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The four-tier model which underpins the career framework in radiotherapy was first proposed in 1999 and initially piloted within the national breast screening programme. The College of Radiographers (CoR) published a Strategy for the Education and Professional Development of Therapeutic Radiographers(1) in 2000 and from that time continuing developments have made implementation increasingly imperative. The Department of Health (DH) funded a national pilot project - New Ways of Working in Radiotherapy - to develop implementation of the four-tier structure following early indications of successful piloting of the model in breast screening. The subsequent Report(2) of the skills-mix projects for breast screening, diagnostic imaging and radiotherapy identified four aims for the Four-Tier Model:

  • to define multidisciplinary teams not by profession, but by the skills and competencies that best deliver the patient or client’s needs;
  • to promote new roles, extended roles and advanced practice that will encourage lifelong learning;
  • to widen the routes of access to clinical careers and improve recruitment and retention of the health professions;
  • in the public interest, to maintain practice standards and develop the inherent potential of all clinical practitioners.

Development of the four tiers presented career progression and development opportunities for radiographers to Advanced and Consultant practice levels while developing a level of Assistant Practitioner under the supervision of the radiographer. However, implementation following the Report of the Skills-mix project was identified as essential to deliver the ambitious targets contained within The NHS Plan(3) and the NHS Cancer Plan(4) in 2000. These, and subsequent DH strategy documents such as Meeting the Challenge: A Strategy for the Allied Health Professions(5), as early as 2000 included reference to changing roles and roles at different levels including those of assistant and advanced practitioner.

The aims of skill-mix and implementation of the associated four-tier career framework model were part of a series of reforms designed to deliver the NHS Cancer Plan. Subsequently the Cancer Reform Strategy(6), building on work following publication of the NHS Cancer Plan, gives guidance on the direction for cancer services over the five years to 2012. Structures were put in place to oversee development and monitor progress at a national level. These have evolved over time but currently the National Cancer Action Team, on which the CoR has representation via the National Radiotherapy Implementation Group, maintains an overview of the Cancer Reform Strategy. The National Radiotherapy Advisory Group (NRAG), which included therapeutic radiographers, was established by Professor Mike Richards in 2004 to advise on the development and delivery of radiotherapy services and development of policy. Several sub-groups, including a Workforce Subgroup, reported to the NRAG.

NRAG identified a significant increase in demand for Radiotherapy as a result of both earlier diagnosis leading to an increase in the opportunity for radical treatment and an increased incidence of cancer as a consequence of an ageing population. It estimated that around 80% of current cancer - centre workload could be carried out by advanced or consultant level practitioners with appropriate oncologist support. Endorsement of NRAG recommendations, which include full implementation o the four- tier radiography career structure in all radiotherapy departments as a potential solution to achieving the increase in capacity required, is now included within the Cancer Reform Strategy(6) (Para 20, Executive Summary).

It is against this general background, and over a similar period of time, that the College has been working on policies and providing guidance on a career framework for radiotherapy which develops individual professionals and a workforce able to deliver the high quality, patient-centred care needed to meet the requirements of current and future cancer strategies.

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