Re-profiling the Cardiac Physiology Workforce

SCST HODs 30-11-12

John Hutchinson

Lead Cardiac Physiologist

(Interventional Cardiology and

Education)

Papworth Hospital NHS

Foundation Trust

Cardiac Physiology on

NSHCS CVRS theme

Board

MSC early Adopter

Project East of England

CVRS MSC Project

Team

Council

In writing this talk I have drawn on my

involvement from all of these bodies and

it its important to note that the

information presented comes from

multiple sources.

MSC Arguments To Overcome

• Its already happened

• PTP, STP

• HSST imminent

• Stop saying “it cant work”

• Time to capitalise

Starting to see

much more

interest in MSC

Moving from this

The train has left the station

There are some brave souls

that have boarded the train!

However!

MSC Training Pathways

Associate

/Assistant HCS Assistant

HCS Practitioner

HCSA/HCSP

Scientist

Training

Programme

STP

Practitioner

Training

Programme

Full time student

PTP

Higher

Specialist

Scientific

Training HSST

NVQs, Apprenticeships and in house education for Assistants

Foundation Degrees for Associates

3 year programme comprising of separately delivered and

awarded academic and workplace-based components leading

to MSc & Certificate of Achievement

3 year BSc (Hons) programme integrating academic and

workplace based elements

4/5 year work based training programme similar to specialist

research training leading to medical college exams, where

these exist, & doctoral award

Proposed training pathways through Modernising Scientific Careers

Msc Time Line

Strategic Health Authorities

2010 2011 2012 2013 2014 2015 2016 2017 2018

1st intake

on new

PTP

Last intake

of old Bsc

1st intake

of STP

1st PTP

intake

Graduate

Last of old

Bsc

Graduate

1ST STPs

intake

Graduate

6

2nd STPs

intake

Graduate

21

3rd STPs

intake

Graduate

??

2nd intake

of STP

2nd PTP

intake

Graduate

3rd PTP

intake

Graduate

2nd intake

on new

PTP

3rd intake

on new

PTP

MSC: Career and Training Pathways

My Interpretation of How MSC Might Look In

the future (not official DH material).

Accredited

Specialist

Scientific

Practice

Accredited

Additional

Scientific

Practice

Accredited

Expert

Scientific

Practice

Why Will We Be OK?

We are “Patient Facing” which is at the heart

of MSC and the recent White paper.

As Technology has moved on cardiac

physiologists have adapted / up skilled.

Modernising Scientific Careers has been designed jointly with the other countries of the UK.

The England Action Plan is the result of co-production with Strategic Health Authorities (SHAs)

to ensure delivery of a sustainable, fit for purpose, scientific workforce for the future that is

affordable, builds upon the best of the past and ensures that patients and the public receive

the greatest benefit from its skills and talents. It will enable employers to profile the

workforce more effectively and ensure that it is appropriately trained and developed,

where appropriate, to take on more advanced clinically facing roles. It will also enable the

education sector to better understand the needs of the NHS and support the education and

training of the scientific workforce.

How is MSC Financially Viable if we have to

train all these STP’s?

BSc (PTP) Students picking up cost of

their own education.

Technology move forward, non-patient

facing HCS roles that have been in

existence for many years need skills mix re

adjusted.

Increasing the usage of Band 1-4.

Life Sciences66%

Physiological Sciences10%

Cardiac Physiology8%

Physical Sciences12%

Other4%

Higher Specialist Scientific Training

(HSST)

• Consultant Cardiac Physiologists

• Taught Doctorate

– D ClinSci. + OLAT portfolio

• Equivalence route AESP. – ? BSE TOE + PHD + Portfolio of evidence?

• 5 years with tapered funding.

On completion of an HSST programme Clinical

Scientists will be enabled to:

• Compete for available Consultant Clinical Scientist posts, providing

clinical and scientific expertise and leadership

• Work synergistically and in partnership with medical consultants,

– providing consultant level advice within the context of direct patient

care,

– enabling medical consultants to have additional capacity to

provide specifically required medical services

• Strategic direction of services and care, using their highly developed

specialised skills to steer innovative service development through

incorporation of technology/scientific advances into service provision

• Leadership for proposing and developing formal research activities

and

• Direct involvement in leading education/training

Roles/

Programs

Bands Educational

programme

Ownership Cost structure for 2012/13 E.g. of Level of Tests,

Once Qualified

Assistant

Practitioner (AP)

2-3 NVQs or New

equivelent

Employed staff Funded by departments ECG, Fitting 24hr tapes

Associate

Practitioner(AP)

4 Foundation Degree Employed staff Funded by departments 2nd person ETT, 24hr

tape analysis

Practitioner

Training

Programme (PTP)

5-6

possible

management

route.

BSc (Hons)

programme

Full time student-integrating

academic and workplace

based elements.

Funded by Students, Departments may be

reimbursed for training costs but

arrangements vary across the country

ECG, ambulatory BP

and ECG analysis, ETT-

2nd person

Preceptorship

year

5 with Local

trust funding

arrangement

s

Local trust sign -off Locally agreed conditional

employment

Funded by Departments Basic Cathlab (LHC)

Basic Brady pacing

implant, 1st person ETT

Accredited

Specialist Practice

5-6 Not yet known Employed staff Funded by departments or individuals Basic Cathlab (LHC)

Basic Brady pacing

implant, 1st person ETT

Scientist Training

Programme (STP)

6-8c MSc & Certificate of

Achievement

3 year programme

comprising of separately

delivered and awarded

academic and workplace-

based components

Direct entry fully funded by SHA for 3 yr fixed

term at bottom of Band 6 + plus funding may

be available to the dept. to cover expenses

Or in-service trainees funding for course fees

+ contribution towards training costs for

13/14. Arrangements vary across the country.

PCI ,

Implant and follow-up for

complex devices,

BSE standard Echo

including reporting.

Research and

Innovation

Accredited Expert

Practice

7-9 BSE –TOE

Accreditation

IBHRE devices or EP

Paediatrics

Employed staff Funded by departments or individuals Specialised Echo,

EP,

Paediatric testing.

Higher Specialist

Scientific Training

(HSST)

8a-9 DClinSci-

(Taught Doctorate)

or PHD

Probably employed staff -

details yet to be defined.

Tapered SHA funding- details yet to be

defined.

Consultant Physiologist-

roles yet to be defined

Disclaimer – guide, not policy

2 XSTP 12/13

Colour key

Scientific Staff

Re-Profiling

Use DH physiological WFP tool to Map the current work force

bands 2-8.

Show how using this work force can be cost efficient

o E.g. Band 2 physiology assistant practitioners who now attend

pacing follow-up

Identify gaps where for example bands 1-4 are absent but could be

created.

Work with local HEI's to develop foundation degree programs as

well as in house training programs.

DH Physiological Sciences Workforce Re-

Profiling Tool.

DH WFP Tool

Tips for Capturing Data

• Gather info from each type of role or individuals.

• Short list applicable tasks

• Divide a normal average week into tasks (% or

hrs)

• Find and populate largest % / hrs first.

• Divide up remainder into the smaller tasks

• Don’t worry about anything less than an ½ hr.

My Dept Activity Split by Band

Code Description Band 1 Band 2 Band 3 Band 4 Band 5 Band 6 Band 7 Band 8A Band 8B Band 8C Band 8D Band 9 Task Total

WTEs

0.00 9.73 4.70 1.00 14.37 11.11 7.20 1.95 1.00 0.80 0.30 0.00 52.16

010101 Plan the service 0.00 0.07 0.00 0.00 0.00 0.00 0.00 0.04 0.05 0.08 0.02 0.00 0.25

020101 Manage and work with users of pathology (e.g. GPs and PCTs) 0.00 0.08 0.00 0.00 0.00 0.00 0.00 0.08 0.05 0.04 0.00 0.00 0.25

030101 Manage others 0.00 0.00 0.19 0.16 0.00 0.00 0.00 1.00 0.03 0.08 0.02 0.00 1.47

030102 Develop and train others (e.g. train students and employees, conduct appraisals, provide support for formal examinations) 0.00 0.05 0.00 0.05 0.12 0.27 0.79 0.03 0.05 0.02 0.05 0.00 1.43

030201 Manage and develop yourself (e.g. receive training). Do not include research work here 0.00 0.10 0.26 0.00 1.67 0.60 0.50 0.02 0.03 0.01 0.02 0.00 3.21

040101 Travel (as part of obtaining samples) 0.00 0.08 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.08

040102 Prepare to obtain samples (prepare your environment, validate the patient's identity and the request, obtain consent) 0.00 0.08 0.00 0.00 0.00 0.10 0.00 0.00 0.01 0.00 0.00 0.00 0.19

040103 Obtain specimens from individuals 0.00 0.08 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.09

040104 Complete documentation and maintain sampling records 0.00 0.31 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.32

040105 Provide expert advice on the collection of specimens 0.00 0.15 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.17

040201 Plan routes and manage the activities of drivers 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

040202 Collect samples from external facilities and deliver to the laboratory 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01

040203 Collect samples from internal wards and departments and deliver to the laboratory 0.00 0.15 0.02 0.00 0.00 0.09 0.00 0.00 0.00 0.00 0.00 0.00 0.26

040204 Complete documentation and maintain transportation records 0.00 0.08 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.08

040301 Unpack and sort deliveries of samples and book into the system (including receipting and addition of date, time etc.) 0.00 2.07 0.38 0.16 0.55 0.20 0.08 0.01 0.00 0.00 0.00 0.00 3.44

040302 Prepare your environment for processing samples (including sterilisation of equipment) 0.00 0.26 1.00 0.00 0.00 0.00 0.07 0.00 0.00 0.00 0.00 0.00 1.34

040303 Verify details of the request (patient ID, tests requested), prioritise samples and generate appropriate records and labels 0.00 1.83 0.63 0.16 1.10 0.29 0.08 0.01 0.00 0.00 0.00 0.00 4.11

040304 Prepare media for samples 0.00 0.07 0.15 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.22

040305 Determine and communicate the suitability of samples for testing and examination (e.g. regarding rejects) 0.00 0.94 0.06 0.16 0.55 0.13 0.08 0.01 0.00 0.00 0.00 0.00 1.93

040306 Place samples for automated analysis into appropriate containers and batch trays 0.00 0.75 0.32 0.16 1.10 0.00 0.00 0.01 0.00 0.00 0.00 0.00 2.34

040307 Load samples and batches into analysers 0.00 0.31 0.32 0.03 1.10 0.48 0.00 0.01 0.00 0.00 0.00 0.00 2.25

040308 Prepare samples for manual analysis in suitable media (slides, cultures, cell blocks etc.) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

040309 Prepare transplant samples in suitable media for analysis 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

040310 Prepare cancer (resection) samples in suitable media for analysis 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

040311 Prepare cancer (diagnostic biopsy) samples in suitable media for analysis 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

040312 Prepare routine surgical samples in suitable media for analysis 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

040313 Prepare post-mortem samples in suitable media for analysis 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

040314 Prepare neuropathology samples in suitable media for analysis 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

040315 Prepare electron microscopy samples in suitable media for analysis 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

040316 Prepare muscle and nerve biopsy samples in suitable media for analysis 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

040317 Prepare interoperative frozen sections samples in suitable media for analysis 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

040318 Prepare other samples in suitable media for analysis 0.00 0.00 0.00 0.00 0.22 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.22

040401 Perform or initiate fully automated tests (automated and tracked systems) 0.00 0.00 0.30 0.00 1.10 0.04 0.73 0.01 0.00 0.00 0.00 0.00 2.18

040402 Perform semi-automated tests (some automation but not, for example, tracked) 0.00 0.00 0.17 0.00 4.41 2.19 0.43 0.01 0.00 0.00 0.00 0.00 7.20

040403 Perform routine manual tests 0.00 0.00 0.17 0.00 0.22 0.10 0.03 0.01 0.00 0.00 0.00 0.00 0.52

040404 Perform complex manual tests 0.00 0.00 0.15 0.00 0.00 0.06 0.03 0.01 0.01 0.00 0.01 0.00 0.26

040405 Perform point-of-care testing 0.00 0.00 0.00 0.00 0.00 0.00 0.07 0.00 0.00 0.00 0.00 0.00 0.07

040406 Record test results 0.00 0.00 0.03 0.00 0.33 0.28 0.03 0.02 0.01 0.00 0.00 0.00 0.70

Transfer the data from the PAT list to the

Task Entry spreadsheet

Make a copy of the baseline data and use it

to reprofile the workforce

Outputs – the impact of re-profiling in (£)

This does not mean job losses!

• Happens over time

• Take advantage of :-

• Resignations

• Retirements

• People wanting to drop hrs.

• Does not take into account activity growth

Saving of £89300 37 people 35.8 people

Associate Practitioner in Cardio-Respiratory

Physiology

Flexible worker able to perform a range of

protocol driven tasks:

Height / Weight

Spirometry

Spot Check Pulse Oximetry

Capillary Blood Gases

Blood Pressure

ECG

Venapuncture

• Interpretation / Analysis done by Qualified Staff

Strategic Health Authorities

Proposed Modular approach

Inter-relationship roles and curriculum

Roles

(Rolemap)

Curriculum

Themes and modules

Core

5 modules

4 themes

Functional categories and modules

13 categories Detailed and

specialist functions

Professional, Personal, cognitive

functions - underpinning

Rolemaps - national framework for consistency

CURRICULUM Core functions Assistant Core functions Associate

These correspond to the

core curriculum modules

listed below; -mandatory

for awards

The use of Scientific

method in healthcare

science

The legal, ethical and

regulatory context of healthcare science

Working in Partnership

with patients, colleagues

and other professionals

Investigation, Diagnosis,

treatment and

management of human

disease and disorders

Safety, security and well-

being in the healthcare

science working

environment

1. Work within an evidence-based healthcare

science environment

2. Assist with innovation in research and

development projects

3. Work within the legal, ethical and regulatory context of healthcare science

4. Support the delivery of patient-focused

healthcare services

5. Work effectively within a team

6. Contribute to multi-disciplinary review and planning of patient investigations

7. Assist with emergency /life support

8. Support and assist with investigation and

diagnostic services in Healthcare Science

9. Maintain health, safety and security in the working environment

10. Control infection in the working environment

11. Manage personal workload and take

personal responsibility for effective

performance

12. Continuously improve personal skills, knowledge and performance

1. Contribute to continuous improvement of work within an

evidence-based healthcare science environment

2. Undertake basic research and development projects to

explore innovations in healthcare science

3. Promote and maintain the legal, ethical and regulatory requirements of work within healthcare science

4. Provide patient focused healthcare services

5. Co-ordinate team activities to ensure patient-focused

service delivery

6. Contribute to multi-disciplinary review and planning of patient investigations and management

7. Perform basic life support

8. Perform investigation and diagnostic services in

Healthcare Science

9. Promote and maintain health, safety and security in the working environment

10. Manage the control of infection in the working

environment

11. Manage personal workload and ensure achievement of

personal and team objectives

12. Continuously improve personal skills, knowledge and performance

Curriculum and Award Structure and selection

Core

5 modules

5 modules

Themes (x4)

Selection of modules –

may be cross theme

Selection of modules –

may be cross theme

Functional Categories

(13)

Relevant functions/units

from category(ies)

Relevant function/units

from category(ies)

Assistant

Associate

Core = defined

credits/points for each

module

Each themed module

carries credits/points Remaining credits/points

selected from categories

2 exit

routes –

Cert and

Dip

Exit FD

Progression

to PTP

Questions Thank You

My Questions to you.

• Where are you going to get your CRM / Echo trainees from if you

don’t sign up to STP?

• What AFC pay band should PTP/STP’s be on once they graduate?

• What do you think about a preceptor year for post graduate, pre

HRUK / BSE accreditation?

• The STP funding is out there what are you waiting for?