A workforce review in diagnostic ultrasound

Abstract

Current ultrasound education for sonographers is at post-graduate level and it is a service expectation that sonographers are equipped with advanced skills on qualification. The aim of the working party review was to assess the current roles and responsibilities of the sonographers, with a view to determining whether there was an opportunity to introduce a lower band practitioner role within the local hospital ultrasound department as well as the wider ultrasound community. Qualitative data, for the review, were obtained from two sources: (i) a local working party consisting of two ultrasound managers, two sonographers, one consultant radiologist, one line manager and one lecturer in diagnostic imaging and (ii) radiologists of the local department, ultrasound colleagues within the Yorkshire and Humber Strategic Health Authority (SHA), local and national Higher Education Institute and Consortium for the Accreditation of Sonographic Education colleagues. The career structure of sonographers was reviewed with options to introduce a band 6 ultrasound practitioner post in the local radiology department. The level of work expected of sonographers within the local Trust demands advanced skills, currently recognized as Agenda for Change band 7, are utilized on a daily basis. Little opportunity for practitioners to work at a lower grade which would require only technical reports, with no diagnostic opinion, was identified. In conclusion, there is currently no scope for a band 6 ultrasound practitioner within the local radiology department. The review suggests there is a need for an ultrasound practitioner career structure, which is comparable with other professional groups. Such developments will require input and support from clinicians, radiologists, the professional body and the higher education institutions. The review recognizes the need for an ultrasound governance team within individual Trusts to oversee ultrasound provision, reporting and clinical developments.

Keywords

Sonography ultrasound diagnostic imaging scanning education professional issues miscellaneous

The Modernisation Agency¹ outlined descriptions of a range of roles within the National Health Service (NHS) and attempted to match posts to such descriptions and subsequently match this to Agenda for Change (AfC) pay banding. Differentiation between a band 7 Advanced Practitioner and a band 6 Specialist Practitioner relates to knowledge and skills and there have been attempts to link this to the NHS Knowledge and Skills Framework appraisal system. The introduction of AfC in 2004 saw the national job profile for sonographers being matched at band 7.²

Historically, the development of diagnostic ultrasound practice in the UK has been driven by clinical need and has been multidisciplinary in nature. Since its inception the largest group of professionals working in ultrasound has come from a radiography background via accredited programmes of education. These were offered initially by NHS-based schools of radiography. Since the mid-1990s, ultrasound education has been at post-graduate level. The latter courses have been delivered by Higher Education Institutes (HEI) and most are accredited by the Consortium for the Accreditation of Sonographic Education (CASE).³

Over the last 15 years there has been rapid expansion of ultrasound services, not only in the diagnostic field but also in screening, surveillance, interventional and therapeutic procedures, all of which are coupled with advances in ultrasound technology.³ The scope of practice of sonographers has consequently expanded and the role of the sonographer is somewhat different from that of 20 years ago. Despite some examinations appearing simple or routine, there is always the possibility that complex or subtle findings arise which challenges the knowledge and skill of even the most experienced practitioner. A held belief, particularly from non-sonographic staff, is common examinations are simple and routine and therefore advanced technical and interpretative skills are not required. It is the technical skill and interpretation of complex findings that may be required in any examination, which makes the differentiation between band 6/band 7 work.

Table 1 outlines the Modernisation Agency descriptions on which the current banding system is based.¹ With this loose description of roles, the increasing demand for ultrasound examinations, a national shortage of sonographers, which ultimately leads to long waits for appointments, and financial pressures on Trusts, it was only a matter of time before the role of a sonographer would be reviewed and discussions about banding, knowledge and skills and responsibility occurred.
Table 1
A career development framework for the NHS¹ – level descriptors

Advanced Practitioner Specialist Practitioner

Experienced clinical professionals who have developed their skills and theoretical knowledge to a very high standard. Empowered to make high-level clinical decisions and often have own caseload Staff who have a higher degree of autonomy and responsibility than ‘practitioners’

Since the early 2000s the issue of a career framework within ultrasound has been discussed in the professional literature and there are several documents reviewing the scope of practice in medical ultrasound. In addition, there has been extensive work reviewing and publishing National Occupational Standards and required competencies to undertake ultrasound procedures.^3–5 The background to the review has been clearly outlined in many of these articles.^6–8 This has not been repeated in this article although the working party made extensive use of this documentation.

The job description for the role of sonographer in the local radiology department was locally matched to the band 7 Advanced Practitioner profile² and the NHS KSF has supported continued development of all sonographers within this role.

All sonographers working in the local department undertake postgraduate education and currently all are from a radiographic professional background. All the sonographers hold a medical ultrasound qualification: a postgraduate certificate (PG Cert), a postgraduate diploma (PG Dip), a Masters (MSc) degree in Medical Ultrasound or a Diploma in Medical Ultrasound (DMU).

Following a workforce review within the local radiology department, which encompassed radiographers in plain film radiogaphy, cross-sectional imaging, vascular and cardiac procedures, a need was identified to review the workforce within the local ultrasound profession.

The remit for the review was to determine whether there was an opportunity to introduce a lower band practitioner role. The rationale behind introducing this role was two-fold:
To introduce career progression from a band 5 first post role into the specialty area of ultrasound working at band 6;

Reduce workforce costs in ultrasound. Annual savings of £7158 per band 6 post compared with a band 7 post would be realized.
The challenge faced was to determine whether the drive for a band 6 practitioner by the local Trust was a realistic career choice for the imaging profession in addition to a money-saving venture for the employer.

Aim

The aim of the working party review was to assess the current roles and responsibilities of the sonographers, with a view to determining whether there was an opportunity to introduce a lower band practitioner role within the local hospital ultrasound department as well as the wider ultrasound community.

Objectives

Review the current role and responsibility of band 7 sonographers;

Review the proposed role and responsibility of a band 6 practitioner;

Review the remit of a band 6 practitioner within the current department;

Propose options to introduce a band 6 role if applicable;

Consider future developments of a Career Progression Framework.

Methods

A local working party met to discuss, face-to-face, the objectives of the review. The working party consisted of two ultrasound managers, two sonographers, one consultant radiologist, one line manager and one lecturer in diagnostic imaging from the local HEI. Prior to the meeting relevant literature^1–10 and the list of objectives was circulated to the working party members. PP recorded minutes of the meeting. In addition, opinion was sought from local radiologists, ultrasound colleagues within the Yorkshire and Humber Strategic Health Authority (SHA), local and national HEI and CASE colleagues. A short questionnaire, with open-ended questions, was sent, via email, to 61 professionals (Table 2).
Table 2
Ultrasound workforce review evaluation questionnaire

1 Is your department looking at the option of a permanent band 6 role (as opposed to a preceptorship period)?

2 Is anyone aware of a national post outline for a band 6 ultrasound practitioner?

3 Does the education programme offered support band 6 practitioner training?

4 Does the training produce sonographers at band 7 advanced practice level?

5 If training produces sonographers as band 7 advanced practitioners is it appropriate to employ this workforce at a band 6 with a lower level of responsibility and expectations?

The responses were collated to produce the qualitative data used, in conjunction with the published literature to inform working party discussions and decisions.

The working party explored the band 6 and band 7 roles of the sonographer, reviewed current sonographer practice, and education and proposed future developments in these areas. Conclusions were then drawn as to whether the objectives of the review had been met. This article outlines the points discussed during this review and the conclusions drawn.

Data analysis

Descriptive analysis was done.

Results and discussion

Table 3 shows the responses from 11 of 61 (18%) colleagues from HEIs and clinical departments.
Table 3
Responses from eleven ultrasound colleagues

Question Number of replies

Higher Education Institute n = 7 Sonographers n = 4

Q 1 Yes No

Is your department looking at the option of a permanent band 6 role (as opposed to a preceptorship period)? 2 9

Comments:

• I've had enquiries about training midwives to do Obs U/S only, in the hope that they could pay them band 6, because it's a single area of practice.

• The driving force is obviously to reduce costs and resolve some recruitment issues.

• It makes absolute sense to recognise and reward the skills difference between a newly qualified career Sonographer and an experienced advanced practitioner in ultrasound. However, while I would support the concept of a preceptorship grading, the reality is that Trusts trying to attract qualified sonographers at band 6 or below find it almost impossible to fill the posts. That is certainly the case in this region.

Q 2 Yes No

Is anyone aware of a national post outline for a band 6 ultrasound practitioner? 0 11

Comments:

• I am not aware of a post outline for a band 6, but I am sure it will arise.

Q 3 Yes No

Does the education programme offer supported band 6 practitioner training? 2 9

Comments:

• We could train to band 6 and band 7 if role descriptors were established to differentiate a ‘basic’/‘limited scope’ practitioner from an ‘advanced’/‘extended role’ practitioner.

• We have recently completed training a gynaecological nurse in gynaecology ultrasound and early pregnancy scanning at PG Certificate level at band 7, but her colleague, who is a band 6, is now training also to PG Certificate level and she will remain at band 6 on completion.

Q 4 Yes No

Does the training produce sonographers at band 7 advanced practice level? 11 0

Comments:

• The current course qualifies a sonographer as an advanced practitioner so I have been unable to see how we would recruit and retain anyone to the band 6 posts.

Q 5 Yes No

If training produces sonographers as band 7 advanced practitioners is it appropriate to employ this workforce at a band 6 with a lower level of responsibility and expectations? 3 8

Comments:

• All our radiographer sonographers are band 7, but actually very few are at the level of band 7 with regard to their Knowledge and Skills Framework and just scan.

• The idea is that we will have a multi-disciplinary team with band 5, 6 , 7s and an 8a in ultrasound with the lower bands doing basic scanning and higher bands a more specialist role.

• How many years has it taken to get autonomy, responsibility, appreciation of the fact we perform the role of a radiologist at a fraction of the cost? It will be a massive retrograde step to get cheaper people to perform limited examinations badly.

The band 7 sonographer role

Regional and national

The review showed there is an increasing need for ultrasound practitioners with the appropriate skills in advanced and consultant level practice to take on proactive roles in service developments which combine experience, complex analysis and leadership.² Appropriate continuing education is required to underpin career development and must be able to support the maintenance, broadening and development of a sonographer's skills and knowledge, which in turn will promote opportunities for career progression.⁴ Questionnaire responses raised the issue of which is the most appropriate grade to undertake the most common ultrasound procedures.

Local practice

Ultrasound services are delivered locally by the radiology department in both a primary and a secondary care setting. Secondary care examinations may be delivered within the department, at the patient's bedside or in the operating theatre. Thus, sonographers must be able to work single-handedly in some areas, and as part of a multidisciplinary team in others.

The structure of the local ultrasound department is such that the number of radiologist-led sessions is small compared to the number of sonographer-led sessions. Only 25 sessions per week out of a possible 153 (16%) are utilized by a radiologist or a general practitioner with special interests. The annual activity is approximately 80,000 examinations with over 64,000 (80%) being performed by sonographers. In our opinion this represents a good value diagnostic imaging service.

The role of an Advanced Practitioner sonographer within the local department requires a relevant examination to be performed and extended if findings dictate. The advanced practitioner role requires image interpretation with correlation to the clinical presentation, formulation of a diagnosis/differential diagnosis, clinical problem solving, report writing and referring for further diagnostic tests in their relevant specialty of clinical practice. Appropriately trained sonographers are also required to administer drugs (e.g. ultrasound contrast agents, steroid injections) or undertake image-guided invasive techniques (e.g. biopsy).

The requirement for a sonographer working within the local radiology department is an individual who has obtained relevant and appropriate education and clinical experience. They will have demonstrated competence to undertake diagnostic, screening, surveillance, interventional or therapeutic procedures enabling effective management of the patient pathway.

Our sonographers are autonomous practitioners who perform with high levels of accountability and responsibility. They exercise critical judgement and skills to ensure the efficient, effective and safe delivery of the ultrasound service, taking responsibility for the conduct, assessment and reporting of the ultrasound examination.² Therefore the current job profile of band 7, and local matching to this, is appropriate. It is acknowledged that consultant sonographers work in the UK and it is likely the extended role of some of the local sonographers would match the consultant job profile. The development of consultant sonographers has not been embraced locally and discussion of this is outside the remit of the current review.

The band 6 practitioner role

Professional perspective

The Society and College of Radiographers (SCoR) has developed a career progression framework for clinic practice that includes Assistant Practitioners, Practitioners, Advanced Practitioners and Consultant Practitioners.³ Radiology departments have embraced the roles of the Advanced Practitioner and to a limited extent the role of the Consultant Practitioner but have not embraced the role of the Assistant or Practitioner in the ultrasound service.

The concept of a Practitioner level sonographer, who would report using a technical report proforma, is not readily apparent although there are changes that could lead to the establishment of a Practitioner level in due course. This may be achieved through the incorporation of ultrasound skills and competencies into undergraduate Radiography courses.¹¹ The course could be accredited by SCoR and CASE. The service would require an ultrasound practitioner to produce a technical report at the time of the examination, which suggests practitioners should go through an accelerated programme of preceptorship development in order to be on pay band 6 in approximately six months.¹¹ Development to Advanced and Consultant practice would then be available by undertaking further training and education at MSc degree level.²

National review

Currently there is no national profile available for a Practitioner who produces ultrasound reports from their examination.

The reviewers recognized there was a need to address issues of sonographer shortage by re-designing how ultrasound is delivered and the training being provided. The NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) uses assistant practitioners (screening technicians) who perform focused abdominal aorta ultrasound examinations at AfC band 4. These assistant practitioners hold a specific focused 30 credit undergraduate modular qualification from the University of Salford to underpin their practice.¹² It is recognized these are highly specific examinations with strict image section and measurement criteria and no expectation of individual interpretation and diagnosis of pathology. The question was raised as to what other ultrasound procedures may fall into such a category and no doubt will be asked by managers as funding becomes more scarce.

A novel approach has been taken by one Trust in the South of England, which has taken obstetric ultrasound out of radiology and into obstetrics. It is now piloting a CASE accredited short course designed to train AfC band 5 individuals in specific areas of dating scans and NT (nuchal translucency) scans so they are of use to the relevant department sooner than the traditional 12–15 month PG Cert/PG Dip ultrasound training of a sonographer. Successful individuals will then be given the option to complete their training but remain a useful member of staff to the department.⁹ Anecdotal evidence suggests there are a minority of Trusts who employ professionals at band 6 who perform limited specific examinations. These posts are midwives who are undertaking limited obstetric ultrasound examinations or nurses employed in Early Pregnancy Units and are not usually part of the radiology department.

Responders suggest most departments continue to train professionals, predominantly radiographers, through CASE accredited MSc Imaging (ultrasound) programmes offered by HEIs, and with exit points at PG Cert, PG Dip or MSc. The majority of responses from clinical departments indicated the need to maintain the level of responsibility and advanced practice of sonographers and a desire to maintain the band 7 matching for sonographer posts. However, there were some comments indicating that sonographers in some departments were all matched at 8a rather than 7. The practice of Trusts matching sonographers at band 8a rather than the more usual band 7 may be for recruitment and retention purposes rather than a recognition of advanced skills and responsibilities.⁶

Summary of current practice and education provision

Reviewing the current local education provision, the PG Cert, Pg Dip, MSc pathway provides the relevant training and education required for the current workforce. HEI practice of offering a PG Cert in a specific clinical module is not embraced by our local radiology department due to the range of examinations sonographers are required to undertake. Ultrasound training for our sonographers will continue with the MSc pathway and exit at PG Dip. Completing the PG Dip gives an appropriate skill set for an Advanced Practitioner role and ensures sonographers have transferable knowledge and skills in the employment market.

Given that the local ultrasound department demands independent diagnostic reporting and not technical descriptive reports, the responsibility and knowledge required of our sonographers remains matched at band 7. There is no scope to ‘carve out’ individual areas of practice that could be reported with a technical report proforma by a Practitioner, as to do this would reduce flexibility and add pressure to capacity for the increasing demand for activity. Any scans done that were deemed to be complex would need either a second report or a repeat examination by an Advanced Practitioner or Consultant Radiologist, neither of which have sufficient capacity to allow this.

The working party identified other clinical areas within the Trust, such as obstetrics, accident and emergency and urology, which in the future may want to develop their own ultrasound service and thereby develop professionals at band 6 who could perform limited specific ultrasound examinations. This may benefit individual services by enabling instant access to ultrasound imaging and reduce the cost of delivering ultrasound to the Trust overall. However, the major disadvantage to this is the fragmentation that may result and the consequent lack of support and governance by experienced professions. Arguably, maintaining a broad-based service delivered by experienced professionals ensures: a well supported service with a robust clinical governance programme in place, equipment used to its greatest potential and a service that keeps abreast of professional developments. The belief from the working party is that any development of ultrasound in individual clinical specialities should be overseen and agreed by the Trust Board. This is to ensure that fragmentation of a successful service is ultimately in the patient's best interest and therefore appropriate clinical governance support is in place for any ultrasound procedure being undertaken. The working party fully recognized and supported the need for a Trust Ultrasound Imaging Governance Committee as per the recommendations by the National Ultrasound Steering Group.¹³ This group would oversee any developments to the ultrasound service and ensure that staff work within a competency based framework⁷ regardless of the specialism in which they work.

Future developments of a career progression framework

Analysis of questionnaire responses from managers and some clinical departments suggests the development of a band 6 practitioner role in ultrasound will happen but at this time, with the current workforce climate and educational programmes available, this is not going to happen overnight. The service needs to determine what is required, who should deliver it and to what level they want the workforce to be educated to deliver a robust ultrasound service. This will then drive changes in education and the development of short focused courses specific to service needs. For this to occur there needs to be a fundamental change in the ultrasound community and recognition of sonography as a profession.

The working party considered two models which could see the development of band 6 practitioners performing ultrasound. The first is most likely to be finance and workforce driven. The national shortage of sonographers may lead to individual services wanting to provide a cheaper and quicker pathway for getting an ultrasound examination such as an NT scan performed. The individual services would train their own staff to perform the specific focused areas of ultrasound practice. With the development of short focused courses in specific clinical specialties it is increasingly likely that some areas of ultrasound, in particular obstetrics, will move away from radiology and into specific services. Band 6 midwives are well placed to extend their skills and take over ultrasound practice and we believe that this route could be taken if the ultrasound profession does not take the lead in developing a more accessible and financially cheaper career pathway, despite all the disadvantages such a route may bring. The current shortage of midwives combined with the potentially huge changes required in their training curriculum make this option unlikely.

The second model could be led by the core ultrasound profession; those for whom sonography is their primary career. This would help reduce the fragmentation of ultrasound into small groups of isolated practitioners. For band 6 practitioners to become a reality within ultrasound there is a need for a first degree qualification and therefore the need for direct entry into the profession. Direct entry would offer an educational route for those seeking to work in this field without the necessity to undertake a first degree (or equivalent) in another health-care discipline and would give rise to a more structured career progression for sonographers.² The in-depth knowledge and skills delivered and assessed in the current post-graduate programmes cover all the areas necessary for a first-post competent practitioner and could be embedded in a dual qualification: MSc Diagnostic Imaging (radiography and ultrasound) programme. The exit points may be: BSc Diagnostic Imaging (Radiography) (Hons), PG Cert, PG Dip or MSc level. Exiting with a BSc Diagnostic Imaging (Radiography) (Hons) with focused specialization in ultrasound would ensure the practitioner may register with the health professions council (HPC) and may undertake a dual first post role with the skill-mix to provide a technical report ultrasound service. The length of time the ultrasound practitioner remains at this first post banding becomes the joint responsibility of the practitioner and employer (preceptorship) but, as previously discussed, these practitioners should go through an accelerated programme of development in order to be on pay band 6 approximately six months post qualification as per Annexe T of the Agenda for Change handbook.¹⁰ Their own professional development to Advanced Practitioner would be supported by the completion of PG Cert, PG Dip, MSc in Diagnostic Imaging. The practitioner who exits with a PG Cert, PG Dip or MSc level will be able to undertake advanced practice roles at band 7 and above. The accumulation of the knowledge and skills required by an advanced practitioner would start on completion of the degree, and would be supported by the clinical teams, and personal CPD.⁵ Their own professional development would be supported by the completion of Professional Doctorate and PhD, leading to, ultimately, a consultant practitioner or academic (lecturer/researcher) post.³

With CASE being established in accrediting short focused ultrasound courses and postgraduate education, both models represent an opportunity for HEIs to engage with clinical service providers and stakeholders to design service specific programmes. This will enable them to develop and design short focused ultrasound courses, BSc, MSc and Professional Doctorate Diagnostic Imaging programmes with an emphasis on ultrasound practice, which are fit for purpose and meet service requirements. In addition, with the proposed changes to the HPC, it is likely that professional registration will not be a mandatory requirement¹⁴ making a direct entry ultrasound degree a reality rather than an ideal.

Conclusions

The conclusions drawn by this review were:
Our Band 7 Ultrasound Advanced Practitioners are correctly matched to current workload and clinical demands;

Band 6 Practitioners are currently not a viable option for practice within our ultrasound department;

Band 6 Practitioners undertaking ultrasound are a possibility in individual clinical specialisms but these would need to be supported by robust clinical governance. Focused short courses will need to be developed by HEIs and aligned with service needs;

Changes to ultrasound delivery and education within Trusts should be developed in conjunction with an over-arching Trust-based ultrasound clinical governance board as recommended by the National Ultrasound Steering Group;

A direct entry, dual qualification, BSc in Diagnostic Imaging (radiography and ultrasound) would facilitate a career progression framework for imaging practitioners but would need developing in conjunction with stakeholders such as clinical service providers and HEIs.

Advanced Practitioner	Specialist Practitioner
Experienced clinical professionals who have developed their skills and theoretical knowledge to a very high standard. Empowered to make high-level clinical decisions and often have own caseload	Staff who have a higher degree of autonomy and responsibility than ‘practitioners’

Question	Number of replies
	Higher Education Institute n = 7	Sonographers n = 4
Q 1	Yes	No
Is your department looking at the option of a permanent band 6 role (as opposed to a preceptorship period)?	2	9
Comments:
• I've had enquiries about training midwives to do Obs U/S only, in the hope that they could pay them band 6, because it's a single area of practice.
• The driving force is obviously to reduce costs and resolve some recruitment issues.
• It makes absolute sense to recognise and reward the skills difference between a newly qualified career Sonographer and an experienced advanced practitioner in ultrasound. However, while I would support the concept of a preceptorship grading, the reality is that Trusts trying to attract qualified sonographers at band 6 or below find it almost impossible to fill the posts. That is certainly the case in this region.

Q 2	Yes	No
Is anyone aware of a national post outline for a band 6 ultrasound practitioner?	0	11
Comments:
• I am not aware of a post outline for a band 6, but I am sure it will arise.
Q 3	Yes	No
Does the education programme offer supported band 6 practitioner training?	2	9
Comments:
• We could train to band 6 and band 7 if role descriptors were established to differentiate a ‘basic’/‘limited scope’ practitioner from an ‘advanced’/‘extended role’ practitioner.
• We have recently completed training a gynaecological nurse in gynaecology ultrasound and early pregnancy scanning at PG Certificate level at band 7, but her colleague, who is a band 6, is now training also to PG Certificate level and she will remain at band 6 on completion.

Q 4	Yes	No
Does the training produce sonographers at band 7 advanced practice level?	11	0
Comments:
• The current course qualifies a sonographer as an advanced practitioner so I have been unable to see how we would recruit and retain anyone to the band 6 posts.
Q 5	Yes	No
If training produces sonographers as band 7 advanced practitioners is it appropriate to employ this workforce at a band 6 with a lower level of responsibility and expectations?	3	8
Comments:
• All our radiographer sonographers are band 7, but actually very few are at the level of band 7 with regard to their Knowledge and Skills Framework and just scan.
• The idea is that we will have a multi-disciplinary team with band 5, 6 , 7s and an 8a in ultrasound with the lower bands doing basic scanning and higher bands a more specialist role.
• How many years has it taken to get autonomy, responsibility, appreciation of the fact we perform the role of a radiologist at a fraction of the cost? It will be a massive retrograde step to get cheaper people to perform limited examinations badly.

Footnotes

DECLARATIONS

Ethical approval: Not required as study related to professional issues.

Funding: None declared.

Conflicts of interest: None declared.

Guarantor: PP.

Contributorship: PP and SW.

Acknowledgements: The authors thank the following for their contribution to the workforce review: Working Party members: Hull and East Yorkshire Hospitals NHS Trust (HEYT): Dr David Horton, Consultant Radiologist; Gillian Allinson, Sonographer; Jayne Gamble, Sonographer; Northern Lincolnshire and Goole Hospitals NHS Foundation Trust: Tracey Broom, Acting Head of Diagnostics; Nick Church, Head of Obstetrics and Gynaecology, Ultrasound; and Regional and national ultrasound colleagues radiologists, HEYT.

References

Modernisation Agency. A Career Development Framework For The NHS – Discussion Document. London: NHS, 2004

Department of Health. Modernising Allied Health Professions (AHP) Careers. London: Department of Health, 2008. See http://dh.gov.uk/publications (last checked 20 April 2012)

SCoR. Implementing Radiography Career Progression: Guidance for Managers. London: Society and College of Radiographers, 2005. See http://www.sor.org (last checked 20 April 2012)

SCoR. Ultrasound Training, Employment and Registration. London: Society and College of Radiographers, 2010. See http://www.sor.org (last checked 20 April 2012)

United Kingdom Association of Sonographers. Guidelines for Professional Working Standards. Ultrasound Practice, 2008. See http://www.doc-lib.sor.org/guidelines-professional-working-standards-ultrasound-practice (last checked 20 April 2012)

SCoR. Developing and Growing the Sonographer workforce: Education and Training Needs. London: Society and College of Radiographers, 2009. See http://doc-lib.sor.org (last checked 20 April 2012)

SCoR. The Scope Of Practice In Medical Ultrasound. London: Society and College of Radiographers, 2009. See http://doc-lib.sor.org (last checked 20 April 2012)

SCoR. Education and Professional Development Strategy: New Directions. London: Society and College of Radiographers, 2010. See http://doc-lib.sor.org (last checked 20 April 2012)

10.

SCoR. Agenda for Change Annex T – Representatives Briefing. London: Society and College of Radiographers, 2006. See http://doc-lib.sor.org (last checked 20 April 2012)

11.

Ultrasound 4-tier structure skill mix development. Phase 1 practitioner sonographer pilot. NHS Yorkshire and the Humber SHA, The University of Bradford, The University of Leeds, January 2008

12.

NHS Abdominal Aortic Aneurysm Screening Programme. Education and Training Framework, 2010. See http://aaa.screening.nhs.uk/training_documents (last checked 20 April 2012)

13.

NUSG. Ultrasound Clinical Governance, 2008 . See http://www.bmus.org/policies.../ClinicalGovernanceInUltrasound-061108.pdf (last checked 20 April 2012)

14.

Department of Health. Enabling Excellence: Autonomy and Accountability for Health and Social Care Staff. London: Department of Health, 2011. See http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124359 (last checked 20 April 2012)

1	Is your department looking at the option of a permanent band 6 role (as opposed to a preceptorship period)?
2	Is anyone aware of a national post outline for a band 6 ultrasound practitioner?
3	Does the education programme offered support band 6 practitioner training?
4	Does the training produce sonographers at band 7 advanced practice level?
5	If training produces sonographers as band 7 advanced practitioners is it appropriate to employ this workforce at a band 6 with a lower level of responsibility and expectations?