Yes / Objectives: 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. Methods: 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. Results: 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. Conclusions: 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. Advances in knowledge: 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. / This study is funded by the NIHR Health Services and Delivery Research programme (I.D. NIHR133813).

Yes / Introduction: In the UK the development of skill mix in radiography at the end of the 20th century formalised the assistant practitioner role, separating it from the support worker function. The key aim was to increase imaging capacity whilst enabling opportunities for career progression within both the support and radiography workforce. There has been limited examination of these support and assistive roles and this review aims to explore the current evidence. Methods: This scoping review used a systematic search strategy and interrogated MEDLINE, CINAHL, Scopus and Google Scholar. Primary research articles published in the English-language referring to studies conducted in the UK on assistant or support roles in radiography were sought. The sourced data was uploaded to a web-based review platform for screening. Results: The literature search identified only 11 articles which met the search criteria, of which only one referred to the support worker role. Adopting a primarily qualitative approach the quality of the articles varied. Thematic analysis was undertaken using a priori themes role purpose, outcomes, aspirations and capacity building. Conclusion: There is limited research evidence of capacity generation with most presenting individual perspectives. Job satisfaction and career aspirations within the support and assistive workforce are evident but there is still confusion over scope of practice and supervision. Implications for practice: The support and assistive workforce are a key part of the diagnostic imaging workforce but limited research evidence examining these roles has been published. Further research exploring the impact of skill mix changes across all levels and imaging professions is required. / The study was funded by the NIHR Health and Social Care Delivery Research programme (I.D. NIHR133813).

Yes / Introduction Over the last 2 decades the assistant radiographer practitioner (ARP) role has been introduced into NHS diagnostic imaging departments as a strategy to expand the workforce and create capacity. This skill mix initiative has not been implemented in a standardised way and there is limited knowledge of the current role scope within general radiography (X-Ray). Method An electronic survey of ARPs working within UK diagnostic imaging departments was conducted. Both open and closed questions sought information regarding basic demographic data (age category; gender; geographic region), scope of practice (patient groups; anatomical regions; imaging outside of the diagnostic imaging department), limitations placed on practice, supervision and additional roles. Results A total of 108 responses, including 13 trainees, were received. Most sites employ three or less ARPs in general radiography (n = 43/66; 65.2%), although 11 sites have five (range 1–15). The majority undertake imaging of both adults and children (n = 85/108; 78.7%), although limitations on age were described. Their scope of practice covers a broad anatomical range and included some non-ambulant patients. The level of supervision varied with some sites empowering ARPs to check the referral prior to examination (n = 25) or images post acquisition (n = 32) (both n = 20/66; χ2 = 16.003; 1df; p = 0.000). Conclusion ARPs are helping to maintain capacity in imaging departments but we suggest there is further scope for expansion. The practice described by the post holders suggests that many are working beyond the scope envisaged by the radiography professional body.

Yes / Skill mix has been established as one method of maintaining imaging service delivery, with vertical and horizontal substitution of roles and tasks. Assistant practitioners (APs) have been undertaking limited imaging practice for almost two decades, but there remains a paucity of evidence related to the impact of their roles. Methods: This article reports on an electronic survey of individual APs within the NHS in the UK to explore utilisation, role scope and aspirations. Results: Responses were analysed from APs (n = 193) employed in 97 different organisations across the UK. The majority work in general radiography or mammography, with very few responses from other imaging modalities. Training routes varied across modalities, with most achieving Band 4 under Agenda for Change on completion of education. Limitations on practice vary between organisations and modalities, with many reporting blurring of the radiographer-AP boundary. Many aspire to continue their training to achieve registrant radiographer status, although there were clear frustrations from respondents over the lack of overt career prospects. Conclusion: Integration of the role into imaging department practice does not appear to be universal or consistent and further research is required to examine the optimal skill mix composition. Advances in knowledge: Skill mix implementation is inconsistent across modalities and geography in the UK. Opportunities for further workforce utilisation and expansion are evident.