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Assistant Practitioners

Scope of practice

The introduction of the role of the assistant practitioner has been widely implemented within departments of clinical imaging and radiotherapy such that they make a significant contribution to service delivery. Their practice has been recognised through the SCoR’s accreditation scheme and accreditation renewal through the use of the ‘CPD Now’ on-line CPD management system. New roles for assistant practitioners are being developed particularly within screening programmes such as the screening technician role within the Abdominal Aorta Aneurysm (AAA) screening programme in England.   

The assistant practitioner role is a relatively new development resulting from the modernisation drive within the National Health Service. It is appropriate, therefore, to describe the SCoR’s expectations and requirements in some detail. The identification of all new roles should be underpinned by an analysis of current and future workflows. The introduction of assistant practitioners should be as an adjunct to the development of advanced and consultant roles such that a clear career progression strategy for all staff is implemented in order to meet service demand.

Assistant practitioners, like general support staff, are also likely to be diverse but they will differ from the general support workforce in that, as part of their duties, they will perform limited clinical imaging examinations or treatment procedures in concert with and under the supervision of, registered radiographers or other registered healthcare practitioners. The range of such examinations or treatments will vary in accordance with locally identified need but is likely to be confined to standard examinations or treatments carried out on adults and conducted in accordance with locally agreed protocols.

The SCoR supports the need for the particular roles of assistant practitioners to be identified and agreed locally, in accordance with identified service requirements. However, while duties of assistant practitioners will vary according to local need, the effective use of registered radiographers, proper risk management and good clinical governance procedures are likely to preclude the use of assistant practitioners in settings outside main clinical departments, such as in operating theatres, wards, or oncology outreach clinics, except under the direct supervision of a radiographer.

Similarly, assistant practitioners are unlikely to undertake imaging examinations or radiotherapy where the expected patient groups are less predictable or more dependent. Examples of these can be paediatric patients, patients with major or complex injuries, the very ill or elderly, or where protocols frequently need to be adapted, amended or departed from as in out of standard hours working, during emergency duties or in operating departments. Providing that appropriate protocols and practices relating to supervision are in place, there may be a role for the assistant practitioner in supporting radiographers during extended hours of service.

Changes in future service provision related to proposals in the NHS Next Stage Review in England and in implementing access and choice health policies may present opportunities for assistant practitioners to work in primary care or community settings, for example, as the AAA screening programme is implemented.

Further detailed information can be found in the following publication that describe the Scope of Practice of assistant practitioners

https://www.sor.org/learning/document-library/scope-practice-assistant-practitioners

Accountability and responsibility

Assistant practitioners work under the supervision of registered radiographers who take responsibility for the episode of care. This does not diminish or negate the responsibility of assistant practitioners to ensure that they act within their limits of competence and take responsibility for their actions. They must  neither accept nor undertake tasks for which they have not been trained and authorised Code of Conduct and Ethics13 (2008).

Responsibility for the proper supervision of assistant practitioners rests at all times with the nominated supervising radiographer. The level of supervision may vary according to need from direct oversight of the actions of the assistant to authority for the individual to work independently of the supervising radiographer. The supervising radiographer must have full knowledge of the examinations being undertaken and be immediately available to provide support Clinical Supervision Framework and Clinical Supervision: A Position Statement14 (2003).

The standard of work of the assistant practitioner must conform to the required competency standards for the work being undertaken. Occupational (competence) statements relevant to the practice of assistant practitioners can be viewed at www.skillsforhealth.org.uk. It is expected that clear lines of responsibility and accountability will be drawn up locally to ensure that assistant practitioners maintain their competence and engage in clinical supervision where they can reflect on their practice. This is particularly important in the re-accreditation process.

Education requirements

Support staff who aim to become assistant practitioners will need additional education and training, both in order to undertake the broad range of general tasks associated with the role and the limited clinical imaging or radiotherapy tasks they may be required to undertake.

The SCoR believes that the general educational requirements for assistant practitioners are provided by the S/NVQ level 3 in Health. However, additional education related to specific national occupational standards (NOS) and to the safe use of ionising radiation is required to enable them to perform identified diagnostic imaging examinations or assist with radiotherapy procedures. The SCoR has published its Learning and Development Framework for Clinical Imaging and Oncology3 (2008) for the profession and this describes the broad educational expectations regarding the assistant practitioner workforce.

A consultation exercise has been conducted by Skills for Health into generic standards for assistant practitioners, including education and training standards. The results of this consultation were not available at the time of publication of this guidance document.

The range of education provision for assistant practitioners includes:

  • S/NVQ 3 units, professionally developed and accredited, similar to the one developed for use in mammography
  • work-place based learning units, developed locally to meet specific service needs, preferably in conjunction with a local further education (FE) or higher education (HE) provider, or health care provider’s training unit and based on the NOS. These need to be of a similar or higher standard to that of an S/NVQ 3 unit. These may be accredited by the College of Radiographers or other national bodies. Again, Skills for Health is consulting on an accreditation framework
  • higher education qualifications, for example Certificates or Diplomas of Higher Education (Cert HE; Dip HE), or Foundation Degrees (FD) that embed NOS within them have also been developed. Where such qualifications are offered, they are expected to provide a broad higher education experience that is relevant to the role and function of the assistant practitioner but which also supports some advanced standing in the context of a BSc (Hons) degree in radiography.
  • in Scotland, the HNC in Diagnostic Imaging and the HNC in Radiotherapy that have been developed specifically for the assistant practitioner role.

If generic standards for assistant practitioners are introduced, it is likely that the range of educational programmes to support individuals to become assistant practitioners may be limited.

Accreditation of the Assistant Practitioner

Across the UK at present there are no formal proposals to regulate the support workforce although Scotland and Wales are keeping the need to regulate support workers under consideration and Scotland has issued standards and guidance to employers and employees http://www.scotland.gov.uk/Publications/2009/10/22092739/1 . The SCoR, in upholding its duty to the public, has implemented a voluntary register of assistant practitioners. Assistant practitioners can apply for accreditation of their scope of practice on the basis of having successfully completed a SCoR approved course of education and training or by the submission of a portfolio of evidence. This latter approach is of greater relevance to those who have followed the S/NVQ route.

Application for accreditation as an Assistant Practitioner: Guidance Notes15 (2009). https://www.sor.org/career-progression/assistant-practitioners

Successful applicants will have their name and scope of practice displayed on the Public Voluntary Register which can be viewed at https://www.sor.org/career-progression/assistant-practitioners/aap-register

The SCoR’s Public Voluntary Register of Assistant Practitioners (PVRAP) has been developed in association with accreditation processes to ensure that those engaged in clinical imaging or radiotherapy have been appropriately educated and trained for their role. Entry on to the PVRAP follows the accreditation process and identifies the scope of practice for the individual. Those applicants who are successfully accredited will be placed on the register, initially for a 2 year period. Maintenance on the register is dependent on participation in CPD and either remaining in SoR membership or paying the appropriate accreditation fee.

Initial accreditation demonstrates to the employer that the individual has been externally assessed by the profession as having been appropriately trained for their role. At re-accreditation, evidence of continued competence is required as well as evidence of additional training and experience to support claims for extension and recognition of their individual scope of practice  The Scope of practice of Assistant Practitioners in Clinical Imaging9  (2007)  and The Scope of practice of Assistant Practitioners in Radiotherapy10 (2007)

Pay and grading

The SCoR has established that the job evaluation profile for an assistant practitioner will place them on Band 4 of the NHS pay spine.

Further development of the support workforce

It is expected that the whole of the support workforce in clinical imaging and radiotherapy and oncology will have access to further development, and will be able to build a career in radiography via the skills escalator, if they so wish. For those with the S/NVQ 3 and additional radiography specific units, or accredited work based learning, and wanting to progress, it is expected that this would provide entry into professional level education. Advanced standing with this level of qualification is unlikely unless it can demonstrate learning outcomes equivalent to those within BSc (Hons) programmes in radiography.

For those holding a Certificate or Diploma of Higher Education, a Foundation Degree or an HNC (Scotland), some advanced standing is appropriate. A higher education institution seeking to offer advanced standing will need to demonstrate that it has mapped the outcomes of the qualification offered against the qualification to be pursued and should be able to offer up to two years advanced standing, sometimes in association with a tailored ‘bridging’ programme.

The SCoR expects that where the decision is made to develop a Certificate or Diploma of Higher Education or a Foundation Degree, these are to be aimed at meeting the specific needs of the assistant practitioner. As such, caution needs to be exercised in embedding these in current or future programmes aimed at producing graduate radiographers. Where such an approach is intended, the development will need to demonstrate clearly how the needs of both groups, assistant practitioner trainees and student radiographers, are to be met.

Importantly, all support workers undergoing S/NVQ 2 or 3 level qualifications or equivalent are expected to register with the SoR; and all those developing work based learning programmes, Certificates or Diplomas of Higher Education, or Foundation Degrees for assistant practitioners, need to gain approval of these programmes prior to admitting trainees to them and ensure that the learners/students are registered with the SoR.

Progression beyond assistant practitioner level is most likely be to radiographer level by applying for advanced standing on a pre-registration undergraduate degree programme. For some assistant practitioners such as those employed in NHS Breast or Abdominal Aortic Aneurysm screening programmes this route is possible although less straightforward. For all assistant practitioners, other routes for progression may be through the development of non-clinical aspects of their roles.

 

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