1. Workforce Planning in Radiography
John Parker
Medical Imaging Services Manager
NHS Ayrshire and Arran

2. ‘but we’ve always done it this way..’

3. After 70 years of universal health care, is the NHS at a crisis point?
Radiologist shortage 'affecting cancer care' in the UK
'There are patients with cancer and no-one knows'
In 10 years three out of four cancers 'will be detected at an early stage'
'There are patients with cancer and no-one knows'
After 70 years of universal health care, is the NHS at a crisis point?
NHS staff vacancies rise nearly 10% in three months amid unfolding ‘national emerge NHS staff vacancies rise nearly 10% in three months amid unfolding ‘national emergency’, report shows
NHS in grip of staff crisis: Experts warn 50,000 medics urgently needed
10 charts that show why the NHS is in trouble
AAA: the screening programme that has cut early deaths by half
NHS Highland gives assurances on radiologists
Scottish health board debts to be written off
NHS bosses will be sacked if they fail to stamp out 'alarming' bullying of hospital staff

4. Workload ? Scope to absorb
Radiology activity to
2015-6
2016-7
2017-8
diff 1-3
Total
2.7%
General/Plain X-ray Films
0.3%
General Ultrasound (excl. obstetric)
494724
499509
488444
-1.3%
Obstetric Ultrasound
112956
148519
149740
32.6%
Computer Tomography
394579
417832
433772
9.9%
Magnetic Resonance Imaging
200871
205577
211071
5.1%
Fluoroscopy
66963
65661
64590
-3.5%
DEXA
36545
38213
32564
-10.9%
Nuclear Medicine
48005
51023
50227
4.6%
Cardiac Cath
20530
23187
23028
12.2%
Angiography
8993
9255
8885
-1.2%
Dental
31291
30610
29448
-5.9%
Interventional
2620
3541
3572
36.3%
Symptomatic Mammography
7510
7695
7489
-0.3%
Mammography
60168
66265
63919
6.2%
Mobiles
2959
7050
6958
135.1%
Theatre
7269
9457
9846
35.5%
Arthro 13 40 35
169.2%
Foreign Films 29 9
0.0%
Lithotripsy
3488
3467
3547
1.7%
? Scope to absorb
no wli’s to support service, impact on staff

5. Workload Based on US=17/ day Mammo 15 day CT 40 day Mr 12 day
Radiology activity to
2015-6
2016-7
2017-8
diff 1-3
Exams
Radiographers
Machines
Total
2.7%
94080
General/Plain X-ray Films
0.3%
6420
General Ultrasound (excl. obstetric)
494724
499509
488444
-1.3%
-6280
Obstetric Ultrasound
112956
148519
149740
32.6%
36784 10
Computer Tomography
394579
417832
433772
9.9%
39193 5
Magnetic Resonance Imaging
200871
205577
211071
5.1%
10200 8 4
Fluoroscopy
66963
65661
64590
-3.5%
-2373
DEXA
36545
38213
32564
-10.9%
-3981
Nuclear Medicine
48005
51023
50227
4.6%
2222 2 1
Cardiac Cath
20530
23187
23028
12.2%
2498
Angiography
8993
9255
8885
-1.2%
-108
Dental
31291
30610
29448
-5.9%
-1843
Interventional
2620
3541
3572
36.3%
952
Symptomatic Mammography
7510
7695
7489
-0.3%
-21
Mammography
60168
66265
63919
6.2%
3751
Mobiles
2959
7050
6958
135.1%
3999
Theatre
7269
9457
9846
35.5%
2577
Arthro 13 40 35
169.2% 22
Foreign Films 29 9
0.0%
Lithotripsy
3488
3467
3547
1.7% 59 36 24
Based on US=17/ day
Mammo 15 day
CT 40 day
Mr 12 day
Also need support staff, assistants, A&C etc

6. Radiology Staffing Diagnostic radiography Scotland wte Dec-14 Dec-15
% change
Band 8C
11.0
9.5
8.5
7.5
68.2
Band 8B
21.8
20.6
21.6
30.6
21.3
97.7
Band 8A
65.1
67.3
71.3
71.8
109.5
Band 7
333.0
336.8
345.8
330.0
349.8
105.0
Band 6
795.1
796.2
796.1
841.0
842.1
105.9
Band 5
329.4
344.4
348.1
310.5
331.3
100.6
Band 4
71.2
73.4
68.7
68.6
103.1
Band 3
280.5
275.4
290.1
296.5
302.1
107.7
Band 2
54.5
55.1
62.6
65.0
58.8
107.9
1961.6
1978.7
2012.8
2022.5
2057.6
104.9
headcount
10.0
9.0
8.0 73
22.0
21.0
100
69.0
72.0
76.0
77.0
112
381.0
387.0
395.0
385.0
410.0
108
952.0
955.0
954.0
1005.0
1004.0
105
362.0
375.0
341.0
354.0 98
83.0
86.0
81.0
80.0
84.0
101
334.0
329.0
343.0
353.0
360.0
66.0
67.0
79.0
71.0
2280.0
2308.0
2331.0
2350.0
2390.0

7. Staff age profile Everyone’s looking at workforce!
Up to 300 staff in the next few years
England 9% ( 1290) due to retire by 2021

8. How does it feel now?

9. National Drivers Increasing demand Ageing workforce Realistic Medicine
Transformational change and progressing SRTP work streams:
Implementation of National Recommendations / Guidance to inform treatment decisions and improve patient care
Pension reforms
Tax/ IR35 changes!
Realistic medicine vs custom and practice, defensive medicine/ threat of being sued, training for junior doctors

10. Radiology Transformation
To develop a sustainable diagnostic radiology service to improve patient access across Ayrshire and Arran

11. Local Challenges Facing the Service
Number of patients waiting beyond the SG WTG for diagnostic test
Demand continues to outstrip capacity for both inpatients and outpatients: referrals 2010 – 2016 and 2017
CT risen by % 9%
MRI risen by % 10%
US risen by % %
Service user expectations (patients and referrers)
Recruitment challenges for both Radiographers and Radiologist

13. General x-ray

14. Challenges - general
Increasing demand (in hours vs out of hours/ referral patterns
Shift system
Acute demand versus routine demand
Increase in no concurrent referrers
Service user expectations (patients and referrers)
Recruitment challenges
Theatres/ mobiles

15. DEXA
Train additional DEXA reporting Radiographer, should be complete in October & allow us to implement the follow-up of patients on medication for bone health.
Waiting time reduced from 21 weeks to 8 weeks over 12 months, allows service to cope with :
increase in demand due to aging population
increase in clinical conditions at risk of osteoporosis requiring access to service.

16. DEXA Recruit to fill current vacancies
Train additional DEXA reporting Radiographer
Evening & weekend working to manage waiting times.
Updated SIGN guideline142- Management of osteoporosis and the prevention of fragility fractures
Fracture risk assessment required to be carried out and those with a risk over 10% to have DEXA scan carried out if appropriate.
Implement NOS recommendations once staff fully trained.
Train additional DEXA reporting Radiographer, should be complete in October & allow us to implement the follow-up of patients on medication for bone health.
The cost to the NHS of fragility fractures is significant and as a result of the aging population the NHS faces an enormous increase in fragility fractures. This in turn puts pressure on acute and community services as these injuries result in significant long term disability. Therefore preventing fragility fractures is beneficial to patients and makes good financial sense to NHS.

17. CT

18. CT -Current service Key support for ED/ CAU / Stroke service
Increase no trained staff
All radiographers to gain CT skills – skill mix
Increase capacity
Increase in out-of-hours scans – reliance on call service
Compensatory rest
Shift length
Service provided by a few specialist (radiographers)
Service development- eg cardiac CT
HCPC standards of Proficiency
Radiographers
Section14.31

19. Future CT Requirement ?

20. CT Capacity planner

21. MRI

22. MR - Current service Increasing complexity of exams
Service creep – eg MR small bowel exams
Stroke service
Scanning service provided by a few specialist radiographers
Reliance on mobile service (£120k/yr) and GJNH
No weekend service – scanner downtime / impact on inpatients
Recruitment and opportunities for staff development
GJG – 50% pts decline invite

23. US- General

24. US- Obstetric

25. US -Current service Train additional sonographers
Increase capacity – US machines
Increasing demand –general and obstetrics
Acuity of obstetric scanning- increase in guidance (small for dates/ affirm/ smokers etc)
Limited availability of sonographers
Reduce/ remove reliance on locums (cost 150k/yr)
RSI concerns for operators

26. Unblocking the pipeline
Why is radiography in Scotland a 4 year course?
Direct to modality training (US, CT, MR?)
Apprenticeships ? (bring back the DCR!!)
Assistant practitioner – extending their scope
Practitioners – all need CT training/ experience
PG training - ? Appetite to develop/ succession planning
Finance to support development
6 Pay protection
Esp B6 level
Impact on B5
Finance – revenue – not short term/ 1 off funding
Access monies

27. Reporting -Current service
2017 Part (n= 54993)

28. Consultant radiologist numbers
Region
No. of whole-time equivalent consultant radiologists
Estimated NHS scan outsourcing/overtime/ locum costs
Vacancy rate of NHS consultant radiologist posts
2014
2018
2017
U.K.
3,048
3,622
116 million pounds
165 million pounds 9%
England
2,503
3,038
99.3 million pounds
136.9 million pounds
Scotland
288
303
4 million pounds
10.4 million pounds 8%
Wales
143
155
4.9 million pounds
8.8 million pounds
10%
Northern Ireland
114
126
7.7 million pounds
9.2 million pounds
18%
Medica 1.3M
Wli 215k

29. Reporting- Current service
Increasing demand –all modalities
Reliance on locums/ outsourcing/ wli’s to meet demand
Consultant recruitment challenge
Retirements
Super sub- specialisation
Scope for advanced practice

30. Reporting- Current Use of nighthawk
Increase scope of advanced practice
Develop home working
Transformational change (shared services)
Future
Impact of AI?

31. - the numbers-the money (PF)
Advanced practice
- the numbers-the money (PF)
MSK
Cost/ case
Exams/ Session
Cost (4hrs)
Advanced practice
wli
Locum Consultant
Outsource
Share+
B8B 91
£169.16
£1.86
£6.17
£4.40
£5.00 ? B7 54
£124.76
£2.31
per year
No sessions
No exams
Cost
180
15,946
£30,448.80
990
38,299
£123,512.40
54,245
£153,961
Risk of delay in reporting - treatment/ outcome/ reputation etc
What is advanced practice aiming for - =to radiologists (error rate 5-20%)
Could afford to add some SPA time to cons job plan and still save.
Ave 1/2hr/week
England to train another 300 reporting rads

32. Advanced practice - the numbers (CT/MR)
Cost/ case
Exams/ Session
Cost (4hrs)
Advanced practice
wli
Locum Consultant
Outsource
Share+
B8B 10
£169.16
£16.92
£51.33
£36.67
£33.00 ? B7
£124.76
£12.48
Could afford to add some SPA time to cons job plan and still save.
Cost of not reporting human/ financial etc etc
Potential savings -? 2x investment

33. Questions/comments