Advanced practice is about providing a better outcome for the patient and creating new career opportunities for radiographers, said Charlotte Beardmore, director of professional policy at the SCoR.
“We want to add value to improve patient outcomes and we have so much more to offer,” she told delegates at Leading the Way, a conference organised by Sheffield Hallam University and held at its city centre campus, in September.
Charlotte spoke about the work being done by the College of Radiographers (CoR) in conjunction with colleagues around the globe, to develop definitive definitions of advanced practice, both clinically and educationally, in the UK and across the world.
Also speaking at the event, was Suzanne Rastrick, Chief Allied Health Professions Officer (CAHPO), NHS England, who, in her closing address, discussed the challenges faced in the health service and how the profession must consider the delivery of healthcare in terms of health and wellbeing in spite of funding gaps, while maintaining high levels and care and quality.
“There is real opportunity in adversity,” she said, “It makes us think differently. Advanced practice is understanding how you can pitch your skills into what’s needed for the future and appropriately into this planning process.”
“What can members of your profession do that no one else can? Advanced practice means extending skills and knowledge to improve service efficiency and outcomes.”
More than 110 delegates, presenters, and exhibitors attended the conference across both diagnostic and therapeutic disciplines.
Co-organiser, Joanne McNamara said that the aim of the conference was to move away from the traditional themes often discussed at radiography conferences and instead focus on sharing international perspectives and experiences of advanced practice, with a view to inspiring radiographers from around the world.
James Harcus who was also involved in developing the conference, commented: “Themes of Leading the Way included terminology, harmonisation, international perspectives of advanced practice, managing an advanced practice service, scope of practice and role creep, and the impact on practice/service, as well as advanced practice research.”
Presentations and papers across the event were wide-ranging, from discussing advanced practice from a manager’s point of view; benchmarking advanced clinical best practice; to personal reflections of role development. Uniquely, it included perspectives from representatives of professional bodies outside the UK.
A packed programme
The event was opened by Ruth Allarton, head of department of allied health professions at Sheffield Hallam University, who introduced four speakers representing four unique perspectives – the Society and College of Radiographers, a consultant radiographer, radiology manager and a health authority.
“It’s about having the right skills in the right place at the right time; sharing practice from across the world and enhancing practice wherever we are. The opportunities are out there – we just need to lead the way,” said Ruth.
A range of proffered papers was presented over three days, showcasing examples of the work of advanced practitioners globally, across different disciplines and how this has influenced practice in individual countries.
Other highlights included workshops on subjects such as patient care and what it means; accreditation; how to make the most of research opportunities; and how to plan for an advanced practice role.
On the final day, a panel comprising Richard Evans, SCoR CEO, Mark Given from Canada, The UK’s Bev Snaith and Jillian Harris from Australia, discussed the main points arising from the event and the audience participated in a lively debate on topics including accreditation, the necessity to achieve MSc and PhD and how to proceed and move advanced practice to the next level.
Advanced Clinical Practice: What does this means? What can this offer in the current healthcare context?
Charlotte Beardmore, director of professional policy, College of Radiographers, UK
We are looking to colleagues around the globe to understand how advanced practice is developing in their countries,” Charlotte told delegates in her opening keynote address. “It’s about providing a better outcome for the patients, and providing new career opportunities for the workforce both in the UK and globally,” she said.
Charlotte spoke about the work SCoR has been doing to develop and promote accreditation, especially in the past two years. “We now need to push this forward – it will give us a good grounding to offer a high level of professionalism for our patients,” She said.
She discussed the Society’s strategy to help increase the number of professionals working towards a doctoral qualification. “There is a need for learning outcomes to be clearly defined for all levels of practice.
“We know there are gaps in the workforce so we need to look differently at the service. We want to add value to improve patient outcomes.”
Commenting on developing a definitive definition of advanced practice Charlotte said: “I don’t underestimate the amount of work involved in this – a lot of work has to happen in the next two years to reach a definitive definition.”
“You’re at the leading edge of your practice – without you we can’t move forward for our patients. It will be hard and it will be challenging but achievable.”
Identifying Advanced Clinical Best Practice; Benchmarking
Dr Joanne Fillingham, clinical fellow to the chief allied health professions officer, NHS England
Joanne asked – what do we mean when we talk about advanced practice? Are we talking about the same thing as a nurse or another AHP? Joanne noted that the introduction of these new roles presents a challenge in terms of benchmarking and there has been a historical lack of policy. She also spoke about the need to separate definitions for extended roles and advanced practice, and the challenge of creating a national framework.
“There is a need to clarify and define the role, so that when we use those terms we are talking about the same level of competence. We need a uniform definition/framework and set of metrics to evidence that. Most definitions leave us with more questions than answers at the moment.”
Role impact analysis is crucial, said Joanne. “Increasingly, when you look across the broad range of professions it gets more confusing. We should define by the level of practice rather than a specific role.” So how do we evidence the value of these roles? Benchmarking is about implementing changes and making things better for patients.
Advanced Practice: Manage, lead or enable – how do you do all three?
Dr Beverly Snaith, lead consultant radiographer, Mid Yorks NHS Trust
“Not only am I an advanced practitioner but I manage advanced practitioners and enable”, Beverly told delegates. She asked them to consider how they would go about leading, managing and enabling. She also spoke about the process via case studies in her own hospital trust and how that was achieving cost savings and improving patient outcomes and experience.
“We have to think about the fundamentals of our practice – what are the building blocks of practice and advanced practice?
“It is important to stress that we are talking about radiography, which requires a broader skill set than just clinical.
“There is a huge issue around terminology across different professions and across the world. It’s not about plugging a gap, it’s about doing things differently.”
Beverly urged delegates to think about the management of it in the realm of the service. “How do we develop the next generation of advanced practitioners? Will they need to be self-driven rather than in a prescriptive education framework? For all of us the future is going to be about proposing things not demanding things.
We’ll get there: A manager’s perspective? Humm, so what’s in it for me?
Benjamin Rowe, oncology clinical service lead and professional head of radiotherapy, Taunton & Somerset NHS Foundation Trust
Benjamin began his presentation, by looking at advanced practice from a manager’s point of view, asking why managers can come across as creating barriers and behave grumpily. He told delegates that the profession should go back to basics and decide what we do well and how to respond to the changes – more patients, more work and less money.
“There are huge challenges out there,” he said. “I firmly believe that we can use advanced practice to solve problems. The question should be – how do we make advanced practice fit our organisation? We can’t deliver advanced practice alone – it’s about coming together as a profession.”
Benjamin reinforced many of the points raised, saying: “We need to plan and manage, and see what we need to change, as well as aligning demand with capacity.
“This is not about one person being responsible but the core team, and it’s a really good opportunity to engage managers. Look at the problems we are trying to solve – and keep talking, within our profession and to other healthcare professionals.”
“The business case is the challenge – don’t give up. Make the case and this is where influencing is very important – you need to convince people, so start thinking about the data and evidence you may need.
“It is better to over achieve a target than under achieve it. It’s all about leadership – it’s a leadership opportunity – an opportunity to bring the department together.
Further advice included approaching advanced practice and service development from less of a personal standpoint, and more from a team point of view. “You will have failures” he acknowledged, “but they can help you define what you need and want.”
The panel discussed the similarities and the differences, and challenges faced globally, and unanimously agreed that collaboration will only strengthen the position of advanced practice worldwide.
Dr Denyse Hodgson, professional lead, radiotherapy and oncology, Sheffield Hallam University, opened the programme for day two, which introduced the first of the event’s international speakers.
Louise Coleman, professional officer for accreditation and education; Mark Given, Canadian Association of Medical Radiation Technologists; Jillian Harris, Australian Institute of Radiography; and Mike Odgren, American Society of Radiologic Technologists, each gave a ten minute ‘snapshot’ of the current status of advanced practice in their respective countries in a session entitled Global Perspectives from Professional Bodies.
“There are many common issues – we need to work with our British and American colleagues on this.”
Mark Given, Canadian Association of Medical Radiation Technologists
“We need to sort out accreditation so that it will be unusual not to be accredited.
Louise Coleman, SCoR
“We need people to support our position from different professions.”
Jonathan McConnell, NHS Greater Glasgow & Clyde
“It’s not just about advanced practice, it’s about advancing practice.”
Denyse Hodgson, Sheffield University
“It is going to be tough to produce a job description that will be relevant across the board. Australia is huge, with urban centres that have very different needs from rural areas.”
“Core principles: Improving patient outcomes, critical thinking, complex decision making and autonomy and leadership.”
“Advanced practice is in a difficult place – there are plenty of advanced practitioners but a significant percentage are not working in their fields and there is a lack of acceptance and recognition. Once we gain recognition our field is really going to thrive.”
The Benefits of Accreditation
Louise Coleman, professional officer for accreditation and education, Society & College of Radiographers, UK
“By the end of this session, you should be clear where you are in the four core domains,” Louise told workshop attendees. “It’s all about the patients but you have to get something out of it as well.” The group talked about the impact of advanced practice on patients, both specific and general, and the benefits for employers in having a better qualified and knowledgeable workforce.
“For those people who want more, accreditation is the ultimate achievement. If you publicise you are supporting your staff through education then you become a more attractive employment proposition.
Speaker Mark Given, from the Canadian Association of Medical Radiation Technologists, also gave some sound advice: “Recognise your strengths and develop your role around your strengths. Be true to yourself and where you fit.”
Workshops: Time to talk
Not forgetting the patient
Spencer Goodman, Society & College of Radiographers, UK
What do we know and perceive about patient care and how can we enhance patient care and experience? This was one of the questions tackled in this workshop run by SCoR professional officer Spencer Goodman. Attendees were also asked how pressure from above to deliver patient-centred care is translated into service delivery. Anne Goodlad, a nurse who has worked both in the NHS and private sectors, and who had undergone treatment for breast cancer, shared her experiences of the patient pathway.
Anne said: “Not one of my experiences at work gave me any preparation for being diagnosed with breast cancer.
“Don’t forget that when they come to radiotherapy, especially from chemotherapy, patients are at the most vulnerable time of their lives. Just think of us – keep us informed – be mindful that we may not always have the energy to question.”
The Elephant in the Room. MSc? Accreditation? Desirable or essential?
The panel gave brief position statements followed by a discussion and questions from audience.
Bev Snaith, Richard Evans, Mark Given and Jillian Harris
There was a very intense debate on this subject which could have far reaching implications for the profession over the coming years.
Members of the panel also gave their personal impressions of the previous two days of discussions, presentations, workshops and papers. Jillian Harris had been very impressed with the conference and was encouraged to hear that everyone seems committed to accreditation, although a little worried that not everyone thought it was essential.
Canadian Mark Given found the conference truly inspiring – especially the discussions around education and expectation.
Beverly Snaith emphasised that it’s all about impact and accumulating the evidence to support this. It’s not just about extended scope, it’s about advancing practice and the profession.
“A master’s is only one component, but what it does is give the public and the MDT the belief and safety net, that people are going out as advanced practitioners with a solid back up in education.”
Nick Woznitza – audience
“How can you sell the advantage of a full master’s to your department manager? Is it a barrier or an enabler?”
Jonathan McConnell – audience
“It’s the whole package – we need to take our own knowledge base forward and research enables that.”
Conference closing keynote
Suzanne Rastrick, chief allied health professions officer, NHS England
“Advanced practitioners and allied health professionals are going to transform care in the future,” said Suzanne, who thought that the conference had offered delegates a breadth of international work and experience to draw from. Future challenges faced included health and wellbeing, and care and quality, all in the face of a huge funding gap. This will not be easy and will shape how we deliver care in the 21st century, she said.
“Advanced practice is understanding how you can pitch your skills appropriately into what’s needed for the future,” she said.
“Advanced practice is about extending skills and knowledge to improve service efficiency and outcomes. For example, ask yourselves: What tasks or roles do other professions perform that our profession could?
“The need for change is very important and I see many good things happening, so why am I not seeing that everywhere, I ask myself.”
“What does success mean? What will success look like?” she asked. “It will be providing the things that we would all want for ourselves, our families and our friends.”