surveys demonstrate the variety of tumour site specific, technical specialist posts and community liaison specialist posts that have been implemented. A recent collaborative project with Prostate Cancer UK19 has also demonstrated that significant growth in numbers is expected in the next three years, for both prostate/urology tumour site specialist radiographer and palliative specialist radiographer posts.

Practitioners
Practitioners underpin the service and are the largest proportion of the therapeutic radiography workforce 21 responsible for the delivery of daily care for patients attending radiotherapy pre-treatment imaging and treatment units.

Local capacity and demand planning will dictate the hours of service required to operate each available imaging and treatment unit within the radiotherapy centre. All data provided within this appendix has been acquired from the recent SCoR survey22   by benchmarking seventeen radiotherapy centres’ workforce requirements for an 8 hour day, highlighting that all these radiotherapy centres support the following:

  • when working to capacity, a linear accelerator delivering radiotherapy across an eight hour day requires a radiotherapy workforce of four, in their capacity as entitled IR(ME)R Operators. The skills mix of this workforce will be reflective of the required elements of the career progression framework which will be dependent upon the complexity and range of imaging and treatments being delivered. This is to enable the efficient use of technically sophisticated equipment while also delivering patient centred care.
  • an uplift to this staffing level is required for extended hours beyond the eight hour day.
  • when working to capacity, an imaging unit working an eight hour day requires a radiotherapy workforce of four, in their capacity as entitled IR(ME)R Operators. The skills mix of this workforce will be reflective of the required elements of the career progression framework which will be dependent upon the complexity and range of imaging being undertaken. This is to enable the efficient use of technically sophisticated equipment while also delivering patient centred care. In smaller centres, the imaging unit may not be working to capacity and/or may not be working an eight hour day, in which case the data suggests a reduced staffing level is appropriate.

Assistant practitioners

Assistant Practitioners are a small proportion21 (3.8%) of the workforce and the current data highlights that:

  • multi-site centres support between 0.5  – 5 WTEs 
  • large centres support between 1 - 2 WTEs
  • medium centres support between 1.8 - 5 WTEs
  • small centres support between 0 - 1.2 WTEs. 

The data also highlights that assistant practitioners are increasingly working in pre-treatment areas such as imaging units and mould room rather than on treatment units. 

Other staffing requirements
The current data has highlighted the need for a range of support staff such as health care assistants, administrative and clerical staff to undertake a range of tasks such as appointment scheduling, receptionist duties and basic nursing and patient information duties. The variable nature of the data acquired during the survey23 indicates that it will be for each individual head of radiotherapy to identify and employ the required number of support staff to fulfil these tasks in their centre. 

  • Whole Time Equivalent

NB The Operator does not have to be a registered healthcare professional. The definition of ‘Operator’ is stated in IR(ME)R as any person who is entitled, in accordance with the employer’s procedures, to carry out practical aspects of exposures. 

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