28 Jan Advanced Angioplasty 2005 Staffing of diagnostic and interventional catheter labs in the DGH setting Dr David Hackett 28 Jan 2005

Consultant contract (England) Calculations – 1 Consultants available weeks / year: 30-32d annual leave +8d public holidays (= 38-40d total holidays) +10d study leave +?d professional leave +1% sickness absence leave = 48-60d = weeks total leave (5d week) Consultants work 7.5 PAs (=30h) per week in direct clinical care Only ~60% of total annual work time of consultants is in direct clinical care

28 Jan 2005Clin_labfacilities_cardiology04-.pdf3 Workforce required Diagnostic angiography ProceduresRequirement Per million population Diagn angio procedures per year 1650 – 3750 Hours per 40 min each 1100 – 2500 h +20% (inefficiency + peaks & troughs)1320 – 3000 h Lab sessions per – 800 sessions Lab sessions per – 16 sessions Diagnostic cath sessions/w0.7 – 1.6

28 Jan 2005BCS-cardiac-workforce-2004.pdf4 Cardiologists required Diagnostic angiography Per million population Sessions per – 16 pw PAs angios/w6 – 13 Cardiologists (DoH Engl) Expected cardiologists (Engl)

28 Jan 2005Clin_labfacilities_cardiology04-.pdf5 Workforce required Percutaneous Coronary Intervention Per million population CurrentMinimHi-vol PCI procedures per year Hours per 1.5h each % (ineff + peaks & troughs) Lab sessions per Lab sessions per (Assuming 1-2 cases/day out-of-hours) PCI sessions/w

28 Jan 2005BCS-cardiac-workforce-2004.pdf6 Interventionists required Percutaneous Coronary Intervention Per million population Lab sessions per – 23 pw PAs PCIs/w9 – 19 PAs PCIs/w5 – 10 Interventionists (UK) Expansion interventionists

28 Jan 2005Agenda for Change (2004)7 Calculations – 2 NHS staff available weeks per year: 27-33d annual leave +8d public holidays (= 35-41d total holidays) +?d internal clinical governance +?d study leave (internal & external) +?d external professional leave +4.7% sickness absence leave = 36-52d = 7-10 weeks total leave (5d week)

28 Jan 2005Agenda for Change (2004)8 Calculations – 3 Staff work 37.5h per week = 10 x 3.75h sessions Allow clinical staff time for: service management, training, audit, continuous education & development, appraisal, clinical governance. Either one-third (senior) staff x 3 sessions per week Or all staff one session per week Perhaps 90% of work time by professional clinical staff is in direct clinical care = h per week Only 70-80% of total annual work time of clinical staff is in direct clinical care = weeks/yr

28 Jan 2005BCS-cardiac-workforce-2004.pdf9 Non-medical workforce required Per million population DiagnPCITotal Sessions pw Nurses x Physiols x Radiogrs x Total Current Cardiac Physiologists (DoH Engl) ~3000 WTE = 61 pmp

28 Jan Non-medical workforce Non-medical workforce: More specialisation No service contribution from trainees General core training (University) Degree entry; State Registration Agenda for Change Post-graduate sub-specialisation

28 Jan 2005BCIS auditdata2003.ppt11 Interventionists required on-call Emergency 24h/7d PCI Interventionists per PCI centre UK (2003) Intervents1-5≥61-9 ≥10 Centres Expansion by 2010: 600 interventionists in UK If 10 interventionists on-call rota in each centre = 60 on-call centres each serving 1m population

28 Jan 2005BCS-cardiac-workforce-2004.pdf12 Non-medical workforce on-call Emergency 24h/7d PCI Per million population DiagnPCITotal Sessions pw Nurses x Physiols x Radiogrs x Total

28 Jan 2005www.bcs.com13 BCS workforce resources > resources > workforce issues BCS Cardiac Workforce Requirements in the UK (2004): Workforce-2004.pdf BCS Clinical and Laboratory Facilities (2004): ology04-.pdf

28 Jan 2005Clin_labfacilities_cardiology04-.pdf14 AA2005 How many cath labs required in the UK? per million pop Diagnostic coronary labs0.7 – 1.6 PCI + other card intervention1.7 – 2.7 Total coronary labs2.4 – 4.3 PPM, device & electric labs3.7 – 4.6