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Principles of therapeutic radiographer staffing

The Principles of Safe Staffing for Radiography Leaders 16 outlines key considerations when reviewing staffing models, for both clinical imaging or radiotherapy/oncology services.

This guidance outlines principles of staffing that apply specifically to the therapeutic radiography workforce, thus building upon the generic guidance.16 In order to provide high quality, efficient, effective and safe radiotherapy services it is now recognised that the radiotherapy workforce profiles differ from those modelled in 2006.24 This is owing to the increasingly sophisticated nature of radiotherapy especially at the time of radiotherapy delivery. However, it is acknowledged that workforce requirements will continue to be dependent upon a number of other factors such as:

  • service provider model eg single site, multiple site services
  • commissioning arrangements eg regional, supra-regional or national service providers
  • culture to enable implementation of innovation and transformational service changes
  • skills mix across care pathways
  • links to other centres and the extent of regional-wide protocol standardisation, governance arrangements and staff cover arrangements
  • case mix
  • geographical location
  • radiotherapy equipment, eg availability of dosimetric planning (on site or remote)
  • modality and technical ability of units
  • optimal use of available technologies
  • use of automated and computer-assisted technologies when appropriate and safe
  • IT infrastructure within the centre and links with neighbouring centres.

There will be an expectation that therapeutic radiography staffing provision will enable services to provide clinical placements for pre-registration therapeutic radiographers and the clinical education of other relevant professionals.

Once the above factors have been identified within the clinical setting, there will need to be provision for the effective leadership and management of the radiotherapy service and the required therapeutic radiography workforce to ensure the following criteria are fulfilled:

a) Patient-centred service. Staffing requirements to be based upon the need to provide a patient-centred, holistic approach across the entire radiotherapy pathway of care including the provision of patient information and psychological support. It will be need to be streamlined care, sensitive and responsive to patients’ needs, and not based upon professional roles and /or historical practices.29,48 Overall staffing requirements must be identified to ensure appropriate staffing arrangements at all times, so that planned absences (professional development, mandatory training, annual, maternity and paternity leave) and unplanned absences (sickness) do not compromise the quality and continuity of treatment and care provided. 

b) Head of radiotherapy and professional lead for the therapeutic radiography workforce and named deputy/deputies. The post holder will be a registered therapeutic radiographer who works in conjunction with all relevant professional colleagues involved in providing care across the patient radiotherapy management pathway, while adhering to all relevant multi-disciplinary guidance thus enabling a multi-professional approach to workforce planning across the wider cancer care pathways.

c) Clinical governance, quality management and audit.  Service provision will need to conform with all required applicable legislation and national guidance.  Local procedures and documentation must be in place to ensure all legal requirements are met as outlined in the  recent SCoR guidance,16 examples of which are the current Ionising Radiation (Medical Exposure) Regulations and amendments (IR(ME)R)49 and the Ionising Radiations Regulations 1999 (IRR) . 50 IR(ME)R is designed to ensure patient safety and IRR to ensure public and staff safety. Non-statutory guidance exists for both Regulations.51,52 The new European Medical Exposures Directive (MED) was published at the end of 2013,53  the basis of which will form new UK radiation protection legislation in 2018.

d) Implementation of effective and appropriate skills mix across the multi-disciplinary radiotherapy workforce. The development of the radiotherapy workforce to enable effective skills mix is essential so that therapeutic radiographers play a vital role in the delivery of the more routine elements of the radiotherapy pathway previously delivered by clinical oncologists. This was clearly outlined by the National Radiotherapy Advisory Group Report24 and recently reaffirmed by the Vision for Radiotherapy Report:2014-2024.14
This principle is facilitated by the following:

i) Implementation of the career progression framework (See diagram below) to suit local service need, while enabling and supporting innovation. The Education and Career Framework for the Radiography Workforce1 defines the educational outcomes for each level of practice and is sufficiently broad to allow education and service to respond to service need when implementing innovation. Completion of SCoR accreditation54 at consultant, advanced and assistant level practice also provides assurance to employers and patients of individuals’ competence and capability to fulfil their roles.






















ii) Implementation of the three models of radiographer-led expert practice at both advanced and consultant practitioner roles:
• site specialist expert practitioners
• technical specialist expert practitioners
• community liaison expert practitioners.

Progress with the implementation of these roles across clinical practice is evident from a series of SCoR surveys.19,20,21

The three models of radiographer-led expert practice in the cancer care pathway.

iii) Effective succession planning of key posts within the therapeutic radiography workforce to ensure continuity of service provision when post holders resign.

iv) Appropriate and effective use of support workforce in radiotherapy such as:
• health care assistants being employed to support radiotherapy services by providing basic nursing tasks such as dressings, blood tests and patient care
• administrative and clerical staff providing support to all levels of practitioner throughout the pathway. These staff may cover a range of activities such as appointment scheduling, active monitoring of the service activity and cancer tracking.

e) Research and development. To provide high-quality, evidence-based and outcome-improving radiotherapy, all therapeutic radiographers must have research and development activity scheduled within their job plan. Departmental workforce planning should include provision for dedicated research and academic radiographers to lead research, to engage in international, national and local research policy, to publish findings and to translate research findings into clinical implementation. As set out in the SCoR vision for research39 all radiotherapy centres should strive to have a local research strategy and the workforce to deliver this. There is emerging evidence that patients treated within a research-active setting do better than those who do not15 and therapeutic radiographers have a vital role in the development, implementation and quality assurance of local, national and international clinical trials.

f) Data management. Increasingly the provision of high quality accurate data is a requirement to comply with mandated national data gathering eg Radiotherapy Data Set (RTDS) and locally for business planning and finances. The radiotherapy service is best placed to manage and quality control the data flows from the department. Therapeutic radiographers are integral to ensure that accurate data is inputted at source ie the record and verify systems connect to the treatment units. The management of these data items is often best supported by a dedicated therapeutic radiographer who has the knowledge and skills to verify data across the patient pathway.

g) Professional education. Professional practice with practitioner outcomes and an indicative curriculum is in place to ensure pre-registration radiographers can achieve the HCPC Standards of Proficiency55 and be well prepared for their on-going career development. There is a clear focus on professional development and collaborative practice to ensure provision in the learning environment for both pre and post registration professionals; this must be reflected in the clinical setting. Both the employer and employee are responsible for ensuring an individual’s competence to practice, enabling them to be competent to practice across the entire range of responsibilities within their current role. There should be the appropriate provision of educational and supportive roles to facilitate education and supervision for all practicing therapeutic radiographers.

The extent and manner in which (a) to (g) have been implemented in radiotherapy centres across the UK is inconsistent at the time of writing this guidance. It is imperative that these approaches are fully implemented by all service providers to the benefit of all patients in order to meet changing service need and optimise care. To assist radiotherapy managers make informed decisions about their local service needs, the information in Appendix A provides outline therapeutic radiography workforce profiles based upon the current situation for a range of differing radiotherapy service models and sizes.

It is realised that the therapeutic radiography profession is continually evolving and therefore future therapeutic radiography workforce profiles will change. In the light of this, it is expected that Appendix A will be reviewed in the future, to ensure it remains in line with the progression of therapeutic radiography professional practice.


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