Julie Nightingale

Introduction: The assistant practitioner (AP) role was introduced into the United Kingdom radiography profession to grow diagnostic imaging capacity and enable radiographers to take on more complex tasks. Despite limited evaluation into the utilization and impact of the role, recent national workforce strategies have called for further expansion of AP numbers. Purpose: To examine the contemporary status of the AP within imaging departments, identifying how and why roles have been established, the benefits and challenges of their deployment and potential for further expansion of this workforce group. Methods: Forming part of a wider mixed methods explanatory study, this qualitative research utilized a case study approach. The individual cases represented nine geographically diverse English NHS imaging departments. Data collection took place during single day visits and comprised multiple interviews and focus groups including APs (n = 30) and service leads (n = 34) together with collation of AP specific role documents. Within and across case analysis was undertaken. Results: The assistant practice level expands the healthcare workforce and increases clinical capacity. Whilst some imaging services have embraced the role, others are reticent. The reasons appear multifactorial including an unclear scope of practice, lack of standardized education pathway or curriculum and limited career progression opportunities. Conclusion: Twenty-five years after its inception in the radiography professional landscape, the AP role is embedded in imaging departments, but not at the scale originally envisaged. There remains a clear potential to utilize the AP workforce to expand capacity in the diagnostic imaging sector.

Background: Demand for imaging in England massively outstrips supply in terms of workforce capacity, with well-documented shortages of both radiographers and radiologists. The COVID-19 pandemic exacerbated already stretched services, which have remained ‘in crisis’. Three high profile national reports highlighted the urgent need to develop the capacity and capability of the imaging support workforce, yet it is unclear how this vital workforce is utilised. Aim: To investigate the development, deployment and contribution of the support workforce to diagnostic imaging activity across England to determine effective models of practice that will support future workforce transformation and re-design. Research question: What models of deployment of the support workforce exist within diagnostic imaging departments and what service, hospital, regional and national factors may encourage or inhibit implementation of these models? Design: The study employed a mixed-methods explanatory research design, comprising six consecutive workstreams spanning 27 months: (Workstream 1) scoping review; (Workstream 2) census of imaging workforce; (Workstream 3) engagement with imaging networks; (Workstream 4) deep dive review of selected trusts; (Workstream 5) qualitative case studies; (Workstream 6) determinant framework. Setting and participants: All National Health Service diagnostic imaging (radiology) services and imaging networks located within England were in scope. Participants included imaging network representatives ( n = 18), radiology service managers ( n = 24), and Imaging Support Workers and Assistant Practitioners, their supervisors and department managers (WS5, n = 113). Interventions: This was an exploratory observational study. Outcome measures: Findings were synthesised to create a determinant framework (Maturity Matrix) for the effective deployment of the imaging support workforce. A Public Summary encapsulated the key findings for imaging services, the wider healthcare community, and for patients and the public. Data sources: National Health Service Electronic Staff Record database ( n = 144 National Health Service Trusts); interviews ( n = 38); focus groups ( n = 15); documentary analysis ( n = 48). Results: The support workforce (National Health Service pay Bands 2–4) constitutes 23.6% of the non-medical imaging workforce (22.2% median, interquartile range 14.9–29.1). Opposing deployment models were identified, based on grade preference (Band 2 or Band 3) and role flexibility (static or rotational). Wide variations in job titles, roles, grades, competencies and scopes of practice are evident both between National Health Service Trust hospitals and within individual imaging departments. With the exception of breast imaging, assistant practitioners (Band 4) appear underutilised in most imaging services. Limitations: Inconsistent and incomplete data in the Electronic Staff Records potentially compromised data quality; however, subsequent participant-supplied data were comparable. Conclusions: Imaging support workers are ‘absolutely pivotal’ to smooth patient workflow and the patient experience; however, unwarranted variations in support workforce deployment and utilisation compromise recruitment, retention, career progression and innovation. This workforce appears to be operationally managed rather than strategically planned which potentially limits the impact of the support workforce on the wider imaging workforce crisis. Future work: The Imaging Support Workforce Maturity Matrix provides a management tool to support review and harmonisation of the imaging support workforce at national, regional, hospital, imaging department and modality levels. A widespread reluctance to fully utilise Assistant Practitioners and enable them to seamlessly progress to registered practice requires further investigation. Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR133813.

Background: Radiology is a multidisciplinary specialty, combining the medical specialism of radiologists with the clinical expertise of diagnostic radiographers. Radiographers are skilled in performing imaging procedures such as X-Rays, ultrasound and computed tomography scans to diagnose and monitor conditions within a wide range of patient pathways, and they are assisted by support workers who enable service delivery by providing patient facing and ancillary activities. Imaging service demands in the United Kingdom continue to outpace growth in the radiographer workforce, and there is an urgent need to explore the potential for developing the capability and capacity of the imaging support workforce. A multi-centre mixed methods study investigated the determinants for the utilisation of the radiography support workforce in England, presenting the findings in a maturity matrix. A maturity matrix is an actionable tool which aims to facilitate practice improvements, presented as a series of distinct, iterative steps that showcase the desired developmental path towards an effective service. Methods: The mixed methods study employed an explanatory sequential, multi-stage advanced framework design, involving six consecutive workstreams. The final workstream synthesised and integrated findings from the previous workstreams to identify the key factors that contribute to best practices in imaging support workforce deployment. Documentation of critical determinants and articulation of quality indicators were modelled into a maturity matrix to be used by imaging managers to review and plan the development of their support workforce. Results: The Imaging Support Workforce Maturity Matrix is constructed as a means of tackling workforce improvements and tracking progress over time at service level. Fifteen critical determinants within three themed categories (evidence-based workforce planning; deployment; development and progression) were embedded within the matrix. Each determinant is presented for self-assessment against four levels of service maturity (Emerging, Developing, Maturing, and Thriving). These support assessment and action-planning towards the goal of fully developing the role and progression route for the support workforce. Conclusion: The Imaging Support Workforce Maturity Matrix is presented. The actionable tool was reviewed with service managers in a first stage of validation and further research will be undertaken to implement appropriately across other allied health professions.

The imaging support workforce is a key enabler in unlocking imaging capacity and capability, yet no evidence exists of the workforce size and configuration. This research provides the first comprehensive analysis of workforce data to explore the deployment of the support workforce within National Health Service (NHS) imaging services in England. Using a census methodology, an anonymized electronic staff record (ESR) data set extracted in December 2022 was analysed to identify support workers and their employment bandings at NHS Trust, regional and national (England) level. Support workforce proportions, median values, and Spearman’s rank correlations were calculated. Analysis of 137 NHS Trusts, comprising 100% of acute trusts (n = 124) and specialist trusts with imaging services (n = 13), identified that the support workforce (pay bands 2-4) constitutes 23.6% of the imaging staff base. Ranking trusts into 3 categories based on the proportion of support workers in their imaging establishment, median values ranged from 30.7% (high) to 22.2% (medium) and 10.5% (low). Two opposing deployment models of band 2 and band 3 support workers were identified. Comprising almost one-quarter of the imaging establishment, models of deployment at bands 2 and 3 are highly variable. Assistant practitioners (band 4) are under-utilised, providing an opportunity to introduce innovations to address workforce demands. This census is the first to provide evidence of the size and structure of the support workforce, the first step in enabling effective workforce transformation. Further research is required to explain the two opposing deployment models.

The demand for healthcare services internationally continues to increase, exacerbated by patient backlogs resulting from the COVID-19 pandemic and the difficulties in recruiting and retaining healthcare staff. These difficulties have led to increased interest in workforce redesign, and the upskilling of existing staff in all areas of healthcare, including within the Allied Health Professions (AHP). Clinical support staff are a key component of workforce redesign, yet little has been documented on the utilization of this workforce across the wide range of professions that collectively form the AHP workforce. Existing research is also unclear due to the variety of titles used to describe them (eg, allied health assistants, therapy assistants, etc). This study aimed to review how Support Workers and Assistant Practitioners (SWAPs) are utilized within the AHP professions. Electronic databases (MEDLINE, CINAHL complete, Scopus, and Google Scholar) were searched to find English Language primary research articles that explored the deployment of clinical support staff within Allied Health. Following the scoping review methodology, data from each study were analyzed in terms of design, key findings, and implications. A quality assessment was also completed. Thirty-nine articles met the eligibility criteria. Studies were undertaken in Australia, UK, and USA, and covered a range of AHPs and methodological approaches. Most articles employed qualitative methods, with highly variable research quality identified. Key findings were that cost-effectiveness of this workforce has not been formally evaluated in any setting or AHP discipline, and that support workers are a largely underutilized staff group potentially due to inconsistencies in their deployment and scope of practice, and the lack of a clear career pathway. Rigorous, quantitative, and mixed methods research into the deployment and impact of this staff group is needed in order to gain a clearer understanding of how they are optimally utilized across the different AHP disciplines.