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Context

The context for outlining the future of the therapeutic radiography profession is drawn from a range of influences as follows:

National and political influences

Ongoing national work to raise radiotherapy standards since the publication of the National Health Service (NHS) Cancer Plan,23 the subsequent formation of the National Radiotherapy Advisory Group24 in 2005, and the more recently published Vision for Radiotherapy 2014 – 202414  have been influential in improving radiotherapy provision in both quality and accessibility.  This Vision paper highlights the importance of skills-mix and new roles at advanced and consultant levels of practice in order to enable delivery of innovative and advanced radiotherapy to patients. These principles have been endorsed by the Independent Cancer Task Force Report.25

The Independent Cancer Task Force was established in 2015, with an action plan aiming to improve the outcomes that the NHS delivers for people with cancer. The strategy25proposes the following  strategic priorities: increasing access to radiotherapy; investment in a radiotherapy equipment replacement programme; addressing critical workforce deficits; a strategic review of future workforce needs and access to a clinical nurse specialist (CNS) or other key worker for all people with cancer. All of these will impact the therapeutic radiography profession, and this guidance may therefore need to evolve in parallel as the actions of the Cancer Task Force Implementation Group become evident. At the time of developing this guidance there were already a number of NHS initiatives, recognised as being influential in driving these strategies forward. These include:

  • NHS Services seven days a week26
  • Partnership working (centralisation of specialised services, where not all providers will deliver all services)27
  • Financial payments related to outcomes rather than activity27
  • National Cancer Survivorship Initiative.28

The above are all underpinned by the need to ensure holistic patient-centred care,29 that is equitable and accessible to all users.  The SCoR policy outlining the therapeutic radiography profession’s contribution to these strategies is inherent within the approach of the profession implementing the following specialist practitioner roles at both consultant and advanced practitioner level: Site Specific expert practitioner, technical specialist expert practitioner and community liaison expert practitioner.  The implementation of such roles assists with the introduction of treatment innovations and transformational service changes across cancer care pathways, thus contributing to the safe provision and continuity of care across the entire radiotherapy patient management pathway.

Service provider models
Developments in technology, the drive to improve patient accessibility and the increasing provision of radiotherapy by independent sector and private providers is resulting in a rapid increase in the number of geographical locations of radiotherapy services across the UK, as well as an increase in the variety of service provider models: large cancer centres, satellites from existing centres, new centres by new providers, partnership working between providers27 and providers of specialist modalities such as stereotactic radiotherapy and proton beam therapy.

Leadership
The development and implementation of newer technologies requires effective leadership at a local service level, and will necessitate multi-professional guidance from the radiotherapy professional bodies to ensure consistency of implementation and equality of access for patients. The head of the radiotherapy service must work with their medical and physics colleagues to ensure the delivery of a high quality radiotherapy service. One of the strategic mechanisms to facilitate this is the leadership role of the Radiotherapy Board. This was set up in 2013 to develop the work of the now defunct National Radiotherapy Implementation Group (NRIG). It was established jointly by the SCoR, IPEM and RCR to support the delivery and development of radiotherapy services in the UK and has recently published a number of guidelines. 30,31,32

Changes in therapeutic radiography scope of practice
SCoR continues to encourage the therapeutic professional workforce to seize opportunities for developing roles within a dynamically changing health care environment.15 In response, the profession has developed both educationally and in practice, resulting in diversified and expanded roles at advanced and consultant levels, thus contributing to quality improvements to the benefit of radiotherapy provision and service users, all building upon the long established four tiers of the career progression framework .5,6

The increasing complexity of both radiotherapy planning and delivery, such as the use of multiple imaging modalities (4DCT, PET CT, MRI, Ultrasound) will require therapeutic radiographers to have complex skills to support the use of existing and newer technologies as they emerge.33,34,35

This includes the implementation of newer modalities such as protons, MRI linacs and molecular radiotherapy, and the increasingly complex decision making required when imaging and delivering radiotherapy.  The increasing use of combined treatment modalities such as radiotherapy, chemotherapy, immunotherapy and biological therapies will also require effective multi-disciplinary working between all involved; working collectively to provide continuity of care across the entire cancer management pathway. Therapeutic radiographers will play a pivotal role in caring for patients before, and during, radiotherapy, and into the survivorship phase of their care pathways.

Studies have identified that the pace of change continues.19, 20,36,37,   The role of the professional therapeutic radiography workforce continues to expand its responsibilities across the entire radiotherapy pathway in the majority of radiotherapy centres: specifically these include advanced and consultant level practitioner-led planning services and on-treatment review, supplementary and independent prescribing.38 Many centres have both tumour site specialists and technical specialist roles within their establishment and a smaller number of centres have developed community specialist radiographer roles. The annual therapeutic radiography workforce census21 and regular therapeutic radiography scope of practice surveys20,36,37 demonstrate the vast majority of radiotherapy services have radiographer-led treatment planning services and radiographer-led on-treatment review. Alongside these there has also been a steady growth in the number of specialist radiographers appointed, particularly in tumour site specialist roles at both advanced and consultant levels of practice.  Therapeutic radiographers in these specialist posts undertake vital roles in co-ordinating and providing consistently high quality care to their patients while being a point of contact and the patients’ key worker during their radiotherapy pathway, as specified in the Cancer Task Force Report. 25

Clinical governance, audit and research
All therapeutic radiographers have a duty of care to ensure they deliver the highest possible standards of care to all their patients. To embrace service innovation and technical developments, the therapeutic radiography workforce needs to undertake service evaluation, audit and radiographer-led research in line with the SCoR Vision for Research39 to drive local quality improvements while also ensuring patients’ treatment and care follows evidence-based practice that is provided in a transparent and accountable way with a patient-centred approach.

Professional education
Education underpins the therapeutic radiography profession, where the effective implementation of skills mix is a key component within the comprehensive education and career framework for the therapeutic radiography workforce.1  This outlines the importance of individual practitioners’ competency, while also placing significance on the need for education providers and service managers to provide educational and supportive mechanisms in the clinical setting, for both pre and post-registration radiographers. This should include access to the tool for use in education programme development, while also facilitating, supporting and monitoring the achievement of both professional and personal development goals of therapeutic radiography professions across their career pathway.

The indicative curriculum40 for practitioners reflects the requirement for a highly professionalised workforce with a clear identity and set of values. These, together with the appropriate knowledge and skills, ensure that radiographers are able to operate professionally in uncertain environments and in a dynamically changing work place.  The values of integrity, person-centred, personal responsibility, respect, trustworthiness, collegiality and reflective practice are embedded to ensure the curriculum prepares newly registered radiographers entering the workplace as novice professionals to develop the level of professional maturity required to enable them to progress to advanced and consultant level practitioner roles, including those with a remit of leadership and management.    

The role of therapeutic radiographers in public health education.
While there are around 40,000 people employed directly to work in public health, it is increasingly recognised that this workforce alone cannot tackle the nation’s public health problem. 41 The recent report from Public Health England42 recognises the role therapeutic radiographers already play as one of the twelve Allied Health Professionals, in championing the public’s health and wellbeing through their day to day contact with patients.

Health conversations or making every contact count (MECC)43 encourages all those working within the health care sector to use every opportunity to make a significant contribution to the national prevention agenda as outlined in the NHS Five-Year Forward View.44 The PHE report identified examples of where therapeutic radiographers are already making a difference to their patient’s health through having health-related conversations with them while caring for them across their entire cancer management pathway.  There have also been a number of case studies published where therapeutic radiographers have been involved in developing local strategies and improving patient care, leading to improvements in the health and well being of their patients. 45,46 The regular contact therapeutic radiographers have with patients gives them the opportunity to provide continuity of care prior, during and after completion of their course of radiotherapy. During this time they develop a relationship, so allowing them to discuss more sensitive issues such as the need for emotional and psychological support and the benefits of adopting health life style behaviours as they enter their ‘survivorship’ phase of their cancer journey, hopefully leading to improved survival and quality of life.47 The growing number of specialist therapeutic radiographers at advanced and consultant level18,19 will provide increasing opportunities for therapeutic radiographers to play an ever increasing part in improving the nation’s general health.

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