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Consultant Practitioner

The context of consultant practitioner posts in clinical imaging and radiotherapy and oncology needs to be clarified in terms of the nature, purpose and intended outcomes professionally, personally and for the organisation involved.  Key to this is the agreement and specification for relationships and accountability. The consultant practitioner is a champion in the clinical, academic or research field bringing innovative solutions to patient care Developing the business case for consultant radiographers69 (2003).

Their role is one that defines professional development and influences at a strategic level. As such, consultant practitioners play a pivotal role in the integration of clinical, education and research findings in practice. The consultant practitioner is able to initiate clinical service developments and deliver improved patient outcomes through the implementation of the findings of:

  • clinical research
  • clinical audit
  • clinical governance
  • clinical risk assessment

They are independent, creative thinkers who are advancing practice, research and education for service developments and are able to work across professional and organisational boundaries. They provide leadership, function as consultants to other practitioners and are engaged in clinical supervision activities to support them in their role. Consultant practitioners have developed mature clinical reasoning skills underpinned by practice experience and relevant education. They carry their own caseload, including addressing patient and client consent for invasive procedures and radiotherapy Consent to Imaging and Radiotherapy Treatment Examinations70 (2007).

Education requirements

The SCoR believes that the educational requirements to support this highest level of clinical practice are education and/or development through workplace and other learning and practice that is equivalent to doctoral level. 

Education programmes for consultant practitioners should have learning outcomes that enable them to:

  • subject their professional knowledge to critical questioning, reflection and debate
  • integrate the best of current knowledge and practice with their discipline
  • provide original and innovative contributions to the knowledge base of their discipline and practice
  • demonstrate best practice and promote it widely.

Pay and grading

The national Job Evaluation profile places Consultant Radiographers in Band 8 of the NHS pay spine.

Accountability, autonomy and responsibility

Consultant practitioners will work across traditional boundaries, incorporating their expert clinical practice supported by additional functions to benefit their particular patient and client groups. Like all registered radiographers, they are professionally autonomous and work within the profession’s ethical framework. They work within their own level of competency and identify further competences they need to develop to ensure that patient and service needs are met and sustained effectively. Crucially, this role is pivotal in the wider multi-disciplinary team.

Support and resources

Following careful analysis of the post and its impact, there needs to be agreement about the wider resources necessary to support both the consultant practitioner and the post. Particularly for newly appointed consultants, appropriate levels of mentorship and access to development opportunities offered by peers locally, nationally and internationally must be ensured.

Experience has shown that the nature of consultant practitioner posts varies according to local need. It is imperative that the role is dynamic, adapting to external factors and changing demands. Having been implemented on the basis of a defined service need, it is important to keep the role under review and to ensure effective succession planning by developing future consultants from the existing advanced practitioner workforce  Consultant Radiographers: Succession Planning71 (2009)

The role and function of consultant practitioners

Consultant practitioners practise at the leading edge of the profession, with the ability to create and interpret knowledge that extends the forefront of the profession. They provide leadership in relation to clinical practice and the delivery of clinical services. They make informed judgements on complex issues and demonstrate innovation in solving clinical problems, often within multidisciplinary and/or multi-agency environments. Conceptualisation, design and implementation of projects for the generation of new knowledge and understanding may also be part of the role, as is knowledge transfer.

Consultant practitioners as they develop from novice to more experienced consultants will be expected, within their area of expertise, to:

  • strengthen expert clinical practice,  extending the forefront of the profession
  • provide professional and clinical leadership and consultancy widely
  • lead education, training and development
  • lead practice and service innovation and development
  • lead research and integrate findings into practice
  • promote a culture which encourages research and leadership
  • contribute to development of the health and social care economy.

The knowledge, understanding and skills required for the consultant practitioner role are stated in the Learning and Development Framework for Clinical Imaging and Oncology3 (2008).

Accreditation of Consultant Practitioners

Consultant practice in clinical imaging and radiotherapy and oncology has developed as part of the profession’s career framework. It recognises the greater responsibility of some practitioners and the development of new and innovative roles to deliver high quality and patient centred care. The Society of Radiographers (SoR) has established accreditation of consultant practitioners to:

  • ensure there is national consistency in the standards of consultant radiographic practice
  • secure transferability of those standards across the NHS and other health care sectors
  • recognise explicitly the professional achievements of individuals
  • provide clarity for professionals and service users on the nature of consultant practice in clinical imaging and radiotherapy and oncology
  • promote the value of consultant practice skills and status
  • support the development of emerging consultant practitioners in a systematic way, so facilitating succession planning within services
  • support accredited consultant practitioners to remain demonstrably at the leading edge of their specialism
  • build on existing frameworks for consultant practice.

For the purposes of accreditation, the definition of a consultant practitioner is:

"An individual who is practising at the leading edge of their particular scope of practice and the profession, extending this where there are proven benefits to service users. They provide leadership in relation to clinical practice and the delivery of high quality, patient focused clinical services; they make evidenced, informed judgements on complex issues routinely and demonstrate innovation in solving clinical problems."

The processes of initial accreditation and re-accreditation relate to the four core functions of higher level practice (Table 1). These provide a framework within which continuing professional development can be evidenced to ensure it is appropriate to consultant practice roles.

Table 1: Core Functions of Higher Level Practice

  • Expert Practice
  • Professional Leadership and Consultancy
  • Education, Training and Development
  • Practice and Service Development, Research and Evaluation

Information about the accreditation process and how to apply for accreditation can be found at http://www.sor.org/public/ap_accred.htm.

Successful applicants will receive accreditation for two years and will need to seek re-accreditation on a two-yearly cycle. The evidence for initial and subsequent re-accreditation must be submitted through ‘CPD Now’, the SoR’s online CPD management tool. Evidence must clearly relate to the learning outcomes related to consultant practice and detailed in the Learning and Development Framework3 (2008).

Top Level Management, Education and Research Roles

Alongside the relatively new clinical consultant practitioner role, there are top level positions in management and education with roles and responsibilities that are well established. Across the UK, radiographers are already leading and managing clinical imaging, radiotherapy and oncology education departments and services.   These roles are complex and highly demanding, accountable at board/executive level and carrying significant responsibilities for managing large budgets, teams and other resources. Their education and qualifications are diverse, underpinning their specific roles and at, or higher than, master’s level or equivalent. Reward for their roles is at the highest level, for example at 8c/d and 9 on the NHS pay spine.

Further Development

At the top level of the profession, continuing development in the scope of individuals’ roles  is expected. This is likely to be lateral and/or vertical. As clinical consultant practitioners develop their practice and the services they provide, they broaden the range of their activity, for example, leading multidisciplinary/multi-organisational care teams, introducing and validating new techniques and technologies, and leading and directing clinical services.

Service managers are likely to extend their leadership and management across diagnostic and/or cancer care services more broadly, for example, to provide integrated and effective services across health care sectors and to design, test and implement new ways of working to improve the quality of care for the public. In doing so, they may lead and manage complex workforces that include medical, allied health, health science, nursing and support staff.

Research leaders are likely to be responsible for large, nationally funded research projects, building strong research teams that span clinical, academic and industrial partners and disseminating research findings widely so they become embedded into practice. Engagement in work of organizations such as the National Institute for Health and Clinical Excellence and the Scottish Intercollegiate Guidelines Network will be a normal part of their roles.

In education, leadership of interprofessional departments, schools or faculties may be the development pathway, moving on to university wide leadership roles or positions that carry national policy responsibilities for the education and development of the radiography and/or the wider health care workforce. Research and innovation to ensure education is of the highest quality is a different and equally important development pathway.

Professional developments that impact across the top level of the profession include the following:

Imaging Services Accreditation Scheme (ISAS)
This joint development by the College of Radiographers and the Royal College of Radiologists was launched in 2009. The scheme independently assesses  the quality of services delivered by clinical imaging departments with the aim of enhancing the quality of service provision in the UK. It is expected that service managers and consultant practitioners as well as the most experienced advanced practitioners will be involved with this process as accreditation assessors and in various roles as services seek and maintain accreditation http://www.isas-uk.org/default.shtml.

Cancer Peer Review Measures
The College of Radiographers has been involved as a partner in the development of these recently revised and updated standards (available imminently).

These require co-ordination of radiotherapy services across networks, implementation of new technologies and increased capacity to deliver radiotherapy. As with ISAS, service managers and consultant radiographers have key roles to play in ensuring that services meet these national standards and undertaking the required peer review of services to ensure they achieve the measures.

Self- referrals to AHPs by patients
As diagnostic services move into community and primary care settings, they will be led by consultant practitioners who are able to accept referrals from a range of registered healthcare practitioners, justify the examinations requested, provide reports of the findings and onwardly direct patient management and care. As Allied Health Professionals, consultant radiographers are now also able to accept self-referrals for diagnostic imaging examinations directly from patients where this is appropriate and where they have acquired the additional knowledge, skills and competences to do so. 

The Cancer Reform Strategy supports the concept of therapeutic radiographers being involved in the care pathway to provide a bridge between the primary and acute health care sectors. Patients who have received radiotherapy as part of their treatment may wish to seek the advice of a radiographer following their treatment and for some time afterwards and may self-refer. (‘Self referral’ to Allied Health Professionals: A position statement in relation to diagnostic and therapeutic radiographers due to be published May 2010)

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