Gloucestershire Hospitals NHS Trust- Invited Review of Radiology Services 5-6 October 2021

Senior and Executive management should consider with the Chief of Service how to best provide consistent and visible support whilst enabling the Specialty Director, General , and senior radiographers to develop their roles and leadership of the department, so that the voice of practitioners is clear and staff can see their place within the overall trust strategy (4.1.4)

Develop a programme of team building and clarify roles among the department management team so decision making is rapid and clear to all in the department.(4.1.10)

Offer appropriate development, coaching and support for the General Manager and Specialty Director so they are clear about their responsibilities and how to escalate problems. . (4.1.10)

Prioritise seeking a permanent Radiology Service Manager, perhaps using alternative or creative approaches. (4.1.10)

The leadership team need to create and communicate a vision and plan articulating specifically what the aims are over the next 5 years, including milestones that the workforce understands and supports. This could be facilitated by the trust organisational development team involving all staff groups to discern their ideas and aspirations and generate enthusiasm and ownership of their future. (4.1.12)

Consider the Quality Standard for Imaging and working towards it. (4.1.12)

Clarify the arrangements for Retire and Return and other flexible working options for experienced consultants to make the option financially viable(4.1.17)

Ensure there is a robust and documented programme of induction and mandatory training job-planned for all new staff whether or not they have previously worked at the Trust. This must include the requirements of IR(ME)R 17. (4.1.17)

Allow the departmental managers to over recruit to the establishment at times of the year when radiographers are available in quantities, typically at the time of band 5 graduation. (4.1.17)

Review the departmental processes and systems involving the modality leads to ensure the processes and systems are working effectively (4.1.19)

Check and resolve contractual maintenance obligations to the Cobalt centre

Expedite replacement of Philips PACS (4.2.5)

Ensure that the lack of pre-fetch on PACS is represented on the trust wide risk register. (4.2.5)

Develop, with the radiologists, suitably designed reporting rooms drawing on national guidance and local preference. Ensure there are suitable reporting facilities for complex work. (4.2.5)

Urgently redesign the Home Reporting offer with consultant involvement for all consultants and reporting radiographers who wish to participate. (4.2.5)

It should become an integral part of trust sign-off of any new service or new consultant business case that the implications and true costs of the required radiology capacity are included. (4.2.7)

The service should undertake a complete workforce establishment review in regard to the workforce capacity needed to provide the required activity and out of hours service provision. This must include development of advanced radiographer roles and those currently in AP roles must have job plans agreed. The Trust must ensure that it has an effective out of hours service where sufficient staff are available and supported to deliver care. (4.2.14)

The trust must recruit more radiologists to meet current and planned demand in the short and medium term. The Trust could consider the global radiologist route (4.2.14)

Consider co-location of the booking team and a review of processes to maximize the efficiency of the service. (4.2.20)

Review what items are outsourced. Ensure that a significant proportion of the subspecialty and complex work is kept in-house and prioritise outsourcing plain films based on clinical urgency (4.3.7)

Conduct a systematic review of job plans and rotas, against activity, involving the consultants throughout, to ensure equity and manageability, and that SPAs and commitment to teaching are recognised. There must be a non-voluntary rota of on-call consultants available for the times when there is no other cover in the departments in order that a sustainable and safe level of cover at these times is present. (4.3.16)

Ensure the Risk Register includes progress and completion dates. (4.3.22)

There must be a clear process for induction for new consultants including statutory requirements under employers’ responsibilities. (4.3.19)

Review and standardise pathways of emergency and urgent care including engagement with trauma meetings. (4.3.20)

Formalise arrangements for back-up and cover for the breast and paediatric radiology consultants and prioritise efforts to recruit to these specialisms. (4.4.3)

The service should review the out of hours working arrangements for radiographers with particular reference to those service elements reliant upon single handed on call cover across more than one modality or service. (4.4.4)

The service should review the OOH cover/on call rota to ensure robust consultant cover for the times not covered by the external service.

Safety huddles and staff meetings should take place regularly so that all staff are fully informed and there is a space for communication to take place. (4.4.5)

All relevant staff should be included within the REALM process as set out in the RCR guidance. (4.4.6)

Develop a departmental process which would allow electronic vetting where the consultants could review those cases which the radiographer felt needed a radiologist opinion and mechanisms for liaison with referrers about appropriateness of test requests. (4.4.10)

Ensure that vetting staff have appropriate skills among them to be able to challenge all referrals where required.(4.410)

Consider adopting iRefer to support appropriate referrals. (4.4.10)

The Trust should review the alert mechanisms for unexpected findings and cancers, bringing it in line with national guidance. (4.4.12)

Review arrangements for chaperones and ultrasound patient experience in Gloucester, including all waiting and changing areas. (4.5.2)

Ensure there is staffing assigned to monitor patients in the waiting area at Cheltenham. (4.5.3)

Review the DNA rates in all modalities to determine what action could be taken to reduce them. (4.5.5)