SUSHRUTA
Journal of Health Policy & Opinions
An International Response to the Workforce Crisis in Radiology
Services in the UK
Robin Proctor FRCR, MRCGP, MRCP, MA(Cantab), DRCOG, DFFP, BM BCh(Oxon)
Consultant Radiologist, Morecambe Bay Hospital, UK
robin.proctor@nhs.net
Cite as: Proctor R. Radiology Global Fellows: An International response to the workforce crisis
in Radiology services in the UK. Sushruta 2019 Nov vol12(1):32 DOI:10.38192/12.1.18
Why is there an issue?
Radiology essentially facilitates diagnostic decision making and treatment in almost all
aspects of healthcare. There has been an expansion in demand for imaging, around 10% year
on year in CT and MRI since the turn of the century. Patients are now surviving for longer with
multiple co-morbidities as well as having a greater expectation to be better informed and
involved in their healthcare decisions. These changes have led to a shift towards more
complex imaging. Many older style imaging has been replaced by newer technologies higher
technical equipment and expertise to interpret. Finally there are some factors such as
following up incidental findings or public screening for early detection of diseases which
require serial imaging.
ren’t we going to be moving to I?
Artificial intelligence and machine learning will benefit patients in medical imaging and
radiologists who use this technology may replace those who don’t but this is some distance
off and radiologists to oversee the processes will still be required. There remains a gap in
interpreting images for cancer and other similar pathologies in almost every trust in the land.
(Only 2% of trusts meeting current demand through radiologists’ contracted hours alone.)
What about radiographers reporting?
Radiographers are also a shortage group and are already busy managing the increase in
images being acquired. Radiographers make a further valuable contribution by taking on
specialist roles including reporting, but is insufficient to meet the demand and a medical
training remains necessary to interpret and guide treatment for many patients.
What is the Global Fellows Programme?
This provides Radiologists with an opportunity to work in England as a Global Fellow for a
period of 3 years. Global Fellows perform a mixture of independent service work (60%) and
develop their skills in a subspecialty (40%). Completion of CESR is at their discretion and early
experience is that this is popular both as a credential and for future career planning. The three
year Global Fellowship is a placement, not a migratory programme. This scheme is delivered
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through a partnership between Health Education England, The Royal College of Radiologists,
(UHMB). Following a successful pilot at UHMB (4 radiologists, all still in post), a larger group
of Global Fellows have accepted posts at other trusts across England and are in the final stages
of induction before taking up their jobs in the UK . (24 offers made in this cohort) The scheme
is being further expanded across the country. An anticipated further 50+ radiologists will
become available in January 2020 after a bespoke sitting of the FRCR examination and
placements are currently being sought and assessed for them.
What is required of the radiologist?
Technically the scheme requires independent competence in general radiology and is open
to radiologists who have completed Fellowship of the Royal College of Radiologists (FRCR a
PLAB-exempt route to GMC registration). The key personal attributes are an understanding
of the programme, a wish to experience NHS working life and a willingness and ability to adapt
and learn the professional and interpersonal skills to support this. The induction runs in
Hyderabad, India and assumes previous training or practice in radiology within India.
What do trusts need to do?
A Trust would need to be able to sponsor a Tier 2 visa provide mentorship, opportunities for
learning and discussion with colleagues and practical help with accommodation, schooling
and other pastoral support. The specialist interests of the Global Fellow are matched with the
requirements of the trust during the recruitment process. Global Fellows go through a central
recruitment process assessing professional values and transferable skills. They will be
appointed with individual contracts of employment with host trusts and information packs to
facilitate trusts delivering this are provided as part of the scheme. Experience suggests there
are benefits to small cohorts so preference is given to trusts who wish to appoint a number
Global Fellows.
There is a multi-phase induction for a month in duration, hosted by Apollo Radiology
2 visa and acculturation requirements. Their technical
competence has been demonstrated through the FRCR qualification and although learning
around multi-disciplinary team (MDT)s, drivers for imaging in the NHS and reporting style are
covered the induction is predicated on them already being a technically competent
radiologist.
What are the arrangements for pay?
Trusts would be expected to pay the Global Fellows’ salary. The UK’s experience of radiology
being a shortage specialty is not unusual and there is a global market. Local negotiation and
consideration of experience may be necessary although to be competitive, a point on the staff
typical.
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How is this different from locum consultant posts?
Global Fellow posts are for radiologists who, although experienced and competent outside
the UK, are not on the specialist register and consequently are not consultants. Many agencies
would like to place similar candidates in a consultant post in return for hefty commission but
this disenfranchises those who are on the specialist register, does not develop the radiologist
in a supportive way and exposes patients to potential harm. Although not initially on the
specialist register and still developing many of the soft skills of being an NHS consultant the
programme is educational and it is likely that many will finish their posts at a similar level to
a consultant. As above, CESR is optional.
Is there a clash with trainees?
In almost all cases there is more than enough work to go around. Global Fellows may be
experienced in teaching and with suitable training and accreditation could support sustaining
trainees within a department which would otherwise be unable to do so.
What about efficiency?
The scheme developed from a wish to have a more cohesive, self-supporting and sustainable
team and the principal justifications are in terms of quality and sustainability. Modelling
demonstrates that this scheme is cost efficient in comparison to the alternatives of more
expensive locums and outsourcing of image reporting.
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