Radiotherapy: meeting the current workforce challenges for patient care in a changing context

19 MAY 2014

RADIOTHERAPY MEETING THE CURRENT AND FUTURE WORKFORCE CHALLENGES FOR PATIENT CARE IN A CHANGING CONTEXT Venue: The Royal Society of Medicine, London CPD: 5 CREDITS AND ENDORSED BY CPD NOW

BIR Annual Congress 2014: 22-23 October, London

Welcome and thank you for coming to the ‘Radiotherapy - meeting the current and future workforce challenges for patient care in a changing context’ event organised jointly by the BIR, IPEM, RCR and SCoR. This booklet contains the abstracts and biographies for each speaker.

This meeting has been awarded 5 RCR category I CPD credits and may help to meet outcomes 1, 2, 6, 7, 9-13, 18 and 23 of CPD Now. CPD certificates will be distributed by email within two weeks of the meeting once the online delegate survey has been completed.

Please complete the online delegate survey using the below link. We will use your valuable feedback to improve future conferences. https://www.surveymonkey.com/s/radiotherapyworkforcechallenges We hope you find the day interesting and enjoyable.

We are most grateful to

for supporting this conference

Programme

09:30 Registration and refreshments

10:00 Introduction

Revd Dr Mike Kirby, Lecturer, Medical Physics and Curate, Blackburn

Cathedral and Directorate of Medical Imaging and Radiotherapy,

University of Liverpool

Ms Charlotte Beardmore, Director of Professional Policy,

The Society and College of Radiographers 10:05 Clinical reference group - RT workforce objectives

Dr Peter Kirkbride, Medical Director,

The Clatterbridge Cancer Centre NHS Foundation Trust 10:25 Setting the scene - workforce planning and education in England

Ms Lisa Hughes, Strategy Lead, Health Education England 10:45 Developing the RT workforce - pre-registration workforce challenges

Mr Gary Dakin, Healthcare Science and AHP Lead,

Health Education North Central and East London 11:05 Developing the RT workforce - post-registration workforce challenges

Ms Sue Louth, North West AHP Workforce Lead

North West Centre for Professional Development 11:25 Refreshments 11:40 Radiotherapy board - workforce challenges for radiotherapy services

Dr Diana Tait, Chair, the Radiotherapy Board,

Vice President (Oncology), The Royal College of Radiologists 12:00 Royal College of Radiologists perspectives

Dr Di Gilson, Medical Director for Education and Training for Clinical

Oncology, Royal College of Radiologists 12:20 Society and College of Radiographers perspectives

Ms Charlotte Beardmore, Director of Professional Policy,

The Society and College of Radiographers 12:40 Institute of Physics and Engineering in Medicine perspectives

Professor Andy Beavis, Head of Radiotherapy Physics,

Hull and East Yorkshire Hospitals NHS Trust 13:00 Lunch

13:50

Introduction to second session Mr Andrew Poynter, Consultant Radiotherapy Physicist and Head of Radiotherapy Physics, Peterborough City Hospital Dr Diana Tait, Chair, the Radiotherapy Board, Vice President (Oncology), The Royal College of Radiologists

13:55 Clinical experience - IGRT and adaptive RT

Ms June Dean, Superintendent Therapy Radiographer,

Addenbrooke’s Hospital 14:15 Clinical experience - stereotactic RT and RS

Ms Alexandra Aitken, Radiosurgery Lead Radiotherapist,

The CyberKnife Centre London, The Harley Street Clinic 14:35 RT service development - proton therapy

Dr Ranald MacKay, Director of Christie Medical Physics & Engineering,

The Christie NHS Foundation Trust 14:55 Refreshments 15:10

Radiography education programme development

Revd Dr Mike Kirby, Lecturer, Medical Physics and Curate, Blackburn

Cathedral, Directorate of Medical Imaging and Radiotherapy, University of Liverpool

15:30 Workforce integrated planning tool - clinical dimensions

Ms Julie Massey, General Manager for Radiation Services,

The Clatterbridge Cancer Centre 15:50 Panel discussion

SCoR, IPEM, RCR representatives 16:30 Close of meeting

Please remember to complete the online delegate survey using the below link: https://www.surveymonkey.com/s/radiotherapyworkforcechallenges Your certificate of attendance will be emailed to you within the next two weeks once these have been completed.

BIR Annual Congress 2014: 22-23 October, London

Speaker profiles

Ms Alexandra Aitken Radiosurgery Lead Radiotherapist The CyberKnife Centre London, The Harley Street Clinic Alexandra Aitken qualified at the University of Hertfordshire and has had significant clinical experience in particular Intensity Modulated Radiotherapy (IMRT), Image Guided Radiotherapy (IGRT), Stereotactic Radisurgery (SRS) and Steriotactic Body Radiotherapy (SBRT), clinical trials and research. Alexandra is currently the radiosurgery lead radiotherapist at The Harley Street Clinic.

Ms Charlotte Beardmore Director of Professional Policy, The Society and College of Radiographers Charlotte qualified as a dual qualified radiographer in the early 1980’s from Guy’s Hospital, London, working clinically in radiotherapy at the Royal Marsden NHS Trust, and then as Radiotherapy Services Manager in Reading. During this clinical period Charlotte was also elected to UK Council, 1996-2001, and served as President of the Society and College of Radiographers from 2000-2001.

In 2001 Charlotte was awarded the Fellowship of the College of Radiographers.

In 2001, Charlotte was offered an opportunity to be a project consultant within a team at the Department of Health, leading the Radiography Skills Mix Project.

This work built upon much of the work that she had contributed to during her period on the Society and College of Radiographers (SCoR) Council. The outputs of this work support the College of Radiographers career progression model for radiographers in the UK. In 2004, Charlotte took a post as a Professional Officer for radiotherapy of the SCoR, and in 2012 became the Professional and Educational Manager within the SCoR and later this year takes up the post of Director of Professional Policy.

Charlotte has represented SCoR on many national radiotherapy groups including NRAG and NRIG and is currently a member of a number of national groups which include the Radiotherapy Board (SCoR, IPEM and RCR), the Radiotherapy Programme Board in Scotland, the DH Proton Special Interest Group and the NHS England Radiotherapy Clinical Reference Group. Beyond the UK, Charlotte has been invited to contribute to work being led by the IAEA on Radiotherapy workforce and the WHO on Patient Safety in Radiotherapy, and is an invited speaker to the 2014 Combined Scientific meeting of the Royal Australasian and New Zealand College of Radiologists, the Australian Institute of Radiography and the Australasian College of Physics Scientists and Engineers in Medicine.

Charlotte’s new role as Director of Professional Policy is to provide direction and support to the breadth of the radiographic profession working with key professional groups, stakeholders and patient groups to help support the delivery of high quality services for patients across clinical imaging and radiotherapy services.

Professor Andy Beavis Head of Radiotherapy Physics, Hull and East Yorkshire Hospitals NHS Trust Professor Andrew W Beavis has worked in the NHS, as a clinical Radiotherapy Physicist, since 1992 having gained a PhD and undertaken a subsequent Research Associates post at Newcastle University in Solid State Physics. He is currently a Consultant Medical Physicist also holding a Visiting Professorship at SheffieldHallamshire University, Hon. Professorship at the University of Hull and Hon. Reader at the Hull-York Medical School (HYMS). He is the Head of Radiation Physics in the Hull and East Yorkshire Trust and leads a department of approximately 30 scientists and technicians.

Professional qualifications include Fellow of the British Institute of Radiology, Fellow of the Institute of Physics and Engineering in Medicine, Member of the Institute of Directors, Member of the Institute of Physics, Chartered Physicist and Chartered Scientist.

He has contributed to the development of many new clinical techniques, for the treatment of cancer with radiation, in Hull. These include: continued development of computer aided treatment planning, Conformal therapy (development of the 3D-CRT process), implementation of Intensity Modulated Radiotherapy into clinical use, implementation of Image Guided Radiotherapy into clinical use, use of advanced MRI in routine planning, Virtual Simulation process, Development of Virtual reality training/ clinical tools and the National implementation of this technology into routine use.

He has acted as Medical Expert/ beta test site for Computerised Medical Systems Inc., Varian Oncology Systems, Tomotherapy Inc, ViewRay Inc and Phillips Medical Systems.

Professional activity includes acting as a reviewer for various international journals and teaching on a variety of national and international courses, including ones run by the International Atomic Energy Agency. He is involved with a number of Universities and National training programs in Medical Physics. Between 2011 and 2013 he was Chair of the National Radiotherapy Implementation Groups Service Delivery committee and continues to work on the Tri-professional Radiotherapy Board.

Publications include invited book chapters, contribution to National guidelines and DoH reports, various manuscripts in refereed journals and conference proceedings.

A large number of invited talks and seminars have been given on a variety of subjects related to Radiotherapy.

He is a Founder and Director of Vertual Ltd which manufacturers a Virtual Environment for Radiotherapy Training (VERT). The work that led to this venture has been very successful and references to it in recent national health care documents (National radiotherapy Advisory Group report, May 2007 and Cancer Reform Strategy, December 2007) show that it has changed national philosophy and policy on radiotherapy training. In 2009 he was awarded the IPEM Manufacturers prize and the Department of Health’s Healthcare Science Award for Innovation and Invention for his work in developing VERT and introducing VR training into routine use in Oncology.

Andy has a variety of interests outside of his professional world, although most of his time is absorbed by his three children! Relaxation is provided by his love of music (an obsession with Hawkwind) and Rugby League (Hull FC).

Mr Gary Dakin Healthcare Science and AHP Lead, Health Education North Central and East London Gary has over 25 years experience working as a Biomedical Scientist in NHS pathology services. He was appointed as Healthcare Scientist Lead at the former North Central London SHA in 2004 before moving into a post at NHS London in 2007 to support Professor Lord Ara Darzi to deliver Healthcare for London. Gary then moved within NHS London to become Workforce Lead for Modernising Scientific Careers. Currently Gary is Healthcare Science and AHP Lead at Health Education North Central and East London.

Ms June Dean Superintendent Therapy Radiographer, Addenbrooke’s Hospital June is a Superintendent Therapy Radiographer with more than 17 years of clinical experience, in both the UK and in the USA. She has always been committed to the accurate and safe delivery of radiotherapy and working as a translational research radiographer has provided her with the opportunity to take the lead in introducing new and exciting treatment delivery imaging and systems.

Projects have included the local implementation of Intensity Modulated Radiotherapy (IMRT) (both Linac and tomotherapy), portal imaging, Image Guided Radiotherapy (IGRT), adaptive radiotherapy and tomotherapy based SRS, Stereotactic Body Radiotherapy (SBRT), Stereotactic Ablative Radiotherapy (SABR) and Total Marrow/ Lymph Irradiation (TMLI).

She has served as a radiographer representative on the HPA patient safety group and is currently a member of the RTTQA (IGRT) Subgroup. June has recently completed a secondment with NCAT as one of 2 IGRT support leads for the national implementation of IGRT. Dr Di Gilson Medical Director for Education and Training for Clinical Oncology, Royal College of Radiologists I am currently the Royal College of Radiologists Medical Director for Education and Training for Clinical Oncology and member of the Radiotherapy Board. I am a Consultant Clinical Oncologist working in Leeds.

Ms Lisa Hughes Strategy Lead, Health Education England Lisa Hughes is Strategy Lead at Health Education England with a particular remit for education commissioning, education provision, the regulation of education and the Healthcare Careers Service. In her previous role as Allied Health Professions Officer at the Department of Health, Lisa used her clinical, academic, policy, project and stakeholder management skills to manage a varied portfolio including workforce planning, education and training, leadership and the quality agenda. She stepped down as Co-Chair of the National Allied Health Professional Advisory Board in July 2013. Prior to taking on this role, Lisa demonstrated strong innovation and leadership in her role as Director of the Creating an Interprofessional Workforce Programme, funded by the Department of Health. As part of the programme Lisa wrote the Department of Health’s framework for Interprofessional education and training for health and social care in England. Lisa’s other previous roles include a dual role at the University of Surrey where she prepared undergraduate dietitians for clinical practice. She also managed the South East Region Dietetic Placement Project, which increased dietetic placement capacity by 500%. Lisa qualified as a dietitian in 1992 and went onto specialise in both eating disorders and diabetes.

Lisa has also worked internationally and been on the board of a UK charity. Lisa has excelled in service improvement, evidence-based policy and multiprofessional collaboration. She also has extensive public speaking experience. Lisa is a member of the Institute of Leadership and Management and is currently studying for a Masters in Creativity, Innovation & Leadership at City University.

Revd Dr Mike Kirby Lecturer, Medical Physics and Curate, Blackburn Cathedral Directorate of Medical Imaging and Radiotherapy, University of Liverpool Revd Dr Mike Kirby has worked in the field of radiotherapy for over 25 years, primarily in the NHS at The Christie and Royal Preston NHS Foundation Trusts.

He has helped to lead and develop radiotherapy services, particularly in the establishment of the Christie Satellite RT Centres in Gr Manchester. Throughout his career, he has participated in radiotherapy education for the multidisciplinary teams that make modern radiotherapy possible. Now at the University of Liverpool as part of the team delivering medical imaging and radiotherapy education on radiography courses, he is helping to develop programmes using real-world clinical technology to enhance student teaching and learning.

Dr Peter Kirkbride Medical Director, The Clatterbridge Cancer Centre NHS Foundation Trust Dr Peter Kirkbride trained in medicine at University College, London, and received his MB, BS degree in 1980. Following this he trained in general medicine and then clinical oncology in the UK. In 1991, he was appointed as Staff Radiation Oncologist at Princess Margaret Hospital, Toronto.

In 1999 he returned to the UK, to become a Consultant in Clinical Oncology, specialising in Urological Cancers, at Weston Park Hospital, Sheffield.

Subsequently he also took on the roles of Clinical Director for Radiation Services, Cancer Lead Clinician for Sheffield Teaching Hospitals Trust and Lead Clinician for the North Trent Cancer Network. Since 2012 he has been the Medical Director at the Clatterbridge Cancer Centre, Wirral.

He was the Lead Clinician for the NICE Prostate Cancer Guideline update since 2011, and the National Clinical Lead for Radiotherapy for NHS Improvement/ National Cancer Action Team, and was on the National Radiotherapy Advisory Group and the National Radiotherapy Implementation Group. Since April 2014 he has been acting as Chair of the Radiotherapy Clinical Reference Group (NHS England).

Ms Sue Louth North West AHP Workforce Lead, North West Centre for Professional Development Sue qualified as a dietitian in 1990 and undertook a series of clinical and leadership roles in a number of hospitals. From 1996 - 2004 she was Dietetic Manager across an acute hospital trust and their local community services.

From 1999 - 2002, she also undertook the role of lead manager for education and training across the AHP services and from 2002 - 2004 was the Allied Health Professions (AHP) lead for clinical governance. In 2004 Sue moved into a post as Clinical Governance manager within the medical directorate of a large acute hospital before moving to her current role in 2006.

Sue’s current role is Allied Health Professions Workforce Lead for Health Education North West. She is responsible for the management and delivery of a range of work programmes to support the development of the regional AHP workforce, to ensure it is fit for purpose and able to deliver excellent care. This includes developing leadership capability, supporting the work of the regional workforce transformation team, to develop new ways of working and innovative roles, supporting strategies for graduate employment and influencing CPD priorities.

Sue is co-chair of the North West AHP Workforce Board and through this Board facilitates the provision of professional workforce and education intelligence to key stakeholders. She also provides professional leadership to all AHPs across the region and ensures there are effective systems in place to support two way communications with them.

Dr Ranald MacKay Director of Christie Medical Physics & Engineering, The Christie NHS Foundation Trust Ranald MacKay completed his physics degree at Newcastle University in 1989 and his PhD. in physics at UMIST in 1993, after which he trained as a clinical scientist at Nottingham until 1995. For most of his career he has worked at the Christie Hospital in Manchester, and was appointed its director of medical physics and engineering in 2009. He is presently technical lead on the new UK

proton therapy centre under construction there, and holds an honorary Senior Lectureship in cancer science at Manchester University. His research interests are in dosimetry and biological modelling.

Ms Julie Massey General Manager for Radiation Services, The Clatterbridge Cancer Centre Having been a therapeutic radiographer for many years, working in several departments within England Julie has developed a keen interest in the radiotherapy workforce and how it can be developed. She is currently General Manager for Radiation Services at the Clatterbridge Cancer Centre which is a specialist oncology trust. The role has given her a wider view of both radiotherapy and diagnostic imaging services and the challenges and opportunities that the workforce faces with developing services. She is currently chair of the Radiotherapy Workforce Group which is a sub-group of the Radiotherapy Board.

Mr Andrew Poynter Consultant Radiotherapy Physicist and Head of Radiotherapy Physics, Peterborough City Hospital Andrew Poynter is a Consultant Radiotherapy Physicist and Head of Radiotherapy Physics at Peterborough City Hospital, a post he has held since August 2010. Prior to that he was Head of Radiotherapy Physics at the Ipswich Hospital in Suffolk. He has always had an interest in the practical applications of advanced techniques in radiotherapy and has participated in a number of developments in the field including the introduction of Intensity Modulated Radiotherapy (IMRT) in 2001 and as an early implementer of Image Guided Radiotherapy (IGRT) for prostate and breast cancer.

Dr Diana Tait Chair, The Radiotherapy Board, Vice President (Oncology), The Royal College of Radiologists Dr Tait is a Consultant Clinical Oncologist at the Royal Marsden and has a specialist interest in Upper Gastrointestinal (GI), colorectal, hepatobiliary, anal and breast cancers. She has a particular interest in GI chemoradiotherapy and the use of modern radiotherapy techniques for optimising treatment including Intensity Modulated Radiotherapy (IMRT), CyberKnife and Image Guided Radiotherapy (IGRT), providing complex radiotherapy techniques for patients.

She is presently Vice-President and Dean for the Faculty of Clinical Oncology at Royal College of Radiologists, sitting on numerous national committees looking into developing, setting and maintaining national standards to continue and implement modern radiotherapy techniques to improve quality of care for oncology patients. She Chairs the Radiotherapy Board which was established in April 2013 and which brings together the three professional bodies to coordinate workforce, standards and equipment.

Abstracts (where supplied) Clinical reference group - RT workforce objectives Dr Peter Kirkbride The Radiotherapy Clinical Reference Group (CRG) has been established as the primary source of clinical advice to NHS England in support of the direct commissioning of radiotherapy services. CRGs bring together clinicians, commissioners, and Public Health experts with the patients and carers who use the relevant services. The groups will be leaders in developing the products required for the effective commissioning of specialised services, specifically robust service specifications, which will be updated annually. The workforce implications of the radiotherapy service specification, and of any changes to it, need to be carefully considered by the RT CRG. Setting the scene - workforce planning and education in England Ms Lisa Hughes Health is all about people. Beyond the glittering surface of modern technology, the core space of every health care system is occupied by the unique encounter between one set of people who need services and another who have been entrusted to deliver them (Lancet Report on Health Professional for a New Century). Health services are about people. To deliver high quality services we need staff in the right numbers, with the right skills and the right values and behaviours. Health Education England has been created for this very purpose.

In a fast changing environment, investing in our current and future workforce is the only way of ‘future proofing’ the NHS. In her presentation, Lisa Hughes will highlight how Health Education England will use its four core function of workforce planning, education commissioning, investing in innovation and prompting careers in health to improve the quality of care to patients, carers and communities.

Developing the RT workforce - pre-registration workforce challenges Mr Gary Dakin There is a need to increase the commissions for the pre-registration therapeutic radiography and healthcare science workforce, due to the increasing provision of radiotherapy services and the introduction of the high energy proton service. The 2012 Radiotherapy Services in England report estimated that there needed to be a 39% increase in therapeutic radiography and 31% increase in radiotherapy physics workforce respectively between 2011 - 2016. However, there are significant challenges in developing the non-medical pre-registration workforce to meet this demand, notably high attrition rates, restricted placement capacity and willingness of young students to engage with the cancer pathway within therapeutic radiography and the introduction of the Modernising Scientific Careers (MSC) initiative within the healthcare science workforce. MSC has introduced a new career pathway and underpinning education programmes. However, for a significant proportion of the scientific and technical radiotherapy workforce, these have not yet been fully clarified and much work remains to be undertaken, to ensure both a

sustainable supply of the pre-registration workforce and appropriate development opportunities.

Innovative practice across the country has shown that although there is no “magic bullet”, successful multifaceted interventions can be made to meet the challenges. In addition there is the opportunity to utilise the new education tariff funding to support the learning experience of students within the practice setting. The presentation will explore these issues and enable an informed view to be taken of the required actions to meet the workforce challenges.

Developing the RT workforce - post-registration workforce challenges Ms Sue Louth Therapeutic radiography is a small but highly skilled profession and is the key workforce involved in delivering radiotherapy services. With an increasing demand for radiotherapy and the development of innovative treatment methods, there is a need to not only focus on the size of the therapeutic radiography workforce but also to drive workforce transformation within the profession.

This presentation will focus on the post registration workforce challenges for therapeutic radiographers highlighting the risks and opportunities in relation to the development of this professional group. Enabling therapeutic radiographers to develop skills which have traditionally been outside of their scope of practice and creating new roles such as advanced practitioners and consultant radiographers will contribute to innovative service development. Other key competencies relating to leadership and research skills are also essential to drive the development of the profession, as is access to appropriate professional development activities.

The aim of this session is therefore to identify how the therapeutic radiography workforce should be developed to enable service growth and transformation. Specific learning outcomes are: • To consider the current size and shape of the workforce as a platform for development.

• To highlight where new roles can lead to improved patient experience and clinical outcomes.

• To emphasise other non-clinical skills, which are essential for the development of the professional workforce.

Radiotherapy board – workforce challenges for radiotherapy services Dr Diana Tait The workforce required to deliver a modern radiotherapy service is multi-professional and, beyond the three main professional groups responsible for radiotherapy delivery, involves, amongst others, nursing and administrative staff.

The three professional bodies that represent Clinical Oncologist (RCR) Therapy Radiographers (SCoR) and Medical Physicists (IPEM) have worked closely

together in the past through the coordinating efforts of NRIG (National Radiotherapy Implementation Group). With reorganisation of the Health Service in April 2013, NRIG was dissolved but the professional bodies realised the importance of continuing this coordination of their skills and workforce and formed the Radiotherapy Board, a UK wide organisation to reflect the constituents of the professional bodies.

The Radiotherapy Board first met in April 2013 and its main objectives are to ensure an adequate workforce, delivering high standards of radiotherapy with modern and appropriate equipment. A Workforce Sub-group is in development and is looking at the challenges of making best use of the combined tri-professional workforce through appropriate skill mix.

The presentation will inform about the Radiotherapy Board activities and outline the challenge of most effectively combining the multi-professional workforce at a time when technical advances in radiotherapy need to be available for all patients.

Royal College of Radiologists perspectives Dr Di Gilson The workforce challenges for clinical oncologists include: •

• • • • • • •

Increasing demand for the services that clinical oncologists provide, due to: • The increasing incidence of cancer • The need to ensure appropriate patient access to radiotherapy • Increasing systemic therapy options • The increasing age and comorbidities of the patients receiving treatment • The increasing survival of patients after treatment • Providing input into acute oncology services Increasing radiotherapy complexity with the need for increased radiotherapy planning time Obtaining funding for new consultant posts Funding the expansion of training numbers required to meet demand Uncertainty regarding postgraduate medical training in the light of the ‘Shape of Training’ Report Ensuring that the workforce is trained to make optimum use of technological developments and that clinical oncologists have time their job plans to implement these developments Ensuring that clinical oncologists can lead, support and take part in research More consultants and trainees working less than full time

Society and College of Radiographers perspectives Ms Charlotte Beardmore Therapeutic radiographers comprise over 50% of the radiotherapy workforce in the UK and are key members of the radiotherapy multiprofessional team.

Radiographers deliver care to patients across the entire radiotherapy pathway from referral to follow up.

Since the publication of the College of Radiographers career progression framework the scope of practice of the wider radiography profession has expanded. Importantly therapeutic radiographers roles are adapting and changing, with appropriate underpinning education and training, in order to meet the changing context. These changes are essential in order to continue to ensure that radiographers skills are used optimally and are focussed appropriately to deliver the best possible care to patients across the pathway from referral to follow up. The Society and College of Radiographers (SCoR) survey undertaken in 2012, The Scope of Radiographic Practice, demonstrates this change.

This presentation will provide an overview of this and will include information from the recent SCoR radiography workforce census undertaken in 2013 and findings from a very recent audit of therapeutic radiographers site specialised roles, undertaken in March/April 2014. The presentation will also consider the future challenges and opportunities for the profession.

Institute of Physics and Engineering in Medicine perspectives Professor Andy Beavis Safe and effective provision of Radiotherapy requires many skills and a wide variety of expertise, therefore it has always been delivered by a multi-disciplinary team. Medicine, and specifically Radiotherapy, is arguably quite a unique professional area whereby research and (clinical) operational development often evolve hand in hand resulting in a rapidly changing working environment which is very closely connected to technological revolution and evolution. Furthermore, whereas global economic realities place harsh realities and workforce challenges to any business sector, in the healthcare space we are required to ensure patient safety alongside achieving ‘efficiency savings’ and ‘sweating assets’. The radiotherapy workforce is one of the most expensive assets and there is a clear tension between ensuring safety by overkill and minimisation of costs which may compromise governance.

In this talk, the following challenges arising from a variety of considerations will be discussed: • • • • • •

The ‘ideal’ structure in a radiotherapy physics department against the challenges of attrition, vacancy management and commonly anecdotally reported implications The ‘ideal’ skill set of a 21st century radiotherapy physicist and physics group Efficient adoption and implementation of skill mixing and the ‘evolution’ of the ‘ideal’ workforce Recent changes to the training of ‘physics staff’ and 3 years of STP Managing automation of processes and ‘low level’ functions and operations Potential implication to our aspiration of achieving a “World Class Radiotherapy Service” if we get the workforce wrong

It is hoped that the presentation will evoke thoughts and discussion towards the theme of the meeting and ‘the way forward’.

Clinical experience - IGRT and adaptive RT Ms June Dean Implementation of technologies such as on-line image Guided Radiotherapy (IGRT) and adaptive radiotherapy (ART) require a review of the patient pathway, education, training and skills mix of the radiographers to continue to offer a high-quality service to patients.

Developing competencies for IGRT delivery identified different skills required for decision-making to optimise image registration and responding to change. Standards were introduced to enable IGRT on the treatment unit to be undertaken by the radiographers with no required input from clinical oncologists, making effective and efficient use of staff resources. Efficient management of resources is essential in the NHS where throughput is an important factor in the avoidance of waiting lists without compromising accuracy and the quality of care for our patients Clinical experience - stereotactic RT and RS Ms Alexandra Aitken Stereotactic radiotherapy (SRT) offers an efficient and minimally invasive treatment option for patients diagnosed with malignant, benign and functional indications. It has been well established for cranial lesions however more recently the concept of stereotactic radiosurgery (SRS) has been offered to extra-cranial targets in particular to lesions in the lung, liver, pancreas, spine and prostate. Stereotactic body radiotherapy (SBRT) combines the challenge of achieving the stringent dosimetric constraints of SRS in addition to accounting for both target motion and the movement of normal tissue during treatment delivery. In order to ensure that quality patient care is provided it is essential that a multidisciplinary team consisting of radiation oncologists, neurosurgeons, radiologists, medical physicists and therapy radiographers are involved in the SRS/ SBRT pathway.

SRS and SRT present several challenges with regards to implementation, education, workforce requirements and skill mix. These associated challenges will be addressed independently in addition to the challenges faced with regards to funding of SRS/SRT on the NHS. RT service development - proton therapy Dr Ranald MacKay There are many challenges regarding the development of proton therapy at The Christie NHS Trust. This presentation will discuss the development of a staffing

model for proton therapy and the appropriate training requirements for physicists working in proton therapy. In many ways proton therapy is a natural extension of the conventional radiotherapy job but there are additional complexities that need to be understood.

Looking to the future, proton therapy should be an expanding activity and will face the similar challenges to those encountered with the introduction of other complex radiotherapy procedures such as IMRT. The UK has already lagged behind in the development of a proton therapy service. How do we ensure that the UK is prepared for proton therapy?

Radiography education programme development Revd Mike Kirby Our aims and objectives are to demonstrate how radiography education for radiotherapy (RT) students is being developed using real-world radiotherapy (RT) technology in the academic environment; as an essential part of enhancing learning experience and providing an appropriate platform for developing the skills necessary for alignment with clinical competencies within UK RT departments.

Clinical competencies are a key component of post-registration radiographer training; vital for ensuring competence in accordance with professional, regulatory and local hospital requirements. Trying to align academic programmes with competency frameworks in RT departments may be just one approach to developing the therapeutic radiographer workforce more efficiently and speedily.

Our pre-registration programmes now include real clinical skills, using nearly 80% of the actual technology used for complex RT, such as a dedicated CT scanner, up-to-date Vsim and computerised treatment planning (TP) software, IGRT image review and oncology management systems and a fully immersive 3D virtual RT environment.

Learning and teaching with real-world technology, including skills assessment in both assignment and exam formats (particularly for computerised TP) is vital in forming and maintaining solid educational and professional links between academic classes and clinical placement. But our students are also gaining the skills which form the platform for clinical competency development. E.g. at the Christie, these include some of the core clinical competencies such as 2D and 3D image verification, computerised treatment planning and calculations and treatment records checks Using 21st century real-world RT technology in the academic environment develops students knowledge, understanding and skills; the latter being an excellent precursor for clinical competencies within departments with the potential for accelerating workforce development.

Workforce integrated planning tool - clinical dimensions Ms Julie Massey Robust workforce planning is vital for radiotherapy services across the UK. Trust management will often challenge radiotherapy workforce plans on the basis of cost and value for money. Nursing staffing levels have hit the headlines following the Francis report and the publication of staffing levels on wards is being adopted across England.

The Workforce Integrated Planning Tool (WIPT) helps radiotherapy services to plan for service change and development utilising the current staffing recommendations for physicists and radiographers. Although the tool does not model the workforce requirements for the medical workforce in radiotherapy, it is useful in providing a more scientific basis to workforce numbers and skills mix.

This presentation will consider how WIPT has developed and off some examples of how it is useful in supporting business cases in individual departments.

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FORTHCOMING EVENTS

MOLECULAR RADIOTHERAPY DOSIMETRY 4 JUNE 2014 OXFORD WESSEX BRANCH SUMMER MEETING 13 JUNE 2014 WINCHESTER OPTIMISATION IN CT 18 JUNE EDINBURGH EAST OF ENGLAND BRANCH MEETING: ONCOLOGY HOT TOPICS 5 JULY 2014 CAMBRIDGE IRMER UPDATE 29 SEPTEMBER 2014 LONDON DIAGNOSTIC RADIOLOGY FOR ADVANCED HEAD AND NECK CANCER PLANNING 2 OCTOBER 2014 LONDON MIDLAND BRANCH LAUNCH EVENT: MILITARY TRAUMA IMAGING 9 OCTOBER 2014 BIRMINGHAM OPTIMISATION IN INTERVENTIONAL RADIOLOGY 10 OCTOBER 2014 BIRMINGHAM LINKING ORTHOPAEDICS AND RADIOLOGY II - THE PLAIN FILM REVISITED: THE UPPER LIMB 16 OCTOBER 2014 LONDON BIR UK MRI COURSE 2014 4-7 NOVEMBER LONDON

BIR Annual Congress 2014: 22-23 October, London VISIT: WWW.BIR.ORG.UK FOR MORE INFORMATION AND TO REGISTER!

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