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5. Issues arising from the report

The results from this survey provide a comprehensive picture of the radiographic workforce in the NHS in England and Wales five years after the start of the AfC roll-out. Overall, results indicate that AfC has not been well received. Before its inception the majority of the workforce voted to oppose it (SoR 2004). Despite promises of pay increases for many, large numbers of radiographers were against AfC due to the proposed increase of 2 ½ hours to the working week (SoR 2003). This was viewed as unacceptable five years ago and was still cited by many of the survey participants as their greatest reason for feeling dissatisfied with AfC.

However, this study was concerned with investigating the impact of AfC on the career progression of the radiographic workforce rather than on pay or length of the working week. Nevertheless, it is acknowledged that basic terms and conditions affect greatly workers’ morale, goodwill and their perceived ability to progress. Therefore, it is impossible to consider issues affecting career progression whilst ignoring responses relating to hours and salary.

5.1 Expectations for career development and progression

This study has demonstrated that certain sections of the radiographic workforce felt that their expectations and career progression were adversely affected from the start of AfC implementation. During the assimilation process, although large numbers of staff were banded as they had anticipated, many were assimilated to lower pay bands whilst colleagues performing similar duties in the same department or at other sites were banded higher. Managers receiving inadequate training to handle the roll-out of AfC was cited frequently by key stakeholders and survey participants as the main reason for the inequitable nature of the assimilation process.

Our results suggest that, in general, radiographers and senior II radiographers who were banded  5 and 6 were satisfied, as were senior I radiographers who were assimilated to band 7. Those who were most frequently disappointed were senior I radiographers who were banded 6, and superintendent III radiographers who were banded 7. Discrepancies were apparent amongst both therapeutic and diagnostic staff. Of the large numbers of senior I staff who appealed, only half of diagnostic and one quarter of therapeutic staff were successful, thus leaving a significant proportion disappointed and demoralised. AfC’s pledge to harmonise working arrangements and deliver equal pay for equal work does not appear to have materialised in all sections of the radiography workforce.  

The perception of incorrect assimilation from the start has far-reaching consequences on career development for these staff. Many have no expectations of being able to go forward in their careers, while others claim to have lost the desire to progress since they feel they are defined only by their salary band rather than by their experience and skills. Another important factor is the loss of good will which was highlighted as a potential issue by some of the interviewees prior to the development of the questionnaire. Repeatedly during the survey staff who were dissatisfied in relation to their own banding and/or the increase in hours described a lack of incentive to do anything more than the minimum required. This was most apparent among band 6 staff who felt they should have been assimilated to band 7. 

Arguably, one of the strongest themes emerging from this study is that band 6 is too broad and should not accommodate staff who were graded senior I and II under Whitley Council terms. There is no way of differentiating between experienced and inexperienced band 6 staff. Those who were previously graded senior I and have much more responsibility and many years’ experience have been placed on the same band as colleagues with far less experience and responsibility. In some cases, they had found themselves being paid the same rate as these less experienced colleagues who had progressed up the band while they had remained fixed at the top. A similar situation has emerged amongst the ultrasound workforce where many experienced sonographers reported being ‘stuck’ at the top of band 7, working alongside more junior sonographers for the same pay and with nowhere to progress. These issues have caused not just a loss of goodwill and reduction in morale but there are also reports of a loss of clear lines of authority and management in some departments.

The fundamental problem is that under AfC the radiographic workforce is defined by salary range rather than status. Gone are the old Whitley titles of senior and superintendent and in their wake are many reports of confusion and disappointment. Both participants and key stakeholders indicate that the workforce needs to be defined by their role and practice, and this notion is supported further by our findings at sites where the CPF is recognised. In addition, there is evidence of better career development opportunities for the radiography workforce at sites using the CPF, therefore it is disappointing that its implementation continues to be patchy (Woodford, 2006).

5.2 Opportunities for career development and progression

Regular appraisal is a fundamental element for staff development and forms a key part of AfC. Career development opportunities are likely to be highlighted at appraisal so it was interesting to find that radiographers’ responses indicated that appraisals take place more frequently in departments where the CPF is in place. It is reassuring to find that the majority of all respondents have had an appraisal within the last 12 months, but nevertheless a considerable number claim to have had no appraisal for several years. Common reasons for this absence related not to a fault of AfC but to a culture in their departments that viewed appraisals as having no value and importance.  This perception has to change if career development opportunities are to be increased and if morale is to be lifted. 

Evidence indicates that in centres which have integrated the CPF, career development opportunities are more likely to be identified, the KSF is more likely to have been used to help formulate the appraisal, and radiographers are more frequently satisfied with their pay banding. The responses from the assistant practitioners and HCAs were similar too in that they were more likely to be satisfied with their banding in departments which recognised the CPF. Therefore, in view of the apparent influence of the CPF it is of concern that 33% of assistant practitioners and HCAs, 30% of diagnostic radiographers and 20% of therapeutic radiographers did not know if the CPF was in place at their centre or not.

Results indicate that in therapeutic departments there is a slightly better understanding of the KSF and utilisation of the appraisal system; more therapeutic radiographers (76%) compared to diagnostic radiographers (64%) are aware of the KSF competencies required to perform their role and therapeutic staff are appraised more frequently than diagnostic staff. However, there was no difference in how frequently the KSF was applied at appraisal (61% compared to 60% respectively). Reasons for this may be related to the fact that therapeutic departments are often smaller than diagnostic ones, which may make the appraisal process more manageable for appraisers. There were also comments from the stakeholder interviews suggesting that, overall, therapeutic radiographers were frequently banded higher than their diagnostic counterparts, which may account for their apparent greater awareness of the KSF and how to use it to further their career. This idea is supported by evidence from the survey which indicates that radiographers in lower bands have more uncertainty regarding  the use of the KSF compared to those in higher bands. Arguably, higher band staff will be more confident about their current role remit and their future career direction.

There was a strong indication that younger diagnostic staff were more likely to be given career development opportunities than older ones, but this trend was not apparent among the therapeutic workforce, which again suggests that their use of the appraisal system is more effective and more equitable. As we did not pursue this question further in the survey or interviews it is unclear why older staff are not offered development opportunities: amongst the possible reasons are that managers may believe them to be experienced and hence to not need development; or that managers do not perceive them as being interested in learning about the new technologies becoming available.  Irrespective of the reason, this leads to inequitable treatment and, arguably, sets up a situation in which the skills of older workers may be underutilised. Managers and appraisers of diagnostic staff may need support to address and meet the needs of their older workforce, and harness this valuable source of expertise, especially in view of the fact that diagnostic imaging has an ageing workforce, more so than in radiotherapy.

Although few participants believed that the career development opportunities identified at appraisal would facilitate their progression to the next band the majority still wanted to access these opportunities. This is reassuring since arguably it indicates that although there were many reports of a loss of motivation and goodwill as a consequence of poor banding, there are still large numbers of staff who do wish to develop professionally even in the absence of any overt reward. The recent survey by Price et al (2009) revealed many examples of radiographers developing extended roles and, whilst some may acquire these roles with the hope of gaining increased pay, many are doing so solely out of enthusiasm for their work and professional pride. It is disappointing therefore that although AfC was designed to reward skills without the need to wait for vacancies to arise most participants report that the ‘dead man’s shoes’ culture is still very much alive within their department. There were very few reports of centres where the acquisition and utilisation of additional skills allowed the individual to be escalated to a higher band in the absence of a vacancy, even though this is what AfC was supposed to facilitate.  Most reported that they still had to wait for a vacancy and then apply in the usual manner, even if it was evident that their skills exceeded their current banding.

In addition to providing a new pay structure, AfC was also heralded as a means to develop new ways of working to improve service delivery (DH 2004). Although very few of the career development opportunities identified in this survey were new or innovative there were a few examples where participants felt that, were it not for AfC they would not be accessing this particular role. These included some reporting radiographers, and one or two therapeutic activities including radiographer-led applicator removals within brachytherapy, and radiographer-led volume definition for CT planning.  Some of the stakeholder interviewees claimed that many managers were not adequately prepared for AfC and therefore had to invest all their time and energy into job matching rather than developing new ways of working. A recent report from the National Audit Office (2009) supports this claim stating that most staff are not working differently from when they were on their old pay contracts.  As disputes and inequities among the radiographic workforce are resolved over time, perhaps we will then start to see the emergence of more new roles and improved patient pathways as per the original AfC remit.  Certainly stakeholders predicted that one of the anticipated benefits of AfC further in the future may be the development of more high end staff and more advanced roles amongst the radiographic workforce, which will, of course, facilitate career progression for some.

In line with predictions for future career progression and more advanced staff, it was evident from our survey that, in general, staff occupying higher band positions were less negative towards AfC and more positive towards their own career development.  The most negative were those in bands 5 and 6 and who had been qualified the longest. Solutions to improving the experiences and attitudes of these staff are not easy to find but efforts to identify ways to improve parity of banding between trusts and addressing blocks to progression would be a start. It is also worth noting that, as professionals, radiographers are expected to maintain and improve their practice regardless of reward.  The Health Professions Council (HPC) is due to commence its audit of evidence of radiographers’ Continuing Professional Development (CPD) later this year (HPC 2009).  Those radiographers who currently feel disillusioned and that their career is stagnant will need to be mindful of this.  For the benefit of their patients they will be required to continue to remain up-to-date regardless of personal grievances or else opt for other employment.

In view of the impending HPC audit, it was disappointing to see that very few particpants from any quarter of the workforce enjoyed protected study time from their employer. Only approximately 13% receive any regular study time and, for some, this was as little as one hour per month. Therapeutic radiographers receive, on average, more than diagnostic radiographers. While the majority recognised a variety of CPD opportunties within the workplace most (87%) claimed to receive no time to access them. Research continues to be the CPD activity accessed least often, and even smaller numbers of participants claim that research form a regular part of their duties. This is frustrating considering undergraduate degrees have been in place now for almost two decades. Evidence from the Scope of Radiographic Practice 2008 survey (Price et al 2009) indicated that large numbers of therapeutic radiographers were engaged in active research compared to far fewer in imaging. Our results show that only 13% of therapeutic radiographers claimed that research formed a significant part of their regular duties but, proportionally, this is still more than double the diagnostic responses, which indicated only 6% were research active. According to the recent ‘High Quality Care For All’ publication (DH 2008) which advocates new ways of working, and in line with the philosophy of AfC employers should provide more opportunities for radiographers to engage in collaborative research for the benefit of patient srevices, to raise the profile of the profession, and as a method of enhancing and improving radiographers’ career development.

5.3 Barriers to career development and progression

It is inevitable given that so many respondents have antipathy towards AfC that they would also see it as being a barrier to career progression. This was the case for all categories of staff, the highest proportion of these responses coming from assistant practitioners and HCAs at 68%, but with 58% of diagnostic radiographers and 52% of therapeutic radiographers also indicating they believed this to be the case.

Although the barriers perceived by the respondents were varied there were common themes. Many cited financial barriers to career progression and were unhappy that they had been required to fund further study themselves. Even when they did (and frequently respondents did report doing so), many were still not allowed any protected study time, having to attend courses in their own time. 

Under-staffing and increased pressures from government targets were also cited by many as key barriers to career progression. Even if funding can be found, it seems rare that participants are afforded time off to attend. These ‘vicious circle’ situations sap the morale of staff, make them feel undervalued, and powerless to progress.

In addition, a lack of investment was frequently identified as a problem in other respects, as highlighted by a respondent who stated that for many years radiographers had x-rayed orbits prior to MRI and, when no radiologist was available, had also decided whether or not to proceed with the MRI examination if no foreign body was seen. Under AfC they had been prevented from continuing this practice as it was alleged it would have led to the radiographers being banded at 7. Clearly in this case financial expediency had been put before patients’ interests and had taken priority too over decisions about the best utilisation of individuals’ skills.

In another case, one respondent’s view was that some radiographers do the job of a radiologist but are not supported with anywhere near the study time or available resources to which medical staff have access. There are reports also of radiographers and assistant practitioners being told by their managers not to bother with accessing career development opportunities because their pay band will not change in spite of what they do. This is in complete opposition to the ethos of AfC. One radiographer was told that although there would be no career advancement beyond band 7 she would be trained to consultant level and her skills would be utilised.  To utilise someone’s skills but not recognise them for banding purposes is a prime illustration of taking advantage unfairly of an employee’s goodwill and enthusiasm. Equally, the willingness of the employee to develop their skills regardless is another example of radiographers’ dedication and professionalism.  One possible response by a radiographer placed in such a position may be to take the development and move on, but moving may not always be an option. There are often very good reasons, including commitments outside the workplace, why sometimes people are unable to move. This was supported by the fact that only just over 11% of respondents had moved to another employer since the advent of AfC. Those who had, had relocated largely for career progression purposes.  It was clear that others were looking to move to advance their careers, but as one respondent said “I shouldn't have to move to progress” and if the intention of AfC is for individuals to develop their skills and progress, why indeed should they still have to move in order to do so?

Further disappointment was evident from the belief that in a number of cases radiographers were not supported by their line manager; some respondents going so far as to say that their line mangers were disinterested and others saying that they felt discriminated against on grounds of age, gender or race. In one case, a radiographer who was also a working mother was told by her manager “You choose a career or children, not both”. With a number of the examples given there would seem to be the basis for radiographers pursuing these matters in another forum.

As for some of the barriers cited above, many of the other examples given by staff of challenges to progress did not have their origins in AfC. For example, as in the earlier study by Price et al (2009) it is still reported that radiologists constitute barriers to career progression for some diagnostic staff. Several respondents claimed that they had developed accredited reporting skills but were ‘not allowed’ to practise these skills because of radiological opposition. This was clearly preventing staff from utilising post graduate qualifications and becoming advanced practitioners.  It was suggested that radiologists were reluctant to release certain examinations to radiographers as there is sometimes hostility from other medical consultants “who see radiographers’ reporting as sub standard to a radiologist’s report when it can be the other way round.” This is a key point which needs to be challenged. If there is evidence that radiographers cannot perform at the required standard that is one issue but there does need to be clear evidence of this and such decisions should be consistent and not on the whim of individuals. Resistance from radiologists, however, does seem to be decreasing rather than increasing. It was heartening to see that more participants in this study cited radiologists as a help to their career progression than a hindrance.

Interestingly, history appears to be in the process of repeating itself, since some assistant practitioners now claim radiographers are a barrier to their progression. There are reports of hostility from radiographers towards the role of assistant practitioner, and claims that radiographers’ development needs are put before those of the assistants. These claims were supported by events at a recent conference where a motion was put to an audience of over 200 radiographers to investigate the possibility of facilitating progression of band 4 assistants to band 5. The conference voted overwhelmingly against the motion (SoR 2009). 

The ‘glass ceiling’ phenomenon was felt acutely by many groups of respondents in this survey, and arguably solutions to this major barrier to career progression will remain difficult to find.  Staff in bands 4, 6, and 7 complained frequently that they are ‘stuck at the top of their band’ with no hope of progressing, and this is a significant contributing factor to low morale. Many participants can see no incentive for taking on more study, more responsibility, or more commitment in relation to their role when they will not be rewarded financially or even have it acknowledged in their job title. Equally, they state that currently they are working alongside others who do less for the same salary. Clearly this situation is totally at odds with fuelling career development and needs to be addressed as soon as possible. In theory, a new nationally accepted system of professional titles, which reflect workers’ skills and experience, may go some way to restoring, in those who have lost it, the incentive to progress.

Following The NHS Plan (2000) and Meeting the Challenge: A Strategy for the Allied Health Professions’ (2000) the introduction of AfC and the CPF made it a reality for radiographer consultant posts to be introduced. However, one respondent was told by their manager “there is only progression if there is a vacancy despite working above banding” as an explanation for being denied access to training courses, with the follow-up comment allegedly being that there would “never be a consultant radiographer in our trust”. What hope is there for opportunities and progression if leaders and managers of the radiographic profession are not forward thinkers? 

Irrespective of whether they arise as a consequence of the arrival of a new pay structure or if they arise through either old prejudices or operational issues, barriers are there to be overcome. Radiographers have proven themselves to be a resilient and tenacious workforce. As one consultant radiographer commented “once individual issues are resolved, and this takes time, then career development can usually happen”. Certainly, it is within the scope of the SCoR to address some of the issues reported here.

5.4 Incentives for career progression and development

Approximately a third of all respondents acknowledged that, in addition to experiencing barriers, they had also experienced certain incentives, events or catalysts which had helped their career development. Some 37% of assistant practitioners and HCAs acknowledged these incentives, compared to 34% of therapeutic radiographers and just 29% of diagnostic radiographers. The primary incentive or advantage that all groups, and in particular assistant practitioners, recognised as being a help was having good support from managers and peers. Conversely, poor managers were frequently blamed for stalling career progression, as some of the cameos above illustrate. The importance of good guidance from enthusiastic and professional managers should not be underestimated and this was underscored by some of the key stakeholders who observed that AfC was, in their opinion, a vehicle which exacerbated poor management. Many participants have indicated that they agree in principle with the AfC intentions but that they have been manipulated and selectively implemented by managers:

The concept of AfC remains a good one. The implementation of it is a positive disgrace, and one which the radiology department should be deeply ashamed of being a part.

Our findings indicate that this point may be fundamental to much of the animosity shown by the workforce. If this is the case, the only remedy to improve harmony may be enforced standardisation. Further incentives for career progression identified by radiographers (in addition to good managers) include self motivation and supportive radiologists. Again, this demonstrates the tenacity of this workforce, and equally, highlights the fact that whilst some radiologists can be obstructive to diagnostic radiographers’ progression, this should not allow the fact that many radiologists are facilitators of progression to be eclipsed. In general, those in higher pay bands acknowledge more frequently factors which have helped their progression, which suggests they are perhaps less preoccupied with hours and banding and more in tune with their overall career development.

5.5 Morale

The majority of the radiographic workforce, in every area of practice, claim that their morale is lower since the implementation of AfC and this is unsurprising in view of the experiences described.  The experience of the radiographic workforce correlates with the experiences of nurses (Ball & Pike 2006). Few have positive feelings towards AfC although there are more examples of staff in higher pay bands and staff who qualified recently who report an increase in morale as a consequence of AfC compared with those in the lower pay bands or who entered the profession some years ago. 

Particularly noticeable is the steady increase in morale in radiographers in pay bands 8a and above, which concurs with Buchan & Evans’ (2007) findings that those who felt as if they were the ‘winners’ in AfC tended to be senior health professionals. Radiographers in bands 5, 6 and 7 most frequently reported decreased morale. Equally, only assistant practitioners paid at band 4, the highest possible for assistants, felt an increase in morale since AfC.  Not one individual in bands 2 or 3 reported that their morale had improved.

There are, however, many radiographers in the higher bandings who do not feel that their morale has increased under AfC even though they now receive a higher salary than if they were paid at Whitley Council rates.  The reasons for this are multi-faceted, and clearly morale in the workplace is a complex issue (NAO 2009). One of the most important factors may be length of time in the profession.  Diagnostic radiographers who had qualified in 2003 or earlier, and therefore had worked under both Whitley Council and AfC terms and conditions, were significantly more likely to feel their morale was lower since the introduction of AfC. This trend was most noticeable amongst band 5 radiographers. At first this seems at odds with the revelation that band 5 radiographers were the group that most frequently reported the identification of career development opportunities at appraisal. However, on closer inspection it transpires that it was band 5 radiographers who qualified before 2004 who were most likely to report lowered morale. 

Interestingly, voting patterns correlated with responses on morale. Participants were invited to say how they would vote with regards to AfC, if a ballot was held today. Diagnostic radiographers who qualified in 2004 or later were significantly more likely to vote in favour of AfC compared to those who qualified earlier. Conversely, among the therapeutic cohort there was no difference in voting intentions regardless of how long the individuals had been qualified. Again this indicates that, as with appraisals, bandings, and career development opportunities, therapeutic staff fared better in some instances compared to their diagnostic colleagues.  Equally, staff in higher pay bands were more likely to vote in favour of AfC.

Our findings demonstrate that morale is not only linked with length of time qualified but also with access to career development opportunities. Those who qualified after 2003 were significantly more likely to have had development opportunities identified at appraisal, which is a probable factor for maintaining their morale. Indeed, this same group were far more optimistic, compared with those who qualified in 2003 or earlier, that the opportunities to enhance their professional development might also facilitate their progression into the next pay band. However, it is acknowledged that some staff who may have personally benefitted from AfC may still feel their morale is lower; if they work in an environment where they perceive inequity among staff or if they have friends or colleagues at other sites who may have been ‘losers’ in AfC (to use Buchan and Evans’ phrase), these staff may still feel negative as demonstrated by this respondent: ‘Whilst AfC has been beneficial to my own personal circumstances I feel it has been divisive in many ways for other staff leading to discontent and staff feeling disillusioned.’  Equally, it could be argued that newly qualified staff are obviously more likely to be offered career development opportunities to help them reach the required level of a more experienced member of staff. And conversely, the more experienced staff will not need some of the more basic career development activities since they will be competent already in these areas.  Unless the types of opportunities identified by participants were analysed in more detail, it remains difficult to assess accurately any potential inequalities.

Lower morale amongst staff who have been qualified for longer or are in lower pay bands could, however, be related to their perception of the appraisal system. Many participants thought appraisals were a waste of time and just a ‘paper exercise’ with no value.  Others said their managers were simply not interested in helping them develop their careers. What is not clear from this study is where the fault lies within the system.  Perhaps managers have more time for newly qualified staff. Perhaps they see them as the future and therefore offer them more development opportunities whilst neglecting to provide equity for the longer serving staff.  On the other hand, some of these longer serving staff may be more reluctant to take on additional tasks and responsibilities for reasons already stated and would prefer to stay within their ‘comfort zone’. Comments from participants support both suggestions. However, as the Health Professions Council prepares to begin auditing radiographers’ continuing professional development evidence at the end of this year, it is clear that all staff must be encouraged to engage in lifelong learning (HPC 2009).  Perhaps the impending audit may help to minimise apathy towards professional development, regardless of whether it is on the part of the appraiser or appraisee. Nevertheless, further research into attitudes of staff towards appraisals and how to improve the appraisal system is recommended.

Although the majority of the workforce felt their morale was lower since the implementation of AfC, well over a third felt that AfC had had no effect at all on their morale.  In view of the general negativity which tends to accompany discussions involving AfC it is important to acknowledge that many staff feel it has had little, if any, impact on their working lives. This opinion was held also by some of the key stakeholder interviewees who felt that AfC had had much less impact than anticipated or expected.  Evidence obtained from this study and previous studies indicate that other factors, which participants do not attribute to AfC, continue to affect morale and these include under-staffing and under-funding (Arnold et al 2006; Price et al 2009).

In a similar vein, although the majority of all divisions of the workforce would vote against AfC, a significant minority (around 25%) are unsure how they would vote if a ballot were held today. Arguably, this group feels ambivalent towards some aspects of AfC and is still waiting to be convinced of its value. Our results indicate also that people are not just responding automatically in order to stay consistent with their original position if they voted against AfC in the SoR ballots. Comments from both key stakeholders and from survey participants frequently implied that the principles of AfC are good and that Whitley Council was out-dated, but that the implementation of AfC has been patchy and inequitable.  If trusts were encouraged to apply the AfC terms and conditions more uniformly it is likely that many staff may feel more positive towards AfC and therefore their own careers.

In summary, morale among the radiographic workforce appears to be lower since the implementation of AfC. Equally, the majority state they would vote for dissolution of AfC if given the chance. But would a return to Whitley Council conditions solve the current dissatisfaction? Many participants and stakeholders recognised that Whitley was outmoded and needed replacing, and that AfC per se may not be responsible for all it is accused of.

5.6 Annex T

Since the implementation of Annex T is directly related to career progression for new graduates to the profession and is endorsed by the SoR (2005), it was appropriate to investigate the experiences of new graduates within their trusts.  As anticipated, the new workforce appeared enthusiastic and mobile with the majority claiming that they would be prepared to change employers in order to progress to the next pay band. What was surprising, however, was that the majority also (59%) did not know whether their current employer recognised Annex T or not.  Clearly, although the place of work for some new graduates will be governed by personal factors, efforts are undoubtedly required from the SoR to heighten awareness of Annex T so that new graduates may be more discerning about their choice of employment.  This is likely to have the knock-on effect of encouraging more employers to recognise Annex T if recruitment may become more difficult in its absence.

5.7 On-call arrangements

Although payment for on-call and emergency cover was not the focus this work, it was still relevant to investigate current arrangements since they impact on staff morale and perception of equity.  The old Whitley Council payment arrangements stated that radiographers working on call under clinical supervision of a senior radiographer or above would receive the mean of the radiographer scale plus 50%.  Lone working unsupervised radiographers would be paid at the mimimum point of the senior II salary scale plus 50%. This was in recognition that in working alone the radiographer would be required to work  at a level requiring skill and responsibility which was above that of a nearly qualified radiographer.  Section 2 of the AfC NHS Terms and Conditions of Service Handbook (NHS Staff Council, 2009) describes how assimilation from Whiltey Council to AfC on call payments would occur.  No longer would band 5 radiographers be paid at a higher grade for unsupervised work as in Whitley, but those on the 1st, 2nd or 3rd increment of band 5 would be paid at the 4th increment as a minimum.  In addition, under AfC radiographers on call are given a percentage pay enhancement, with the more on-call cover provided, the higher the percentage, up to a maximum of 9.5%  (CSP 2007; NHS Staff Council, 2009; NHS Whitley Council 2004).

It was interesting to find that the majority (67%) of respondents in the study still retained Whitley Council payment arrangements for on-call duties, with most being paid at senior II grade. Only a third of repondents had been assimilated to the AfC payscale for on-call payments.  Since the AfC and Whitley Council on-call rates do not match, this is another example of inequity between trusts. 

The NHS Staff Council is reviewing on-call arrangements and completion for this review is expected by September 2009 (DH 2007). The review promises equal pay for work of equal value but since this pledge does not appear to have been honoured in some other areas of radiographic practice it is likely that inequities will continue. Implementation of new on-call payment arrangments is anticipated for April 2010 and until then, sites will keep their current local agreements. In view of past experiences around implementation of earlier AfC terms and conditions, it is appropriate for the SoR to work closely with the NHS Staff Council in order to ensure a fair system is introduced across the radiographic workforce.







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