Doc menu

4. Results from the survey

This chapter reports the outcomes of the survey. For clarity, the results are presented in six sub- sections:

Section one presents demographic information relating to the survey participants. 

Section two explores the experiences and attitudes of diagnostic radiographers in terms of the three key aims of the study: expectations of, opportunities for, and barriers to career development. Imaging sub-specialties are included.

Section three explores the experiences and attitudes of therapeutic radiographers in terms of the three key aims of the study; expectations of, opportunities for, and barriers to career development. Therapeutic sub-specialties are included.

Section four explores the experiences and attitudes of assistant practitioners and healthcare assistants in terms of the three key aims of the study: expectations of, opportunities for, and barriers to career development.

Section five considers the experiences and attitudes of the combined workforce by highlighting key trends related to time qualified.

Finally, section six covers the findings relating to Annex T, on-call arrangements and split contracts.

Initial analysis of the results revealed that there were many factors which influence staffs’ career progression. What might be considered a significant obstacle or incentive by diagnostic radiographers may not be viewed the same by therapeutic staff.  Similarly, those in lower pay bands or who qualified recently may have different expectations to those in higher pay bands or who qualified some time ago. For this reason, each set of data was analysed in order to examine whether there were any variations between staff sub-groups and to provide a comprehensive analysis of the outcomes of the survey.

4.1 Section 1: Demographic data

A total of 2373 participants took part in the survey. The majority (97%, n = 2299) were radiographers. Figures obtained from the NHS Information Centre (2009) and the Health Statistics & Analysis Unit of the Welsh Assembly Government (2009) indicated that there were 17003 radiographers working in the NHS in England and Wales in 2008.  This indicates that the present survey obtained a response rate of approximately 13%. Further breakdown of respondents indicates that 18% of the potential therapeutic radiography workforce and 12% of the potential workforce of diagnostic radiographers responded. Only 74 assistant practitioners and HCAs participated in the survey. This number accounted for just 3% of the survey and considerably less than 1% of the available workforce.  In view of the relatively low response rates of both radiographers and support workers, it is difficult to make generalisations from the study findings.  Nevertheless, the survey provided the largest sample of the radiographic workforce to date and provided good indicators of its experiences and career progression under AfC.

Four fifths of survey responses came from diagnostic imaging staff and the remaining 20% from those working within radiotherapy.  Data were obtained from participants working in every Strategic Health Authority region in England and Wales, every type of institution, and from all categories and across pay bands 2 to 9. The majority of staff worked in an institution located in a city or town, while only 5% described their location as rural. 

The demographics of the respondents to this survey were directly comparable with profiles obtained from the Society of Radiographers’ membership data base and from the NHS Information Centre. However, the data relating to staff banded at 8d or 9 must be treated with caution since very few individuals in these categories were present within the sample. Similarly, trends relating to ethnicity are hard to identify since only 8% of respondents were non-white British. However, a small proportion of non-white respondents was not unexpected since, in England, ethnic minorities account for only 12% of the radiographic workforce (NHS Information Centre 2009). 

Analyses revealed no significant differences between the types of centres in which the participants worked and their attitude towards AfC. Participants reported similar experiences and perceptions irrespective of whether they worked in, for example, a teaching hospital, foundation trust or cancer centre. Even though foundation trusts have the capacity to implement alternative employee banding, pay and benefits schemes there was no difference in distribution of pay bandings compared to other institutions. Foundation trust workers did not have different attitudes towards implementation of the career progression framework (CPF), types of opportunities or barriers to career development, or towards AfC. It should be noted that, while several participants in the survey commented that foundation trusts fuelled inequity (see comments below), statistical analysis of the survey results did not support this contention:

AfC was supposed to standardise the pay nationally, however, this has not happened, especially in foundation trusts where they appear to be able to cherry pick which bits of AfC they implement.
Diagnostic radiographer, band 5

Being a foundation trust is used often as an excuse not to follow some AfC terms and conditions. Diagnostic radiographer, band 6

4.2 Section 2: The diagnostic imaging workforce

A total of 1845 diagnostic radiographers responded. The majority worked in teaching hospitals or foundation trusts (Figure 1). Less than 1% were located in cancer centres. Females accounted for 84% of diagnostic radiographers in the study, with only 16% being male. 

Over half (52%) of diagnostic radiography respondents were aged between 41 and 55. The years during which respondents qualified ranged from 1958 to 2008, and many (56) who qualified during the 1960s were still practising (Figure 2).

When asked about their original qualification on entry to the profession, the majority (61%) of diagnostic radiographers who responded said that they held the Diploma of the College of Radiographers, with just over a third (37%) saying that they had a degree in radiography. A small number of participants chose not to answer (Figure 3).

Diagnostic radiographers had multiple duties and practised in a range of disciplines. The most common areas of practice are displayed in Figure 4.

4.2.1 Agenda for Change current pay banding

The majority (71%) of the diagnostic workforce who responded to this survey were in pay bands 6 and 7 (Figure 5).

More than 48% of diagnostic radiographers had been in their current pay band since the implementation of AfC terms and conditions and there was no difference identified either between males and females or between those employed with the different Strategic Health Authority regions in relation to AfC banding. The distribution was similar throughout England and Wales. The length of time which diagnostic and therapeutic staff had spent in their current pay bands were very similar although slightly fewer therapeutic radiographers (40% compared to 48%) had been in their current pay band since the implementation of AfC (Figure 6).

4.2.2 Expectations of diagnostic radiographers in terms of career progression under AfC

Radiographers who were employed prior to AfC were asked about their former Whitley Council grading and band to which they had expected to be assimilated under AfC terms and conditions. This information was then compared to the band on which they were placed following implementation of AfC.

From this study, there were 43 band 5 radiographers who were Whitley ‘radiographer’ grade prior to AfC (Figure 7).  The majority (n = 25, 58%) were placed where they expected to be. Just over a quarter (n = 12, 28%) were banded lower than they had anticipated. None found themselves on a higher band than expected, two were unsure and four eligible participants did not answer.

 There were 49 Whitley radiographer grade staff prior to AfC and who were subsequently assigned a band 6 (Figure 8). A large proportion (n = 22, 45%) were banded higher than they had originally anticipated, since they had anticipated gaining only a band 5 position. Less than a third of those who had ended up being assigned a band 6 had expected this band (n = 15, 31%). Four individuals had anticipated band 7. Very small numbers were unsure or chose not to answer.

Some 254 diagnostic radiographers responded who had been senior II grade prior to AfC and who were banded 6 following implementation (Figure 9). Here, the majority (n = 193, 76%) of this cohort were banded as they had anticipated.  Two per cent (n = 5) were banded higher since they had anticipated being assimilated to band 5. Only 9% (n = 23) anticipated band 7. Again, small numbers were unsure or did not answer.

Only a small number of the respondents (23) reported having been senior II diagnostic radiographers before AfC and banded 7 after implementation (Figure 10). Of these, 60% (n = 14) were banded as expected or higher than expected.  Only four (17%) had anticipated assimilation to band 8a. Five (22%) of this small cohort did not answer. 

There were 245 diagnostic radiography respondents who had been senior 1 grade prior to AfC and banded 6 following implementation (Figure 11). Of these, nearly half (n = 115, 47%) had expected to be banded higher, at 7 rather than 6. Just 37% (n = 91) had expected to receive the banding (band 6) they were allocated. Eleven per cent was unsure and five per cent did not answer.

Senior I diagnostic radiographers who were later banded 7 also responded to the survey in large numbers (299) as seen on Figure 12. Of these, the majority (n = 209, 70%) were placed in the band expected, while 8% (n = 24) were banded higher than expected and only 11% (n = 33) had anticipated a band 8a grade. Small numbers were unsure (3%) or did not answer (6%).

Only 38 participants were Whitley superintendent IV grade prior to AfC and then banded 7 after AfC (Figure 13).  Of these, 66% (n = 25) were banded as anticipated and only two had expected to be banded lower at 6. Eight had anticipated a band 8a assimilation. One or two were unsure or did not answer.

Thirteen superintendent IV diagnostic radiographers in the survey reported being banded at 6 after AfC. Of these, none had expected this and all had anticipated being assimilated onto a higher band: 11 had expected band 7, one an 8a assimilation and one was unsure. Conversely, five more superintendent IV staff reported being banded 8a of which just one had expected this, with the other four anticipating moving across to a lower band 7 grade. 

There were 128 superintendent III radiographer respondents who were banded 7 after AfC (Figure 14). Whilst half (n = 65, 51%) were banded as expected, over a third (n = 49, 38%) had anticipated gaining a band 8a. Only 5% were unsure and 6% did not answer.

On the other hand, 75% (n = 43) of superintendent III staff who were graded 8a were banded as expected or higher than expected; 63% (n = 36) had anticipated 8a and 12% (n = 7) had anticipated band 7. Only eight (14%) had expected to be assimilated to the higher band of 8b.  One or two respondents were unsure or did not answer (Figure 15). 

The figures obtained for superintendent II diagnostic radiographers were too small to support analysis but the data implied that banding was frequently lower than expected.

4.2.3 Appeals

Just over a third (34%) of diagnostic respondents had appealed against their banding compared to 37% of therapeutic staff. 

Appeals by diagnostic staff 

The data from diagnostic radiographers regarding appeals were analysed to identify any differences between regions, grades, and employment status (full time or part time).

There were differences in the number of appeals reported by respondents across regions. The highest numbers of appeals by diagnostic radiographers were reported by respondents in the East Midlands and Yorkshire and Humber Regions. Respondents in London and the West Midlands reported the least number of appeals (Figure 16).

4.2.4 Appeals in terms of staff grade

The responses indicate that overall a higher percentage of more senior grade staff appealed against their banding compared to those in lower grade posts (Figure 17), although it should be noted that whilst many former senior I staff claimed to have been banded lower than anticipated (as presented in Figure 11) they did not necessarily appeal.

4.2.5 Successful appeals in terms of staff grade

The analyses indicate that senior II and superintendent II staff were the staff groups which most frequently had their appeals upheld (Figure 18). The highest grades appealed more frequently, but they were, in general, less successful. However, numbers obtained for superintendent I and district superintendents were small.

4.2.6 Successful appeals for part time versus full time staff

Overall, just over a third of all staff appealed against their banding following implementation of AfC. There was very little difference between the proportions of full time and part time staff who reported having appealed against their AfC banding (see Table 3 below).  There were also negligible differences between the numbers of full time and part time diagnostic radiographers who reported that they were supported by their managers during the appeal process, although a few participants could not remember whether they were supported or not, hence the figures in Table 3 do not add up to 100%. However, a considerably higher proportion of full time staff had had their appeals upheld compared to part time staff (72% of fulltime staff compared to 65% of part time workers).

There were also strong correlations with those who were supported by their managers during their appeal and with those who had their appeals upheld. Of those who were not supported by their managers there was no obvious difference between those winning or losing their appeals. For both part time and full time staff three out of four (75%) not supported by their managers lost their appeals, 22% of full time staff won, and 19% of part time staff won. Again, figures do not add up to 100% since small numbers are still awaiting outcome of their appeals.

Table 3: Appeal outcomes for full time and part time diagnostic imaging staff

  Full time Part time
  Yes No Yes No
Did you appeal? 33% 67% 35% 65%
Were you supported by your manager? Yes No   Yes No  
  68% 18%   63% 16%  
And did you win? 72% 22%    65% 32%  

 

4.2.7 Perceived fairness of banding

Overall, 44% of all respondents believed that the banding they had been allocated had been fair and reflected their level of responsibility. Analyses revealed some differences in the opinions of different sub-groups within the diagnostic workforce. Whilst half of white radiographers (50%) felt their band reflected fairly their responsibility only 29% of radiographers from ethnic backgrounds felt this was the case (Figure 19).  

There were also differences in perception of fairness depending on whether the CPF was in place at their site (Figure 20) and depending on their banding (fig 21). Only 13% of diagnostic radiographers reported that the CPF was fully implemented where they worked, with another 27% saying it was in place partially. However, where the CPF was implemented, radiographers were more likely to think their band was fair. Where the CPF was not in place radiographers were far more likely to be dissatisfied with their banding.

The majority of the higher band staff felt their banding was fair.  Satisfaction increased steadily with each successive level except for those respondents banded at 8b (Figure 21). Here 52% felt their band was fair, 39% felt it was not and 9% were unsure.

The most common reasons identified by both diagnostic and therapeutic staff for feeling that their band did not reflect their level of responsibility were: a belief that their level of autonomy and decision-making exceeded their banding, discrepancies and inequity between trusts in job matching, and that their experience and/or qualifications were not sufficiently recognised. Issues relating to senior I and II staff being grouped together in band 6 were also identified by many respondents as being unfair. The themes are summarised in Table 4.

Common reasons why participants felt their banding was unfair Number of respondents
Lack of recognition of autonomy and high level decision-making 439
Inequity between roles 108
Lack of recognition of experience 67
Lack of recognition of qualifications 61
Stuck' at top of pay band with nowhere to progress 42
Band 6 is too broad and incorporates both senior I and II grades 37
Other 23

4.2.8 Career Development Opportunities for diagnostic radiographers

This section of the survey began by exploring radiographers’ experience of appraisals and the NHS Knowledge and Skills Framework since these form a key element of AfC and are the basis for identifying career development opportunities. 

4.2.9 Appraisals

The majority of diagnostic radiographers who answered this section of the survey had had an appraisal in the last year (Figure 22). There was no difference between full-time and part-time staff in the frequency with which their appraisals were carried out.

Diagnostic radiographers were, however, more likely to have had a recent appraisal in centres where the CPF was in place (68% compared to 52%)(Figure 23). In support of this finding, twice as many radiographers claimed not to have had an appraisal since the implementation of AfC in locations where the CPF was not integrated (20% compared to 9%). Almost a third (30%) of diagnostic radiographers did not know whether the CPF was in place at their site or not.

For those who had not had an appraisal since the inception of AfC a number of reasons were given and were similar regardless of the professional background of the radiographer (Figure 24). The most frequently cited reasons were that appraisals were not taken seriously in their department and that their managers were not interested in completing them.

4.2.10 The use of the NHS Knowledge and Skills Framework

The majority (64%) of diagnostic radiographers were aware of which KSF competencies were needed to carry out the tasks expected in their role (Figure 25). The majority (60%) also reported that the KSF was used during their last appraisal although a significant proportion (30%) claimed it was not and 10% were unsure one way or the other (Figure 26).

There was no significant difference between respondents of different ages in terms of their reports of whether the KSF had been applied in formulating their last personal development plan. There were differences, however, in the application of the KSF in relation to their AfC band.  Generally, the higher the band the less often the KSF was applied during their appraisal. Equally, as the banding increased, there was less uncertainty about whether the KSF had been used (Figure 27). More of the respondents from lower bands were unsure regarding whether the KSF had been used.

In places where the CPF is in place, either totally or partially, the KSF is more likely to be used at appraisals for formulating career development goals (Figure 28). 

4.2.11 Opportunities identified at appraisal

Just over half (52%) of all diagnostic radiography respondents reported having had career development opportunities identified at their last appraisal.  There was minimal difference in the extent to which identification of career development opportunities was reported by female or male diagnostic radiographers, with some 47% of males and 53% of females agreeing that career development opportunities had been identified for them at their last appraisal. Similar proportions of part time and full time members of staff also reported having had career development opportunities suggested for them at appraisal.

There were, however, more career development opportunities identified for younger diagnostic radiographers compared to those in older age groups (Figure 29). Three out of four staff under 26 years old have had opportunities identified for them at appraisal, however, this falls to just one in three for the over 55s. There was no significant difference between age groups, however, when assessing the type of career development opportunities offered, whether they were what the respondent had wished for, and whether they were achieved during the following year. Furthermore, there was no correlation between proportion of respondents being denied access to development opportunities and their age. 

When career development opportunities were measured in terms of AfC banding, a slightly higher proportion of radiographers in the senior bands stated that opportunities were identified at appraisal compared to those in the lower bands (Figure 30).  (Average = 52%).

There were some small differences depending on area of practice (Table 5). For the full table comparing experiences of the specialties see Appendix 2.

Specialty

(numbers of individuals)

Full survey

(n = 2373)

MRI

(n = 223)

Ultrasound

(n = 307)

Mammography

(n = 247)

RNI

(n = 73)

Diagnostic manager

(n = 251)

OPPORTUNITIES
Career development opportunities were identified at my last appraisal
53% 57% 49% 58% 48% 56%
EXPECTATIONS
I believe these identified opportunities may aid my progression to the next band
21% 17% 13% 29% 17% 19%
These development opportunities are the ones I wanted and will support my long term goals 54% 54% 57% 60% 52% 59%

4.2.12 Types of career development opportunities

Diagnostic radiographers described a vast range of career development opportunities which were identified for them at their appraisal.  More than a quarter of diagnostic respondents also said that career development opportunities were identified all year round, not just at the annual appraisal. There was no difference between the types of opportunities identified either at, or outside, appraisal. These opportunities spanned the full spectrum of activities including formal academic courses, reporting, study days, and the acquisition of new clinical or managerial skills. 

Career development opportunities were more likely to be identified in departments which recognised the CPF (Table 6).

Combined responses from the survey Is the CPF in place where you work?
Yes fully No
Career development opportunities were identified at my last appraisal 61% 47%
No career development opportunities were identified at my last appraisal 39% 53%

4.2.13 Opportunities in terms of facilitating progression

However, few of the respondents thought that these opportunities would aid their progression into the next pay band. Overall, only one in five diagnostic radiographers (19%) thought they might but two thirds (66%) did not anticipate being up-graded. Out of the various staff groups, mammographers (29%) and full time radiographers (28%) were slightly more optimistic that this would be the case, but only half this proportion (14%) of part time staff felt the same (Figure 31).

In terms of banding, diagnostic radiographers in band 5 were the most optimistic about their prospects for progression following development. The more senior staff members had lower expectations of progression (Figure 32).

Common reasons why respondents thought the opportunities identified at appraisal were unlikely to facilitate progression were the same for both diagnostic and therapeutic radiographers and were most frequently related to the fact that they would gain access to the next band only if a vacancy arose and not as a consequence of acquiring additional skills. In some instances, however, staff reported that progression was limited due to trust strategies. Responses are summarised in Figure 33 and typical examples are outlined as follows: 

All the superintendents have been at the department for years and there are simply no jobs to apply for. Therapeutic radiographer, band 6

As far as I understand it, my progression to band 7 will involve the retirement of the current post-holder. Diagnostic radiographer, band 6

Promotion to next band is only possible if post becomes vacant. Diagnostic radiographer, band 6

Implementation of AfC in the Trust has focused on limiting or avoiding any upward movement in staff development or remuneration. Diagnostic radiographer, band 8b

However there were some examples of more optimistic comments from radiographers who thought their career development opportunities would aid progression to the next band, such as the following:

Doing a PgD in clinical reporting so once finished should be band 7. Diagnostic radiographer, band 6

Training in CT and MRI will aid in progression to a band 6.  Diagnostic radiographer, band 5

Satisfaction in the type of opportunities identified increased steadily with the banding of the respondent. The majority of those in the higher bands felt strongly that the opportunities were what they personally wanted and would support their long term career plans regardless of whether they enabled them to advance into the next pay band or not. In fact, radiographers of all bands stated frequently that they still wanted access to development opportunities regardless of whether they would facilitate a rise to a higher band. 

Uncertainty about their career future seemed to decrease in the higher bands. The percentage of radiographers who felt that the opportunities were not what they personally wanted remained fairly constant (approximately 28%) across all the AfC bandings 5 to 8c (Figure 34).

Many radiographers provided further information on how they felt about the career development opportunities identified at appraisal. When explaining whether the opportunities were what they personally wanted, a number of both positive and negative common themes emerged (Figure 35). Others were more pragmatic in their stance, believing that patient services will continue to drive and shape career development opportunities regardless of their own personal desires.

Service needs have driven role extension. Diagnostic radiographer, band 7

Of the diagnostic specialties, more mammographers (60%) reported that the development opportunities were what they wanted and would support their long term career plans, closely followed by managers of diagnostic departments (59%). Radionuclide imaging radiographers were least satisfied at 52% (Table 5).

4.2.14 Continuing Professional Development (CPD) activity

More than three quarters (78%) of diagnostic radiographers recognised that they had CPD opportunities in the work place, and these activities were wide-ranging and varied (Figure 36).  Study days and in-house meetings were most frequently cited by respondents. Conducting original research was the least frequently cited CPD activity. Although at least 109 diagnostic radiographers claimed to be participating in original studies, few (35) cited research as one of their main duties (Figure 4).

On average, only 13% of respondents claimed to receive any regular protected study time.  From our survey, departments in the South Central SHA are most likely to offer protected CPD time, with those in London and the Midlands least likely to (Figure 37).

There was very little difference between allocation of protected study time and radiographers’ banding.  However, band 8a radiographers were slightly more likely to enjoy regular CPD time (24 out of 136) whereas, although the sample size was small at a total of just 16, none of the band 8c respondents claimed to be given any time at all (Figure 38).

4.2.15 Barriers to career development

 The majority (60%) of diagnostic radiographers felt that they had encountered barriers which hindered their career progression (Figure 39). The percentage among therapeutic radiographers was less (52%), but higher (68%) among assistant practitioners and HCAs.

Perhaps unsurprisingly, there was a clear trend indicating that those already in higher bands felt that they had encountered fewer barriers (Figure 40). This trend was maintained irrespective of whether the radiographer was full time or part time indicating that, in general, part time staff did not feel disadvantaged in this area when it came to career progression. However, it should be noted that there were no part time participants in the survey who were banded 8c.

Of the diagnostic specialties, radiographers performing radionuclide imaging felt they had encountered barriers most frequently (45%), although of the remaining specialisms which were assessed separately from the main survey approximately one third reported encountering barriers (Appendix 2).

The most common reasons offered by all staff when asked to explain barriers were operational issues including under-staffing and a continuous drive to meet government targets, poor support from managers and peers, and a lack of available funding even if staffing levels were high enough to allow time off (Figure 41). Radiologists were also still perceived as a hindrance to advancement by some diagnostic radiographers.

I went through a gruelling banding appeal and successfully got my banding changed from 6 to 7 only to have my manager veto the change and have me put back to band 6. Diagnostic radiographer, band 6

We have to meet targets and all our time is taken up with scanning patients.  Diagnostic radiographer, band 7

Management supportive but no money and short staffed. Therapeutic radiographer, band 8a

No money or time off for anything other than mandatory training. Barriers were not around when I took my GI reporting course 7-8 years ago, but they are now. Diagnostic radiographer, band 6

Shortage of staff and meeting targets mean that the first thing to be ignored is CPD needs. Also there has been no identification of a radiographer consultant post. Management still don't think there is a need to move somebody into a more advanced clinical role. Diagnostic radiographer, band 7

Radiologists are still very protective of their role and no consultant radiographers are employed in our trust. Diagnostic radiographer, band 7

4.2.16 Incentives

Participants in the survey were asked if anything had helped their career progression, and the views of the majority, irrespective of whether they were therapeutic or diagnostic radiographers or assistant practitioners, were that nothing had assisted them.  Only one third felt that some factor had helped their career progression, while two-thirds felt they had not had any help.  Of the three cohorts, diagnostic radiographers were the most likely (71%) to say that they had found nothing helpful during their career progression (Figure 42).

Once again, in terms of banding, and in support of the evidence gained in the section that explored barriers to progression, more of those in the higher bands reported that they recognised that some factor during their career had assisted their progression (Figure 43)

Those who said that something had helped their career progression were asked for further details. The most frequently cited responses from all staff bands when describing factors which they believed had helped them were: receiving support from managers and colleagues, self determination and self motivation, supportive radiologists in imaging departments, and changes in trust or department structures which had enabled promotion or progression (Figure 44). 

Supportive radiologists and colleagues. Diagnostic radiographer, band 8a

I have a supportive manager who believes in succession planning. Diagnostic radiographer, band 8a

Self motivation to be the best at what I do. To ensure the service users get the best possible service. Diagnostic radiographer, band 6

Encouragement from head of department. Therapeutic radiographer, band 6

4.2.17 Morale

To gain a holistic view of diagnostic radiographers’ attitudes towards AfC and their career progression, participants were asked if their morale had changed since the implementation of AfC.  The majority, some 62%, said it was lower (Figure 45).  Among the specialties, MRI radiographers were most negative, with 72% reporting a reduction in morale, followed closely by RNI radiographers at 67%. Respondents were able to give further details of the reasons for their view:

The way in which AfC rewards service managers is appalling - and needs to be addressed. I have made the decision to leave the profession after many years as a MRI superintendent. MRI radiographer, band 6

I was told that with AfC linked to KSF it would be possible to advance beyond the top of band 6 to band 7 by recognition of academic qualification and not just in a managerial role. My radionuclide imaging diploma has been ignored in the AfC process but I am expected to know "everything" when in the work place. RNI radiographer, band 6

I'm in contact with radiographers at other hospitals. London hospitals place radiographers with much less knowledge, skills and responsibilities at the same or higher band than myself. I've seen those role profiles and there is no evidence to support their bandings. There's little consistency between hospitals, even hospitals only few miles down the road. RNI radiographer, band 7

Over a third (35%) of respondents felt their morale had been unaffected by AfC, and there was a general trend towards those in higher bands believing their morale had increased under AfC.  Equally, and in support of this finding, the higher the band, the less negative in general were the attitudes reported towards AfC.  Noticeably, it was those in bands 6 and 7 who most frequently reported that their morale had been lowered by AfC (Figure 46).

I have now reached the top of my band with nowhere to go. Inexperienced staff are on the same pay as me with no responsibilities. Diagnostic radiographer, band 6

I went straight onto the top of Band 7 through protected pay and I will probably be there for the next 20 years. Diagnostic radiographer, band 7

AfC has improved my financial position, but not my career progression. Therapeutic radiographer, band 8a

When asked if they felt AfC had assisted with their career progression, very few staff from any sectors felt it had. However, a large proportion felt it had had no influence either way (Figure 47)

Common reasons cited by staff when justifying their opinion on AfC included poor implemetation, issues related to band 6 being too broad and the view that it should not contain both senior I and II staff, and a belief  that AfC was designed to save money and not to facilitate career progression (Figure 48).

AfC has condensed the grades.  Now there is no distinction between senior 2 and senior 1 grades, so what is the point in completing further post grad qualifications?  Diagnostic radiographer, band 6

Banding Senior 1s & Senior 2s together on band 6 has been a retrograde step for the profession & we are back where we were in the 1970s when it was radiographer, senior & superintendent grades. Diagnostic radiographer, band 6

From my perspective it was used as a cost cutting exercise by my trust. Diagnostic radiographer, band 6

I have no reason to apply for the current lead interventional post as that is also a band 6 post. More responsibility with no increase in pay. Diagnostic radiographer, band 6

There were however some comments from respondents who felt that AfC had helped their career progression:

It gave me an unexpected band 8. Diagnostic radiographer, band 8a

I don't believe I would be reporting if AfC hadn't come in. Diagnostic radiographer, band 7

4.2.18 Voting intentions

The majority (73%) of diagnostic radiographers would vote against AfC if given the chance to vote today (Figure 49). However, when responses were analysed in terms of staff bands it was clear that diagnostic radiographers in higher bands were less negative towards the AfC initiative (Figure 50). They were more likely now to vote in favour of AfC, although this still only amounts to a third of respondents in band 8c, the band with the largest proportion willing to vote in favour now.

4.2.19 Summary of attitudes and experiences of radiographers in terms of sub-specialties

Diagnostic radiographers’ responses were analysed in terms of whether their specialist area of practice had influenced their experience of AfC compared to the main survey results. Further data is presented in Appendix 2. Those in MRI, ultrasound and RNI had the lowest expectations in terms of career progression. In particular, almost half (45%) of all those practising RNI felt that had experienced barriers to career progression. Staff in mammography were the most optimistic regarding their progression and fewer numbrs of these individuals would vote against AfC given the chance. There were no large differences between the groups when it came to deciding if the opportunities identified at appraisal were the ones wanted by the appraisees. The majority of all the groups said that these opportunities were wanted and would be taken to support long term goals even if they were unlikely to facilitate progression to the next pay band.

4.3 Section 3: The radiotherapy workforce

A total of 441 therapeutic radiographers responded. As with diagnostic radiographers, the majority of therapeutic radiographers worked in teaching hospitals or foundation trusts (Figure 51). Around 9% were located in cancer centres. Females accounted for 87% of therapeutic radiographers participating in the study, with only 13% being male.

The age distribution of the therapeutic workforce differed from that of the diagnostic workforce in that it was predominantly younger, with proportionally more staff in their late twenties and fewer over the age of 50 (Figure 52). No male therapeutic radiographers above the age of 50 responded to the survey (Figure 53). The year of qualification ranged from 1964 to 2008.

When asked about their original qualification on entry to the profession, virtually equal numbers of therapeutic radiographers who responded held either the Bachelor of Science degree (48%) or the Diploma of the College of Radiographers (47%). Just 2% were dual qualified in both imaging and radiotherapy (Figure 54).

Therapeutic radiographers had multiple duties and practised in a range of disciplines. The most common areas of practice are displayed in Figure 55.

4.3.1 Agenda for Change current banding

The majority of the therapeutic workforce who responded to this survey were in bands 6 and 7 (Figure 56). There was no significant difference identified between males and females or between the Strategic Health Authority regions in relation to AfC banding profile. The spread of banding was uniform throughout England and Wales. 

Slightly fewer therapeutic radiographers (40%) compared with diagnostic radiographers (48%) had been in their current pay band since the implementation of AfC (Figure 57).

4.3.2 Expectations of therapeutic radiographers in terms of progression under AfC

Therapeutic radiographers who were employed prior to AfC were asked about their Whitley Council grading and to what band they had expected to be placed on under AfC terms and conditions. This information was then compared with where they were actually placed after implementation of AfC.

Only 13 therapeutic radiographers responded to this survey who were ‘radiographer’ grade prior to AfC and therefore generalisations cannot be made about their experiences. Numbers were also very low for superintendent IV and superintendent II therapeutic radiographers. Reasonable sample sizes were obtained, however, for staff graded as senior II, senior I and superintendent III prior to AfC.

There were 49 senior II therapeutic radiographers who were banded 6 after AfC. The majority (n = 39, 80%) had been banded 6 in line with their expectations. Only two had been banded 7 and they had expected to be assimilated to band 6, therefore their expectations had been exceeded (Figure 58).

Fifty therapeutic radiographers who were senior 1 grade prior to AfC and banded 6 after AfC responded to the survey (Figure 59).  All fifty answered all the questions relating to expectations. Amongst this group, the great majority (n = 39, 78%) had been banded to a lower band than anticipated. Just 16% had been banded in line with their expectations and three were unsure. 

Forty-one senior I therapeutic radiographers later banded 7 under AfC responded to the survey (Figure 60). Amongst this group, 78% (n = 32) were banded as they had anticipated. Only six were assimilated lower at band 6. One or two were unsure or chose not to answer.

The figures obtained for superintendent III therapeutic radiographers were low but indicated strongly that, of those who were banded 7, the majority had been expecting assimilation to band 8a (Figure 61). Of those banded 8a from the start, the majority were anticipating this, with just 10% expecting only band 7 (Figure 62).

Figures obtained for superintendent II therapeutic radiographers were too small for analysis (n = 26) but, of those who responded, banding was mainly lower than expected.

4.3.3 Appeals

The data from the therapeutic radiographers regarding appeals showed that 37% of the therapeutic workforce underwent appeals, which is slightly higher than the 34% of diagnostic radiographers who reported doing so. 

Appeals by therapeutic staff

The data were analysed to identify any differences between regions, grades, and employment status (full time or part time).
The highest numbers of appeals were reported by therapeutic radiographer respondents in the Yorkshire and Humber, North West and East of England regions. Respondents in the South Central and South East Coast areas experienced the least number of appeals (Figure 63).

4.3.3.1 Appeals in terms of staff grade

The responses of the therapeutic radiographers in terms of number of appeals differed from those of the diagnositic radiographers.  It should be noted that the number of respondents at the district grade to this survey were low (n = 5), but most appealed.  Around half of the senior I and superintendent II grades appealed also (Figure 64).

4.3.3.2 Successful appeals in terms of staff grade

The survey analyses indicated that all radiographer and superintendent I appeals were successful, although these two groups appealed the least frequently. Most grades were successful in having the majority of their appeals upheld with the exception of senior I staff where only one in four was successful (Figure 65).

4.3.3.3 Successful appeals for part time versus full time staff

In contrast to the findings for the diagnostic respondents, there were large differences between the numbers of full time and part time staff who appealed against their AfC banding.  Only one in three full time staff appealed compared to half of all part time staff.  There were also considerably more examples of full time staff having their appeal supported by their managers compared to part time staff, although a few participants could not remember whether they were supported or not, hence the figures in Table 7 do not add up to 100%. A considerably higher proportion of full time staff had their appeals upheld compared to part time staff (74% full time compared to only 63% of part time) and these findings mirror the reports given by the diagnostic radiographer participants. An important point to note is that, of those who were not supported by their managers, a greater proportion of part time staff (91%) went on to lose their appeals compared to 67% of the full time staff who were not supported.

Table 7: Appeal outcomes for full time and part time therapeutic staff

  Full time Part time
  Yes No Yes No
Did you appeal? 33% 67% 50% 50%
Were you supported by your manager? Yes No   Yes No  
  77% 14%   57% 23%  
And did you win? 74% 21%    63% 37%  

4.3.4 Perceived fairness of banding

In terms of ethnicity, the majority of white and Asian therapeutic radiographers felt their band was fair (Figure 66). There were no black therapeutic radiographers who responded to the survey. Therapeutic radiographers from other ethnic backgrounds seemed less satisfied with their banding but numbers of respondents were very small and are not necessarily reflective of other members of this group (n = 25).

There were also differences in perception of fairness between those in different pay bands, and between those in organisations in which the CPF was in place or not (Figure 67).  Far more respondents at sites where the CPF was not used reported being dissatisfied with their banding.  However, only 15% of therapeutic radiographers stated that the CPF was fully implemented where they worked, although another 38% claimed it was partially in place. These percentages were higher than those reported by diagnostic staff (§ 4.2.9).

The majority of the higher band therapeutic staff felt that the band that they had been assigned was fair.  In keeping with the findings for diagnostic staff, satisfaction was highest amongst those in band 8 categories. Therapeutic staff banded 6 or 7 were least likely to feel that their band was fair in terms of responsibility (Figure 68).

The four most common reasons identified by both diagnostic and therapeutic staff for feeling that their band did not reflect their level of responsibility included; a belief that their level of autonomy and decision-making exceeded their banding, discrepancies and inequity between trusts in job matching, and that their experience and/or qualifications were not recognised.  In particular, issues relating to senior I and II staff being assigned to the same band (Band 6) were cited frequently.  Some key comments are listed below and the main themes to emerge are summarised in Table 8

I feel there is less recognition of achievement under AFCTherapeutic radiographer, band 7

Under valued, under appreciated, you have to fight for everything. Therapeutic radiographer, band 7

Stuck at top of band. No incentive to progress. Experience not recognised.
Diagnostic radiographer, band 5

Table 8: Common reasons why diagnostic and therapeutic respondents collectively felt that their AfC pay band was unfair

Common reasons why participants felt their banding was unfair Number of respondents
Lack of recognition of autonomy and high level decision-making 439
Inequity between roles 108
Lack of recognition of experience 67
Lack of recognition of qualifications 61
Stuck' at top of pay band with nowhere to progress 42
Band 6 is too broad and incorporates both senior I and II grades 37
Other 23

4.3.5 Career Development Opportunities for therapeutic radiographers

This section of the survey began by exploring therapeutic radiographers’ experience of appraisals and the NHS KSF since these form a key element of AfC and are the basis for identifying career development opportunities.

4.3.5.1 Appraisals

The majority of therapeutic radiographers who answered this section of the survey had had an appraisal in the last year (Figure 69).  There was no difference between full time and part time staff in terms of how frequently their appraisals were carried out.  Overall, a much higher percentage of therapeutic radiographers (72%) had had recent appraisals compared to diagnostic staff (59%). 

Therapeutic radiographers were more likely to have had a recent appraisal in centres where the CPF was fully in place (83% compared to 69%), although high proportions of therapeutic radiographers in all sites reported having had an appraisal in the recent past (Figure 70). There was no match between therapeutic radiographers who claimed not to have had an appraisal since the implementation of AfC and whether the CPF was integrated or not. One in five (20%) therapeutic radiographers did not know whether the CPF was in place at their site or not compared with one in three diagnostic radiographers.

For those who had not had an appraisal since the inception of AfC a number of reasons were given, and were similar irrespective of the professional background of the radiographer (Figure 71).  The most frequently cited reason was that appraisals were not taken seriously in their department and that their managers were not interested in completing them.
 

4.3.6 The use of the NHS Knowledge and Skills Framework

The majority (76%) of therapeutic radiographers were aware of which KSF competencies were needed to carry out tasks expected in their role (Figure 72).

The majority (61%) also reported that the KSF was used during their last appraisal, although a significant proportion (36%) claimed it was not and a small proportion of participants (3%) were unsure one way or the other (Figure 73).

There was no difference between respondents of different ages in terms of whether the KSF had been applied in formulating their last personal development plan. There were differences, however, in the application of the KSF in relation to their AfC band.  In general, the KSF was applied more frequently to appraisals of the lower bands. This pattern was reversed for band 8c respondents; although numbers were small for this group, it should be noted that the same pattern was seen amongst the higher band diagnostic respondents.  Equally, and again in keeping with the patterns seen for diagnostic radiographers, as the banding increased there was less uncertainty about whether the KSF had been used or not at their appraisal (Figure 74). Lower band staff were most unsure regarding the KSF.

At institutions where the CPF is in place, either totally or partially, the KSF was more likely to be used at appraisals for formulating career development goals for therapeutic radiographers (Figure 75)

4.3.7 Opportunities identified at appraisal

Over half (56%) of all therapeutic radiography respondents had career development opportunities identified at their last appraisal.  There was no difference in the proportions of females and males reporting that career development opportunities had been identified, with some 58% of males and 56% of females indicating that career development opportunities had been identified for them at their last appraisal. There were small differences, however, between part-time and full time members of staff in that fewer (52%) part time therapeutic radiographers claimed to have had career development opportunities suggested to them compared to 59% of full time staff.

Unlike the case with diagnostic radiographers, there was no correlation between the identification of career development opportunities and age for therapeutic radiographers (Figure 76).  Nor were there any differences found when assessing the type of career development opportunities, whether they were what the candidate wished for, and whether they were accessed and achieved during the ensuing year.

No trends were identified when career development opportunities for therapeutic radiographers were analysed in terms of AfC pay banding (Figure 77). Amongst diagnostic radiography respondents, however, those in higher bands stated more frequently that opportunities were identified for them at appraisal.

There were some small differences depending on area of practice.  Managers of therapeutic departments were less likely to have development opportunities identified at apparaisal compared to average and compared to other specialist areas of practice (Table 9). Therapeutic staff in specialist areas appeared to be generally better off compared to the main survey results, since not only did they more frequently report having had career development opportunities identified at appraisal, but in addition that these were the opportunities they wanted to support their long term career plans (Table 9). For the full table see Appendix 2.

Table 9: Therapeutic specialties in terms of career development opportunities and expectations

Specialty

(numbers of individuals)

Full survey

(n = 2373)

Pre-treatment simulation

(n = 124)

Treatment verification

(n = 156)

Therapeutic manager

(n = 132)

OPPORTUNITIES
Career development opportunities have been identified at my last appraisal
53% 68% 59% 50%
EXPECTATIONS
I believe these identified opportunities may aid my progression to the next band
21% 29% 32% 23%
These development opportunities are the ones I wanted and will support my long term goals 54% 66% 59% 59%

4.3.8 Types of career development opportunities

Therapeutic radiographers described a vast range of career development opportunities which were identified at their appraisal. Also, there were 37% of respondents who said that career development opportunities were identified all year round and not just at the annual appraisal. There was no difference between the types of opportunities identified either at, or outside, appraisal. These opportunities spanned the full spectrum of activities including formal academic courses, study days, counselling, and the acquisition of new clinical or managerial skills. Career development opportunities were more likely to be identified in departments which recognised the CPF (Table 10).

Table 10: Comparison of frequency of career development opportunities offered at sites with or without the CPF

Combined responses from the survey Is the CPF in place where you work?
Yes fully No
Career development opportunities were identified at my last appraisal 61% 47%
No career development opportunities were identified at my last appraisal 39% 53%

4.3.9 Opportunities identified at appraisal

Few therapeutic radiographers thought that opportunities for developing their career would aid their progression into the next pay band. Overall, just over one in four (26%) thought they might, but 59% did not anticipate being up-graded. Full time radiographers (36%) were slightly more optimistic than part time staff (25%) (Figure 78). Those in specialist areas like pre-treatment simulation and treatment verification were also more positive (Table 9)

In terms of banding, therapeutic radiographers in band 5 were the most optimistic that the opportunities identified may aid their progression to the next pay band. In general, staff in higher bands had lower expectations of progression and those banded 8c were unanimous in believing that they would not progress to 8d (Figure 79).

Common reasons why respondents thought the opportunities identified at appraisal were unlikely to facilitate progression were the same for both diagnostic and therapeutic radiographers. Most frequently they related to the fact that they would gain access to the next band only if a vacancy arose and not as a consequence of acquiring additional skills. Radiographers stated repeatedly, however, that they still wanted access to the opportunities regardless of whether they would facilitate a rise to a higher band. Responses are summarised in Figure 80.

Satisfaction in the type of opportunities identified peaked at band 8a for therapeutic staff. As with diagnostic radiographers, those who were most unsure were in the lower bands. The percentage of radiographers who felt that the opportunities were not what they personally wanted remained fairly constant (approximately 26%) across the AfC bandings 5 to 7 and steadily increased through the band 8 divisions (Figure 81).

Many radiographers provided further relevant information on how they felt about the career development opportunities identified at appraisal.  When explaining whether the opportunities were what they personally wanted, a number of both positive and negative common themes emerged (Figure 82). Others were pragmatic in their stance believing that patient services will drive and shape career development opportunities regardless of their own personal desires.

People’s progression is at the mercy of the needs of the service.
Therapeutic radiographer, band 6

They were objectives that needed to be done to benefit the department. Therapeutic radiographer, band 6

It involves waiting for the opportunity of a possible job to be released which I will then have to apply for. Therapeutic radiographer, band 6

As no money available and no movement between bands it’s difficult for anything to support long term career plans. Therapeutic radiographer, band 6

4.3.10 Continuing Professional Development (CPD) activity

Almost nine out of ten (88%) of therapeutic radiographers recognised that they had CPD opportunities in the work place, and these activities were wide-ranging and varied (Figure 83). In-house meetings and study days were most frequently cited by participants, and these were identical to the diagnostic radiographers’ responses. Conducting original research was, again, the least frequently cited CPD activity although proportionally more radiotherapy staff (58 = 13%) claimed to be participating in original studies compared to 109 (6%) diagnostic radiographers.

More than one in five (22%) therapeutic radiographers claimed to receive some regular protected study time every month. The survey data suggest that departments in Wales were most likely to offer protected study time while departments in the South West and South East Coast SHAs were least likely to (Figure 84).

There was very little difference between allocation of protected study time and therapeutic radiographers’ banding (Figure 85).  Staff from all bandings reported receiving study time.

4.3.11 Barriers to career development

Just over half (52%) of therapeutic radiographers felt that they had encountered barriers which hindered their career progression. Figure 86 shows the figures for therapeutic and diagnostic radiographers as well as for assistant practitioners and support workers. The percentage amongst diagnostic radiographers was higher (60%) than for therapeutic radiographers, but not as high as amongst assistant practitioners and HCAs (68%).

When barriers in relation to staff bands were considered, with the exception of band 5 therapeutic staff there was a clear trend indicating that those in progressively higher bands felt that they had encountered fewer barriers (Figure 87). This trend was maintained irrespective of whether the radiographer was full time or part time indicating that part time staff did not feel disadvantaged in this area when it came to career progression.

The most common reasons offered by all staff when asked to explain barriers were operational issues (including under-staffing and a continuous drive to meet government targets), poor support from managers and peers, and a lack of available funding even if staffing levels are high enough to allow time off (Figure 88). 

The main barrier to my career progression has been lack of qualified and trained staff to cover my role if I am not there. Therapeutic radiographer, band 8a

The main barrier is the fact that I have been demoted to a Band 5 from a Senior II and don’t want to take on any extra responsibility for less pay e.g cannulation. Diagnostic radiographer, band 5

I believe a golden opportunity to recognise and reward people properly has been missed. AFC is now a barrier that Trust boards can hide behind to stop paying fairly for the work they get out of people. Diagnostic radiographer, band 7

4.3.12 Incentives

Approximately two thirds of all respondents, regardless of whether they were therapeutic or diagnostic radiographers, assistant practitioners or HCAs, felt that nothing had assisted their career progress. Just one third felt they had experienced support of any kind. 

Looking in detail in responses across pay bands, with the exception of band 8a, the majority of therapeutic radiographers did not feel that anything had assisted their career progression (Figure 89). This differed from the responses of diagnostic radiographers, where there was a trend among the higher bands recognising more frequently factors assisting their career progression.

The most frequently-cited responses from all staff grades when describing factors which they believed had helped them included good support from managers and colleagues, self determination and self motivation, and changes in trust or department structures which had enabled promotion or progression (Figure 90). Oncologists were cited infrequently in terms of either helping or hindering career progression. 

Being motivated and keen to progress in my career myself. Therapeutic radiographer, band 6

Inspirational line manager in previous workplace who encouraged my development towards service management. Therapeutic radiographer, band 8b

The implementation of the 4 tier structure, and support of clinical and surgical colleagues in supporting service redesign. Therapeutic radiographer, band 8b

The opportunity to set up a part time lymphoedema service supported and part funded by my line manager. Therapeutic radiographer, band 7

High level of support from the oncologists.
Therapeutic radiographer, band 8b 

4.3.13 Morale

To gain a holistic view of therapeutic radiographers’ attitudes towards AfC and their career progression, participants were asked if their morale had changed since the implementation of AfC. The majority of therapeutic radiographers said that it was lower (Figure 91). Amongst the specialties, those in pre-treatment simulation were most negative with 62% claiming a reduction in morale and only 1% felt it had increased. Managers of therapeutic radiographers most frequently reported an increase in morale but at just 7% this still accounts only for a minority of the therapeutic workforce.

Just under half (43%) of respondents felt that their morale had been unaffected by AfC, and among the remaining respondents there was a general trend towards those in higher bands believing their morale had increased under AfC. Equally, and in support of this finding, the higher the band the less negative many felt towards AfC. Noticeably, those in bands 6 and 7 felt most frequently that their morale had been lowered by AfC (Figure 92). The result for band 8c staff should be treated with caution, due to a small sample size of four respondents.

When participants were asked if they felt AfC had assisted with their career progression, very few staff from any sectors felt it had.  However, large numbers felt it had had no influence either way. Almost equal numbers felt it had had a negative impact on their career development (Figure 93).

Common reasons cited by staff when justifying their opinion on AfC included poor implemetation, issues related to band 6 being too broad and the view that it should not contain senior I and II staff, and a belief  that AfC was designed to save money and not facilitate career progression (Figure 94).

Trusts should be named and shamed for the disgusting manner in which they have treated staff and their on going lack of commitment to KSF. Diagnostic radiographer, band 5

I am getting paid less to do the same job as a lead radiographer in another hospital just because we were banded badly. Therapeutic radiographer, band 6

I don't think that a career structure exists within radiotherapy anymore. Radiographers are applying for band 6 post 18 months after graduation and then potentially they will remain there until ready for advanced practice or managerial posts (the senior 2 and senior 1 posts are both banded at 6 in our Trust). Therapeutic radiographer, band 7

Examples from participants who feel AfC had assisted their progression are as follows:

Yes [it has helped] because it provides an opportunity to develop clinically and get some recognition and reward for it. The problem is that there is inconsistency between Trusts and it has failed to deliver some of the things it was supposed to. Therapeutic radiographer, band 7

Gave me the initial idea of further advancement through academic and clinical Therapeutic radiographer, band 7

KSF does help to develop future plans. Therapeutic radiographer, band 8c

4.3.14 Voting intentions

The majority (62%) of therapeutic radiographers would vote against AfC if given the chance to vote today (Figure 95). However, when responses were analysed in terms of staff bands it was clear that therapeutic radiographers in higher bands were less negative towards the AfC initiative. They were more likely to vote in favour of AfC or were undecided. This trend also was apparent among diagnostic radiographers. Those most frequently against AfC were radiographers involved in pre-treatment simulation and those banded 6 and 7 (Figure 96). Perceptions of morale appeared to correlate with AfC voting intentions.

4.3.15 Summary of attitudes and experiences of therapeutic radiographers in terms of sub-specialties

Therapeutic radiographers’ responses were analysed in terms of whether their specialist area of practice had influenced their experience of AfC, similarly to the analyses of  responses from diagnostic radiographers and from the main survey results. The sub-groups identified for further examination were staff in pre-treatment simulation, treatment verification, and managers. Staff from therapeutic sub-groups were more optimistic regarding their progression and there were fewer individuals in these groups (compared to the therapeutic group overall) who would vote against AfC given the chance. There were no large differences between the groups when it came to deciding if the opportunities identified at appraisal were the ones wanted by the appraisees. The majority of each of these groups said that these opportunities were wanted and would be taken to support long term goals even if they were unlikely to facilitate progression to the next pay band (Appendix 2).

4.4 Section 4: Assistant practitioners and healthcare assistants (HCAs)

Fifty-two assistant practitioners and twenty-two healthcare assistants responded to the survey. This comprised 3% of the total responses. The majority of assistant practitioners and HCAs worked in teaching hospitals or foundation trusts (Figure 97). Small numbers were located in PCTs and cancer centres. Females accounted for 86% of these staff, with only 14% being male. 

4.4.1 Areas of practice

As with radiographers, assistant practitioners and HCAs were active in most types of services including breast imaging, MRI, ultrasound and brachytherapy. Areas of work in which assistant practitioners and HCAs were not involved included research, radiotherapy isotopes and counselling.

4.4.2 Agenda for Change current pay banding

The majority (92%) of assistant practitioners were banded 4 and just over half (55%) of HCAs who responded to this survey were in band 3 (Figure 98).

Only one in five (21%) had been in their current pay band since the implementation of AfC terms and conditions but there was no obvious difference identified between males and females or Strategic Health Authority regions in relation to AfC banding (Figure 99).  The distribution was similar throughout England and Wales. Proportionally greater numbers of assistant practitioners were located in the North West, Yorkshire and Humber, and East of England SHAs.

4.4.3 Expectations of assistant practitioners and HCAs in terms of career progression under AfC

Assistant practitioners and HCAs who were employed prior to AfC were asked about their former Whitley Council grading and to what band they expected to be assimilated under AfC terms and conditions. This information was then compared with where they were actually placed after implementation of AfC.

About two thirds of assistant practitioners (n = 32, 62%) had expected to be placed on band 4 prior to AfC. Ten (19%) were unsure, six (12%) had expected to be banded 3 and two to band 5. Since 48 (92%) were assimilated to band 4 most assistant practitioners’ expectations were met or exceeded.

Twelve out of twenty-two (56%) HCAs expected to be banded 3 but eight (36%) were actually banded 2 after implementation. Similarly, four anticipated band 4 but after implementation only one was actually assimilated to this band.

4.4.4 Appeals

From this survey small but equal numbers of assistant practitioners and HCAs underwent a formal appeal to contest their banding. Seven out of eight assistant practitioners had their appeals upheld compared to only three out of eight HCAs.  There was a strong relationship between successful appeals and those staff supported by their managers.

4.4.5 Perceived fairness of banding

In terms of responsibility in relation to the perceived fairness of AfC banding, there were differences in the opinion of the support workforce. Half the workforce, irrespective of ethnic background felt their banding did not reflect fairly their responsibility. White staff felt most often (42%) that their band was fair. In contrast, only 25% of black assistant practitioners or HCAs and none from Asian backgrounds felt their band was fair (Figure 100).

In keeping with the findings for the other staff groups there was a strong trend indicating that assistant practitioners and HCAs were more likely to feel their banding was fair in centres where the CPF was either fully or partially implemented (Figure 101).

The majority (83%) of band 2 HCAs thought their pay banding was unfair (Figure 102). No assistant practitioners were banded at 2.

Reasons given for feeling their banding was unfair were very similar to those provided by therapeutic and diagnostic radiographers.  Commonly, assistant practitioners and HCAs felt that they worked above the responsibilities associated with their band. Assistant practitioners in particular frequently commented that they believed they did the work of a junior radiographer:

I feel the banding should be higher, as APs do the same as a junior radiographer. Diagnostic assistant practitioner, band 4

We assist with injections, drainages and biopsies and other interventional techniques on a one to one basis with the consultant radiologists without support from qualified staff. We are constantly taking on more responsibility for no more pay. Other trusts with job descriptions the same or less intensive than ours are known to be band 3. In this trust we are paid the same as a domestic. Diagnostic HCA, band 2

4.4.6 Career Development Opportunities for assistant practitioners and HCAs

This section of the survey began by exploring assistant practitioners’ and HCAs’ experiences of appraisals and the NHS KSF since these form a key element of AfC and are the basis for identifying career development opportunities.

4.4.7 Appraisals

The majority of assistant practitioners and HCAs who answered this section of the survey had received an appraisal in the last year. The percentage was very similar to figures obtained for diagnostic radiographers. There was no difference between full-time and part-time staff and how frequently their appraisals were carried out (Figure 103).

Just over half (53%) were aware of which NHS KSF competencies related to their current role, 25% did not know and 22% were unsure (Figure 104). Almost two thirds (64%) reported that the KSF has been used at their last appraisal (Figure 105). 

4.4.8 Opportunities identified at appraisal

Just under half (46%) of assistant practitioners and HCAs claimed to have had career development opportunities identified at their last appraisal. There was no relationship between the pay band of the participant and how frequently career development opportunities were identified at appraisal. Approximately half of all assistant practitioners and HCAs reported that opportunities were identified irrespective of whether they were banded 2, 3 or 4.

Of those who had had development opportunities suggested, just 28% were optimistic that these opportunities may aid their progression into the next pay band. Over half (55%) thought that they would not and 17% were unsure. As with the postgraduate workforce, there was a clear trend that the higher the band the more welcome the opportunities were, regardless of whether they would aid progression into the next band or not (Figure 106). Nearly half (48%) of all assistant practitioners and over one third (36%) of HCAs still wished to access these opportunities. Band 2 staff were the most negative towards the activities identified at appraisal.

Career development opportunities identified included access to foundation degree courses, access to assistant practitioner courses, further NVQ study, and in-house training for cannulation.

The reasons given for why respondents thought the opportunities identified at appraisal were unlikely to facilitate progression most frequently related to a lack of funding within their department, and a barrier to progressing beyond band 4. Typical comments are shown below: 

Restricted because development of role prevented by pay banding.
Diagnostic assistant practitioner, band 4

As an assistant practitioner, on this qualification, I have been told that we will never leave pay band 4. Diagnostic assistant practitioner, band 4

I feel that gaining a BSc will be hard due to funding issues.  Therapeutic assistant practitioner in training, band 3

Lack of funding and no time available. Diagnostic assistant practitioner, band 4

4.4.9 Continuing Professional Development (CPD) activity

Almost three quarters (72%) of assistant practitioners and HCAs recognised that they had CPD opportunities in the work place, and these activities were wide-ranging and varied. Study days and in-house activities were most frequently cited by respondents (Figure 107). No assistant practitioners or HCAs were involved in research projects.

The majority (85%) received no protected study time per month, but of the small proportion who did, most were banded 3. There were no examples of band 2 HCAs being provided with any regular development time (Figure 108).

4.4.10 Barriers to career development

The majority (68%) of assistant practitioners and HCAs felt that they had encountered barriers which hindered their career progression.  Of all the staff groups contained within the survey, they reported experiencing barriers the most often (Figure 109).

In terms of pay banding, there was a clear distinction between the experiences of band 2 staff and those in the higher bands who felt that they had encountered fewer barriers (Figure 110). Nevertheless, almost two thirds of those in bands 3 and 4 still felt there were obstacles to their career progression.

The most common barriers cited by assistant practitioners and HCAs involved funding, the feeling of not being valued, and a belief that radiographers’ development is put first:

AfC does not help assistant practioners develop their career, no substantial courses are available to move up a band, and most radiographers are against AP’s progression anyway. Diagnostic assistant practitioner, band 4

Our profile needs lifting and feel the SoR should be supporting our role more. Diagnostic assistant practitioner, band 3

APs have to prove all the time that they are capable of working alongside the radiographers - some radiographers feels threatened that we are here to take their jobs - hence the animosity. Diagnostic assistant practitioner, band 4

Lack of funding and no support from senior staff. 'It won't affect your banding' is a comment I get. Diagnostic assistant practitioner, band 4

4.4.11 Incentives

Across all respondents to the survey, approximately two thirds of respondents, regardless of whether they were therapeutic or diagnostic radiographers, assistant practitioners or HCAs, felt that nothing had assisted them in their career progression, with just one third believing they had experienced support. Of the staff groups, the assistant practitioners and HCAs were the most likely (37%) to say that they had found something or someone helpful during their career progression (Figure 111).

Once again, in terms of banding, and in support of the evidence gained from exploring barriers, those in higher bands reported more frequently that they recognised that some factor during their career had assisted their progression (Figure 112).

The most frequently cited responses from assistant practitioners and HCAs when describing factors which they believed had helped them included good support from managers and colleagues:

Colleagues within department very supportive. Diagnostic assistant practitioner, band 4

I was lucky enough to have an excellent NVQ assessor who helped me obtain my NVQ level 2. Diagnostic HCA, band 3

My line manager encouraged me to apply for the assistant practitioner role.  Therapeutic HCA, band 3

My brachytherapy team leader has given me opportunities to enhance my skills. Therapeutic assistant practitioner, band 4

4.4.12 Morale

To gain a holistic view of assistant practitioners’ and HCAs’ attitudes towards AfC and their career progression, participants were asked if their morale had changed since the implementation of AfC. The majority said it was lower (Figure 113). No staff in bands 2 or 3 reported that their morale was higher as a consequence of AfC and only 2% of band 4 staff felt their morale had increased.  A large proportion of those in bands 3 and 4 felt AfC had not affected their morale in any way.

When the repsonses of assistant practitioners and HCAs were compared with radiographers’ there is very little overall difference in attitude (Figure 114).

4.4.13 Voting intentions

Just over half (52%) of assistant practitioners and HCAs who responded to this survey would vote against AfC if given the chance to vote today (Figure 115). A third (33%) was unsure and 15% would vote in favour.

There was no clear trend when bands 2, 3 and 4 are analysed separately. In fact, it was confounding that those in band 2 were most in favour of retaining AfC in spite of claiming most frequently that their morale was lower. Voting intentions of band 3 and 4 staff appeared to be more consistent in view of earlier responses (Figure 116).

4.5 Section 5: Experiences and attitudes of therapeutic and diagnostic radiographers in terms of length of time since qualification

Since it was possible that radiographers may have different perceptions of their career depending on how long they have been in the profession, key responses on expectations, opportunities and barriers were analysed with respondents grouped according to when the individual had gained their entry qualification.

Those who gained entry to the profession after implementation of AfC claimed more frequently to have career development opportunities identified for them than did those who had qualified prior to AfC. Similarly, the longer a radiographer had been qualified, the less frequently they stated that development opportunities were offered. This clear trend was visible throughout the bandings for 5, 6, 7, 8a, and 8b (see Figure 117, Figure 118, Figure 119, Figure 120, Figure 121).

There were too few band 8c, 8d and 9 respondents to sub-divide by year of qualification.

Within the common bands where samples were very small with just a few respondents, the percentages have been removed since they may not be representative. For example, there were very few band 5 radiographers in the survey who had qualified in the early 1960s or late 1980s. Similarly, there were very few band 7 respondents who qualified in 2005 or later and very few band 8 respondents who qualified more recently than 1999.

Analyses were conducted to determine whether these findings correlated with how they would vote in relation to AfC if given the chance today. In spite of adequate response rates, no band 5 radiographers who qualified before 2000 said they would vote in favour of AfC, and only small percentages of more recently qualified band 5 staff would cast their vote in favour of AfC (Figure 122). 

However, similar trends among other bands were not identified. In bands 6, 7 and 8 the proportion of individuals voting in favour of AfC remained low but fairly constant regardless of how long the individual had been qualified.

4.5.1 Further attitudes and experiences of radiographers pre- and post-implementation of AfC

Radiographers’ responses were analysed in terms of whether they had practised only under AfC terms and conditions or whether they had practised before 2004 and experienced Whitley Council arrangements. Significant differences in career development opportunities, expecations and attitudes towards AfC were identified. The majority (85%) of the respondents obtained their entry qualifications in 2003 or earlier. Those who had qualified in 2004 or later (15%) and who had therefore known only AfC conditions gave more positive responses; they more frequently said that they had had development opportunties offered at appraisal, and almost half (43%) felt optimistic that these could facilitate progression into the next pay band. 

Nonetheless, over half (57%) of those who had qualified more recently would vote against AfC given the chance today; however, this is a smaller proportion compared to staff who had practised pre-AfC (73%). A further third (33%) of recent graduates were unsure as to how they might vote.  These findings are significantly different from answers given by respondents who qualified in 2003 or earlier (Table 11).  However, when asked directly about barriers to career development or whether they felt AfC had helped their careers there were no significant differences between the two groups or with the main survey responses.

Table 11: Key responses in terms of length of time qualified

Key responses from individuals:
comparing those who have practised since 2004 (under AfC terms only) with those who practised before (under both Whitley Council and AfC terms)
Full survey

N = 2373

Qualified in 2003 or earlier


N = 2025 85%

Qualified in 2004 or later

N = 348
15%

Chi-square & P value
OPPORTUNITIES
Career development opportunities have been identified at my last appraisal
N = 1032
(53%)
N = 858
(51%)
N = 174
(66%)
22.0
P = <0.0001
EXPECTATIONS
I believe these identified opportunities may aid my progression to the next band
 
N = 309
(21%)
N = 214
(17%)
 N = 95
(43%)
 73.7
P = <0.0001
These development opportunities are the ones I wanted and will support my long term goals N = 748
(54%)
N = 620
(53%)
 N = 128
(59%)
 5.0
P = 0.025
BARRIERS
I feel I’ve been prevented from accessing some career development opportunities
N = 540
(37%)
 
N = 444
(36%)
 
 N = 96
(42%)
2.45
P = 0.118
(Not significant)
AfC has helped my career
 
N = 190
(8%)
N = 160
(8%)
N = 30
(9%)
 
 1.11
P = 0.29
(Not significant)
My morale is higher since AfC
 
N = 71
(3%)
N = 68
(4%)
 N = 3
(1%)
44.5
P = <0.0001
My morale is unchanged since AfC N = 826
(37%)
N = 657
(34%)
 N = 169
(53%)
My morale is lower since AfC N = 1350
(60%)
 N = 1203
(62%)
 
N = 147
(46%)
 
Today I would vote for AfC N = 175
(8%)
 
 N = 147
(8%)
N = 28
(8%)
44.5
P = <0.001
I’m not sure how I would vote N = 454
(20%)
 
N = 343
(18%)
 
N = 111
(33%)
Today I would vote against AfC N = 1613
(71%)
 
N = 1421
(73%)
 
N = 192
(57%)

4.5.2 Voting intentions of therapeutic and diagnostic staff in relation to length of time qualified

To identify any differences between diagnostic and therapeutic radiographers, responses were subdivided into these two groups and then further filtered in terms of whether the participant had been eligible to vote in the Society of Radiographers’ ballot in 2003. Again, the assumption made was that the majority of those ineligible to vote would have been more positive because they had qualified since the introduction of AfC and had not experienced working under any other conditions. Experiences and attitudes were very similar between diagnostic and therapeutic radiographers for most of the questions including career expectations and barriers. There were differences, however, in terms of morale and perception of AfC. While diagnostic radiographers who were eligible to vote in 2003 are significantly more likely to report lower morale under AfC compared to those who were ineligible to vote (chi-square = 20, p value <0.001), among the therapeutic workforce there was no significant difference in their morale (chi-square  = 1.63, p = not significant).  Similarly, intentions to vote in favour or against AfC if a ballot were held today were in line with this finding.  

In summary, while diagnostic radiographers who qualified prior to 2004 were more likely to say their morale had been affected and they would not vote for AfC than those who qualified after that time, this difference was not seen amongst therapeutic radiographers.

4.6 Section 6: Annex T, on-call arrangements and split contracts

4.6.1 Annex T

Annex T is intended to provide an accelerated progression for newly qualified staff at band 5 under AfC. Sixty-one staff who had first registered in 2008 were represented in the survey.  Sixty were working at band 5 and one at band 4. Most of these (87%) were female and 95% were working full-time. Two thirds of the sample (67%) were working in diagnostic imaging. One third (33%) were therapeutic radiographers. Interestingly, the majority (59%) of these new graduates did not know whether annex T was recognised by their employer or not.

The majority (58%) expected to progress to band 6 in 1 – 2 years and the same percentage was prepared to move and change employers if they did not. Almost a quarter (22%) said other reasons would keep them in their current location regardless of whether they secured a band 6 position or not. A small percentage (10%) felt they might move, and another 10% was unsure (fig 125).

4.6.2 On call arrangements

The survey asked band 5 and 6 radiographers to specify how they were paid when practising out-of-hours as a lone worker.  Out of those who answered this question, most band 5 radiographers receiving AfC rates when on-call were paid at band 5 when acting as lone workers. A small number (9) received band 6 payment.  All band 6 radiographers receiving AfC rates when on-call were paid at band 6. None reported receiving a lower amount (Figure 124).

However, most radiographers in the survey reported that they still received on-call payments under the old Whitley Council system.  Under these terms most band 5 radiographers were paid at radiographer grade or senior II grade.  The majority of band 6 radiographers were paid at senior II or senior I grade when on-call, although small numbers (21) reported receiving a lower payment when on-call compared to within their normal working hours (Figure 125).

4.6.3 Split contracts

Since the implementation of AfC, there have been anecdotal reports of staff holding split contracts where, for part of their working week they were paid at one band, but for the remaining hours, or when performing other duties, they were paid at a different band.  This study uncovered 25 examples of split contracts, seven of which involved staff being paid at a higher rate for clinical/educational responsibilities compared to their other duties, five involved mammographers, four sonographers and the remaining examples included responsibilities regarding reporting, MRI, CT, nuclear medicine, DEXA scanning, pain management and just two therapeutic roles.

Search this document

Content tools

Accessibility controls

Text size

AA A

Colour