1. 28 Jan 20051 Advanced Angioplasty 2005 Staffing of diagnostic and interventional catheter labs in the DGH setting Dr David Hackett 28 Jan 2005

2. Consultant contract (England) 20032 Calculations – 1 Consultants available 40-42 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 = 10-12 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

3. 28 Jan 2005Clin_labfacilities_cardiology04-.pdf3 Workforce required Diagnostic angiography ProceduresRequirement Per million population Diagn angio procedures per year 1650 – 3750 Hours per year @ 40 min each 1100 – 2500 h +20% (inefficiency + peaks & troughs)1320 – 3000 h Lab sessions per year @3.75h352 – 800 sessions Lab sessions per week @50w/y7 – 16 sessions Diagnostic cath labs @10 sessions/w0.7 – 1.6

4. 28 Jan 2005BCS-cardiac-workforce-2004.pdf4 Cardiologists required Diagnostic angiography Per million population Sessions per week @50w/y7 – 16 pw Cardiologists @2 PAs angios/w6 – 13 Cardiologists (DoH Engl) 2003 @609-65913 Expected cardiologists (Engl) 2010 @90018

5. 28 Jan 2005Clin_labfacilities_cardiology04-.pdf5 Workforce required Percutaneous Coronary Intervention Per million population CurrentMinimHi-vol PCI procedures per year150022003000 Hours per year @ 1.5h each225033004500 +20% (ineff + peaks & troughs)270039605400 Lab sessions per year @3.75h72010561440 Lab sessions per week @50w/y (Assuming 1-2 cases/day out-of-hours) 111523 PCI labs @10 sessions/w1.11.52.3

6. 28 Jan 2005BCS-cardiac-workforce-2004.pdf6 Interventionists required Percutaneous Coronary Intervention Per million population Lab sessions per week @50w/y11 – 23 pw Interventionists @2 PAs PCIs/w9 – 19 Interventionists @4 PAs PCIs/w5 – 10 Interventionists (UK) 2003 @3626 Expansion interventionists 2010 @60%+10

7. 28 Jan 2005Agenda for Change (2004)7 Calculations – 2 NHS staff available 42-45 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)

8. 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 = 33.75 h per week Only 70-80% of total annual work time of clinical staff is in direct clinical care = 38-41 weeks/yr

9. 28 Jan 2005BCS-cardiac-workforce-2004.pdf9 Non-medical workforce required Per million population DiagnPCITotal Sessions pw7-1611-2318-39 Nurses x33-64-97-16 Physiols x1.51-32-54-8 Radiogrs x1.51-32-54-8 Total6-139-1814-31 Current Cardiac Physiologists (DoH Engl) ~3000 WTE = 61 pmp

10. 28 Jan 200510 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

11. 28 Jan 2005BCIS auditdata2003.ppt11 Interventionists required on-call Emergency 24h/7d PCI Interventionists per PCI centre UK (2003) Intervents1-5≥61-9 ≥10 Centres2331459 Expansion by 2010: 600 interventionists in UK If 10 interventionists on-call rota in each centre = 60 on-call centres each serving 1m population

12. 28 Jan 2005BCS-cardiac-workforce-2004.pdf12 Non-medical workforce on-call Emergency 24h/7d PCI Per million population DiagnPCITotal Sessions pw7-1611-2318-39 Nurses x33-64-97-16 Physiols x1.51-32-54-8 Radiogrs x1.51-32-54-8 Total6-139-1814-31

13. 28 Jan 2005www.bcs.com13 BCS workforce resources http://www.bcs.comhttp://www.bcs.com > resources > workforce issues BCS Cardiac Workforce Requirements in the UK (2004): http://www.bcs.com/download/221/BCS-Cardiac- Workforce-2004.pdf BCS Clinical and Laboratory Facilities (2004): http://www.bcs.com/download/287/Clin_labfacilities_cardi ology04-.pdf dhackett@globalnet.co.uk

14. 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