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Radiography has seen most development over the last 30 years with the evolution of new technologies, but perhaps more significantly changes in education models and radiographer roles. The development of advanced and consultant posts has facilitated the growth of the profession, although the evidence base is still evolving. Through a number of research projects this thesis will explore the growth in the radiography evidence base with specific reference to the extending role of the radiographer in image interpretation. Parallel clinical and academic developments have provided evidence of a scholarly profession which is slowly establishing its place through publication and a growing research base. / Please Note: The full text of each of the published articles, which are listed on page vii, has been removed from the PhD online copy due to publisher copyright restrictions. Links to the publisher¿s websites are given. To see the final full text version of the articles listed on page vii, please visit the publisher¿s website. Available access to the published online version may require a subscription.

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No / In the face of growing demand in radiology, skill mix initiatives have sought to improve and expand service provision. Within the UK radiographer reporting is now widespread, although the growth in computerised tomography (CT) head reporting has not been as rapid as anticipated. The literature in this area is limited, but case studies have highlighted the successful implementation of this training through new radiographer roles in practice. Method A cross-sectional survey was developed to elicit information from radiographers and managers on their experiences before, during and after post-graduate training in CT head reporting. Results Seventy one responses were received comprising 48 past students (n = 48/111; 43.2%) and 23 service managers (n = 23/67; 34.3%). Key factors for the development were personal continual professional development for students and departmental need for managers. Challenges during training included a lack of study time due to staff shortages and access to radiologist mentors. Only 48.8% of students responding have gone on to use the new skills in practice cited reasons include staff shortages, resistance from radiologists and increase in radiological staffing. Conclusions This qualitative study has demonstrated that those trusts who have implemented CT head reporting have evidenced perceptible benefits for both the department and individuals. Those radiographers who are successfully reporting have shown themselves to be highly motivated and persistent in their development.

Yes / Objectives To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. Methods Using the World Health Organisation definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs and data were systematically extracted using electronic data extraction proforma. Results 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n=7) focussing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The papers were generally considered to be of low to moderate quality with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No papers reported data relating to time to diagnosis, time to recovery or patient mortality. Conclusions Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. Advances in knowledge This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality. Powered by

No / Non-medical consultant posts are a relatively new addition to the National Health Service (NHS) workforce, the role first being announced for nurses in 1998 followed by the Allied Health Professions in 2000. They have been described as multidimensional positions that encompass the four core functions of consultant practice: expert clinical practice; professional leadership and consultancy; practice and service development, research and evaluation; education and professional development. Consequently, the purpose of non-medical consultants is to promote and develop practice at the clinical, strategic and policy level. Despite the professional drive to develop consultant radiographer roles, by the end of 2005 only 15 were in post. One of the reasons for this poor appointment rate is the deficiency in suitably qualified and experienced candidates, a finding acknowledged to be an issue across all the non-medical professions. Further, the development of potential consultant practitioners has been hampered by the lack of clearly defined clinical and educational pathways. This paper acknowledges the limited published material available to radiographers wishing to advance to consultant positions. Yet while recognising the need to establish a true consultant career pathway underpinned by an appropriate education and research strategy, it explores the requirements of consultant practice, identifying some opportunities available to radiographers to develop appropriate consultant level skills.

No / The terms ‘extended’ and ‘advanced’ practice are commonly used to describe clinical practitioner roles. However, these terms have not been clearly defined within the context of modern radiography practice despite their fundamental importance to establishing the 4 tier structure, implementing Agenda for Change and promoting a coherent clinical radiography career structure. This paper discusses the terms ‘extension’ and ‘advancement’ in relation to radiography practice and, using evidence from the debates of other health professions, attempts to offer some clarity to the terminology, presenting one interpretation of its possible application to the radiographer role in the United Kingdom.

No / The number of children in the UK with life-limiting conditions and the demand for home-based palliative care is increasing. Children's hospices remain a dominant provider of palliative care. This study aimed to determine the approaches taken by children's hospices across the UK in meeting the planned and unplanned health needs of children and their families who receive palliative care at home. In addition, the survey aimed to identify the professional composition of community teams and the number of children and families supported by each service. An internet-based questionnaire survey was sent to all children's hospices in the UK, comprising ten questions exploring the size of the team, geographical areas covered, workforce composition, services offered and approaches to managing unplanned, out of hours care. Responses were received from 14 (26%) of the hospices. A total of 1,618 children and their families were being cared for by these hospices, of whom 825 received care at home. Registered nurses constituted the greatest proportion of staff and were employed by all teams. Care provided at home was broadly split into two categories: planned short breaks and responsive palliative nursing. The latter comprised advance care planning, anticipatory prescribing and active symptom control. Out of hours care was usually offered in the form of telephone support. Models of community-based care are evolving to include nurses practising at specialist and advanced levels, allowing more children with increasingly complex conditions to be cared for at home.

Yes / The Health Care and Professions Council (HCPC) regulates fifteen different professions; some of these are large groups like Physiotherapists and some are much smaller such as Speech and Language Therapists (SLT). Most of the people registered by the HCPC work within their own areas of clinical expertise and defined professional scope of practice. However, an increasing number of registrants are undertaking new or additional roles beyond the traditional scope of practice for the defined profession. These roles are often shared with other medical or health professionals and persons undertaking these roles are often, but not consistently, referred to as Advanced Practitioners. Advanced Practitioners are employed within the NHS across all four countries of the UK and are also employed by private healthcare providers. The roles they undertake vary from the highly specialised (e.g. an advanced podiatrist might specialise in biomechanics) to more general roles with greater professional autonomy and decision-making (e.g. a paramedic working in a GP Practice assessing patients with undifferentiated acute problems). As a result, there is currently no consistency in role title, scope of advanced practice, necessary underpinning education or professional accreditation across the HCPC registered professions. This study was undertaken to explore these issues and seek opinion on the need for additional regulatory measures for persons working at an advanced practice level. NB: For the purposes of this study, advanced practice was considered to encompass all roles, regardless of role title, where the level of practice undertaken was considered to be advanced. Method Three approaches to data collection were undertaken to ensure the differing opinions across all HCPC registered professions, different stakeholders and the four nations of the UK were collected. Data were collected through: 1. A UK wide survey of HCPC registered healthcare professionals; 2. A UK wide survey of organisations delivering AHP & scientific advanced practice education; 3. A series of focus groups and interviews across a range of stakeholder groups. Findings The concept of advanced level practice was not consistently understood or interpreted across the different stakeholder groups. Those participants identifying as working at an advanced practice level undertook a range of activities both within and out with the traditional scope of practice of the registered profession adding a further layer of complexity. Educational support and availability for advanced level practice varied across professional groups and inequity of accessibility and appropriateness of content were raised as concerns. There is no consensus across participant groups on the need for regulation of advanced level practice. Perceived advantages to additional regulation were the consistent and equal educational and employer governance expectations, particularly where multiple professional groups are undertaking the same role, all be it with a differing professional educational foundation and lens. However, while some voices across the participant groups felt regulation was essential to assure practice standards and reduce risk of role title misuse, there was equally a lack of appetite for regulation that inhibited agility to respond to, and reflect, the rapidly changing healthcare environment and evolving scope of advanced level practice. Importantly, no evidence was presented from any participant group that advanced level practice within HCPC regulated professions presents a risk to the public. Conclusion The study data presented in this report reflect the complexity of the concept of advanced practice within the HCPC regulated professions. Much of this is a consequence of the differing speeds of professional role development across healthcare organisations and professional groups, often related to service capacity gaps and locally developed education to support local initiatives. Despite this, there is no clear evidence, based on the findings of this research, that additional regulation of advanced level practice is needed, or desired, to protect the public. However, as the HCPC is one of the few organisations with a UK wide remit, it may have a central role in achieving unification across the 4 nations in relation to the future role expectations, educational standards, and governance of advanced level practice.