SONOGRAPHERS AND ULTRASOUND

SERVICES IN THE UNITED KINGDOM

NIGEL THOMSON

PROFESSIONAL OFFICER (ULTRASOUND)

SOCIETY AND COLLEGE OF RADIOGRAPHERS

SONOGRAPHER

TAMPERE, FINLAND

May 6th 2015

POPULATIONS

• England 53,000,000 (83.9%)

• Scotland 5,295,000 (8.4%)

• Wales 3,063,436 (4.8%)

• Northern Ireland 1,810,000 (2.9%)

• Total UK = 63.1 million

Healthcare in the UK

• NHS provision includes primary care (GPs) and hospitals

• Free to the patient at the point of delivery (with some exceptions).

• Four country structure to UK, healthcare is a devolved function.

• Largely funded by taxation with a small independent sector

• NHS hospitals

• Independent hospitals contracting to the NHS

• Independent providers contracting to the NHS

Healthcare in the UK Continued

• Private provision, either self pay or via insurance for some but their choice

• Very politicised, major election issue for May 7th

• Regular ‘re-organisations’

• A typical ‘general hospital’ serves a population of 300,000

• Typical general hospitals employs approximately 15 w.t.e.sonographers plus cardiac physiologists and vascular ultrasound specialists.

The Society and College of

Radiographers

• Professional body representing radiographers

and sonographers

• We are not a regulatory body, radiographers do

not register with us, they are members.

• Annual subscription

• Many benefits of membership including

Professional Indemnity Insurance

British Medical Ultrasound Society

• Scientific organisation

• Member organisation of

the EFSUMB

• Membership open to all

with an interest in

ultrasound

• Publishes safety

guidelines

WHO DOES ULTRASOUND EXAMINATIONS

IN THE UK?

Wide range but mainly:

• Sonographers

• Radiologists

• Obstetricians

• Physiotherapists

• Nurses

• Midwives

• Clinical scientists

• Vascular scientists

• Echocardiographers

Plus the totally unqualified:

3D/4D ‘Souvenir’ or ‘boutique’ scanning in obstetrics.

What is a Sonographer?

• A person qualified to undertake and report on ultrasound

examinations.

• Will seek advice as necessary (‘Third party’ reporting

not used in UK).

• Is not medically qualified

• Autonomous practitioner (not a helper or assistant)

• Holds a post-graduate award in ultrasound

• Usually from a professional background such as

radiography, midwifery or clinical scientist, already has

a primary degree.

• State registration not available for sonographers but

most are e.g. as radiographers or midwives

Sonographers

• Will recognise their limits of competence and will seek advice as necessary, as should any professional.

• Aim to establish a good working relationship with radiologists and are also involved with the training of radiologists. Radiologists are also involved with the training of sonographers and their input is greatly appreciated.

• Sonographers scan within agreed departmental protocols, the clinical director of an imaging department is usually a consultant radiologist

• Recent formalised training relationship for trainee Obstetricians.

WHAT ARE MY QUALIFICATIONS?

• Initially qualified as a radiographer (1976)

• Stautorily (state) registered by the Health and Care

Professions Council (HCPC) as a radiographer

• Commenced ultrasound training in 1979

• Completed ultrasound qualification 1981

• Experienced in obstetrics, gynaecology, general medical

ultrasound. Have been involved with echocardiography

in the past.

What do sonographers do?

• Mainstay of the national obstetric screening programmes, both first and second trimester.

• Obstetric (symptomatic) ultrasound

• Gynaecological ultrasound

• General Medical Ultrasound

• Vascular ultrasound

• Breast

• Abdominal Aortic Aneurysm Screening

• Interventional and biopsy

• Musculo-skeletal

• Testes

NHS Screening Programmes utilising

ultrasound

• 11w 1d to 14 w 1d scan. To include nuchal translucency

as part of the combined test for Down’s syndrome.

• T13/T18 screening being introduced from 1st April 2015

• 18w to 20w 6d fetal anomaly scan

• Abdominal aortic aneurysm screening for males aged

65. This done in the community by assistants with

special training supervised by qualified sonographers.

What about the Independent Sector?

• Sonographers work across all sectors of

employment

• Less likely to be employed in situations where

patients are directly charged.

• Sonographers often work in the community for

firms operating ‘Closer to Home’

• Some sonographers are self-employed or have

formed their own companies

How much does a Sonographer earn?

• Most are on NHS Band 7, with a salary scale between £31,072 and £40,964 which is equal to between 43,464 and 57,301 Euros as at May 2015

• Approx 6 weeks annual leave per year depending on length of service

• Pension and sick pay benefits

• Other benefits as associated with NHS employment (the majority).

• Higher salaries often with Independent providers

• Agency working increasing.

Training

Consortium for the Accreditation of

Sonographic Education (CASE)

• Formed from five

organisations

• Accredits post-graduate

ultrasound education

• At Masters level, post-

graduate certificate or

diploma

• Sonographer education

and training delivered by

18 Universities offering

CASE accredited courses

Training

• Postgraduate certificate 1 year approx

• Postgraduate diploma 18 months approx

• Full Masters after optional dissertation

• Modular structure

• Physics/equipment plus clinical modules

• Masters level

• 18 CASE accredited universities

• Case accreditation not compulsory, however

• Clinical assessment a requirement for accreditation

• Ideally preceptorship period following

Training

FOCUSED/SHORT COURSES

• CASE also accredits shorter, focused courses that are

essentially individual clinical modules or sub-modules

within a PGC/PGD pathway.

• There are also many other providers of short courses

lasting a day to a week or so in duration.

• Organisations such as the British Society of

Echocardiography and the Society for Vascular

Technology also accredit individual sonographers

• So overall training in the UK is a complex picture with no

legal requirements as there are for ionising radiation.

Funding

• Most trainee sonographers are funded by their

employer. They were working perhaps as a radiographer

or midwife.

• Expensive, back-fill often required

• A few trainees pay for themselves

• Shortage of clinical placements

• Ultrasound training is one to one and requires time

• Departments under pressure with demand increasing all

the time

• Some departments and independent providers never

train sonographers, relying on recruiting from those that

do.

Are there problems?

• There are not enough qualified sonographers

in the UK. Estimated 18% shortfall.

• Demand for ultrasound examinations is rising

and will continue to do so.

• Inter-professional issues sometimes come to

the fore and lead to unnecessary tensions.

• The demand for ultrasound can only be met by

good collaborative working.

Are there problems? continued.

• No statutory registration, the profession is not formally recognised

• No central workforce planning

• M- level entry only

• Narrow career structure

• Primary (undergraduate) entry may be a solution but many issues and divides sonographers

• The SCoR administers the Public Voluntary Register of Sonographers for those who are not stautorily registered.

• Limited sonographer audit outside of the national screening programmes.

• Work Related Musculo-Skeletal Disorders

Recent documents

• Standards for the Provision of an Ultrasound Service

RCR/SCoR December 2014

https://www.rcr.ac.uk/standards-provision-ultrasound-

service

• BMUS equipment Quality Assurance advice

• BMUS audit advice for individual sonographer

performance

Thank You

NigelT@sor.org

Society and College of Radiographers

207, Providence Square

Mill Street

London

SE1 2EW

UK