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The Career Framework

The four tiers of the career framework were defined in the skills mix report(2) published in 2003 as:

  • “Assistant practitioner: An assistant practitioner performs protocol-limited clinical tasks under the direction and supervision of a State-registered practitioner.
  • Practitioner (State registered *): A practitioner autonomously performs a wide-ranging and complex clinical role; is accountable for his or her own actions and for the actions of those they direct.
  • Advanced practitioner (State registered*): An advanced practitioner, autonomous in clinical practice, defines the scope of practice of others and continuously develops clinical practice within a defined field.
  • Consultant practitioner (State registered*): A consultant practitioner provides clinical leadership within a specialism, bringing strategic direction, innovation and influence through practice, research and education.”

*N.B. The term ‘State Registered’ applied at the time to those now registered with the HPC as Radiographers.

The Report included an Appendix which indicates distinctions between the four tiers of the framework as well as those areas in common across them. This is reproduced at Appendix 1.

Subsequently, CoR policy and guidance documents have supported these levels within the framework with competencies and underpinning education in the Learning and Development Framework for Clinical Imaging and Oncology(9) and with indicative job profiles designed to be nonprescriptive in a document providing guidance for managers on implementation of the framework.

Assistant Practitioner

The report of recent research(10) indicates that 26 of 33 respondents from the 63 radiotherapy and oncology centres across the UK have assistant practitioners in place. The role is an important one in reconfiguring the workforce to ensure delivery of an effective radiotherapy and oncology service and “should facilitate the development of the advanced and consultant practitioner roles for Radiographers” (Foreword to Scope of Practice of Assistant Practitioners(11) . This document provides guidance and confirms the SCoR support for assistant practitioners “performing limited treatment procedures” identified and agreed to meet local need and with “consideration of the relative risk associated with the activity.” Voluntary registration, alongside accreditation of programmes which provide the education and training for those undertaking the role, are indicative of the relatively advanced implementation of the assistant practitioner role. However, there are broader issues associated with continued funding of the role and for the education and training to support progression to Radiographer where appropriate.

Radiographer (Radiographer Practitioner)

The role of radiography practitioner, while continuing to develop, is well-established and has a history of detailed guidance for example in relation to education and training. However, the expectations associated with the introduction of preceptorship and explicit references to clinical supervision are more recent.

A model of preceptorship, defined as a short-term support process during the first few months of a new or significantly different role until confidence is assured, was tested within the skill mix project(2) and acknowledged as one of the elements required for successful implementation of the career progression framework.

Clinical supervision is defined in the CoR Clinical Supervision Framework(12) 2003 as “an exchange between practising professionals to enable the development of professional knowledge and skills”. It is a continuing process of peer support and guidance distinguished from both “Mentorship - support offered by an experienced professional nurturing and guiding the novice” and the short-term adaptation period which constitutes preceptorship. The CoR Clinical Supervision statement(13) further emphasises the relationship of clinical supervision to professional development and life-long learning and distinguishes it from managerial supervision in the context of staff or students.

Advanced and consultant tiers

The skills mix report(2) published by the Department of Health identified the advanced and consultant tiers of the model as reflecting “the requirements of clinical governance in respect of their contribution to the continuous improvement of the service”. However, more recently the Report from NRAG(14) contained a strongly-worded recommendation for commissioners and service employers to fund implementation of advanced and consultant level posts because:

“… where these roles have been introduced they have demonstrated the potential to drive efficiency, reduce waiting times and refocus radiotherapy services around the needs of patients”

Uncertainty about the definition of, and criteria for, the Advanced Practitioner and Consultant roles was one of the possible barriers to implementation of these levels of the career framework identified and explored in the recently published Report(10) of a project funded by the CoR.

The CoR has continued to develop detailed guidance to support implementation specifically of these senior roles including clarifying the relationship of the Advanced Practitioner and Consultant roles with that of clinical manager(7) which is particularly important since all three roles include elements of professional leadership. This Framework for Professional Leadership identifies competence outcomes which help define and distinguish between the roles but without being overly prescriptive so that they support the development and delivery of services which are responsive to local needs.

Positioning Therapeutic Radiographers within Cancer Services: Delivering Patient-Centred Care(15) was a response to further developments within the NHS and outlines new models of delivery related to the patient pathway and providing site-specific services for patients. Three models of radiographerled practice, each at Consultant and/or Advanced Practice level, are identified:

  • Site-specific expert practitioner;
  • Technical specialist expert practitioner; and
  • Expert community liaison practitioner

Radiotherapy moving forward: Delivering new radiography staffing models in response to the Cancer Reform Strategy(16) is the most recent guidance from the CoR and is provided to support the development of local radiography staffing models for radiotherapy services. It takes account of the NRAG recommendations, the Cancer Reform Strategy and the National Radiotherapy Commissioning Guidance. The guidance offers a series of staffing models based on the career progression framework which when implemented will enable timely responsive and cost effective services to be developed and delivered and national targets to be met and sustained.

Implementing Radiography Career Progression: Guidance for Managers(17) describes both Advanced Practitioner and Consultant levels of practice and what should be expected of those undertaking the roles. Advanced Practitioner Although indicative job profiles are provided there is an expectation of diversity of roles at this level and thus the need for evaluation of individual posts. Appendix 3 of this Guidance for Managers(17) identifies the key features of the Advanced Practitioner role as:

  • working in a specific area of expert clinical practice;
  • involved in delivering specialist care to patients;

• contributing to the evidence base and to the development of other staff;
• acting as an expert resource for their particular field of practice; and
• demonstrating team leadership.

Education and Professional Development: Moving Ahead(18) provides further detail including an outline of the knowledge and skills required.

Consultant Radiographer

Criteria for consultant practice were first outlined in 2000 in Meeting the Challenge: A strategy for the Allied Health Professions(5).

Appendix 2 of Guidance for Managers(17) defines the role of the Consultant as providing “clinical leadership within a specialism or area of service, bringing strategic direction, innovation and influence through practice, research and education, based on specialised knowledge and skills.” The expectation is that the Consultant role would nominally comprise 50 per cent clinical work and significant work on research and development, audit, the education and training of others and policy and practice development.

However, Consultant job descriptions are developed as a response to specific service need and thus are likely to demonstrate some diversity.

Education and Professional Development: Moving Ahead(18) provides further detail including an outline of the knowledge and skills required. It highlights the pivotal role the Consultant plays in the integration of clinical, educational and research findings within practice.

The CoR in 2006 identified the following as essential for successful implementation of the career framework policy(18).

Developing Individual potential

  • Education appropriate to the level of practice
  • Preceptorship on entry and, subsequently, clinical supervision
  • CPD relevant to practice
  • Working within a multi-disciplinary team

Improving patient care

  • Evidence based practice
  • Research
  • Audit
  • Clinical supervision
  • Enhanced roles for clinical experts

Service re-configuration

  • Re-configuration of services
  • Service and role redesign
  • Use of Job Evaluation
  • Education redesign
  • Staff governance

Associated practical issues constituting possible barriers to full implementation of Advanced and Consultant roles highlighted in the recent Scope of Practice study(10) were:

  • Finance
  • Staffing issues
  • Attitudes
  • Availability of education, training and development

The extent to which these areas, identified as requirements for successful implementation, have been addressed within one Trust and the issues still to be resolved, are illustrated by the following Case Study.

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