Radiography (2010) 16, 189e197

ava i lab le at www.sc ienced i rec t . com

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The role of the consultant radiographer eExperience of appointees

Peter Ford*

Western Sussex Hospitals NHS Trust, St Richards Hospital, Chichester, West Sussex, PO19 6SE, UK

Received 21 August 2009; revised 2 March 2010; accepted 5 March 2010Available online 7 April 2010

KEYWORDSConsultant AHP;Non-medicalconsultants;Advanced practice

* Tel.: þ44 1243 788122x3497; fax:E-mail address: peter.ford@wsht.n

1078-8174/$ - see front matter ª 201doi:10.1016/j.radi.2010.03.001

Abstract Aim: To explore the experience of the first consultant practitioners appointed;including the appointment process, nature of the role, their perceptions of success and chal-lenges.Method: This was a whole population study of the known consultant radiographers appointedup to March 2005. It consisted of 3 phases. The first compared appointees job descriptions withthe Department of Health guidance, the second collected contextual information using a ques-tionnaire, and the third explored postholders experiences using telephone interviews.Results: Ten of the possible twelve appointees participated. All posts were established accord-ing to the guidelines, with largely similar job descriptions allowing for the different clinicalspecialist areas. All were very positive in their perceptions of their role, and faced similar chal-lenges. They were strongest in their expert clinical practice working but had strong trainingand leadership roles. The number working at strategic level was low with limited researchand few published papers, although there were notable exceptions.Conclusions: The first appointees demonstrated notable successes, strongest in the expertclinical practice element of roles, with evidence of team leadership, and involvement intraining and education. Strategic engagement was disappointing, with little research beingundertaken. Their experience was that the nature of consultancy was poorly understood bypeers and medical colleagues.ª 2010 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Introduction

The consultant nurse role was established in 1999 but therewere initial reports that many appointments were notsuccessful,1 and early indications of a high number of

þ44 1243 831452.hs.uk

0 The College of Radiographers. P

resignations. Two years later Consultant Allied HealthProfessional posts were outlined by the Department ofHealth (DOH),2 but four years later only thirteen consultantradiographer posts had been established and appointed.While there had been no resignations no evaluation of theseinitial posts has been published.

This research explored the experience of the firstconsultants in radiography to establish their perceptions ofthe roles. If these were positive appointees would be more

ublished by Elsevier Ltd. All rights reserved.

190 P. Ford

likely to stay in post. The positive aspects of roles couldalso be illustrated which could be used to assist more poststo be established.

In 2005 little had been published into the role of theconsultant allied health professional, and none on theconsultant radiographer. The consultant nurse concept hadbeen around for longer and the comprehensive paper byGuest et al at the Kings Fund3 exploring the consultantnurse experience was used to help establish a baseline forthis research and, together with other nursing papers, usedas the major comparator to the research findings.

The nature of consultancy is ill defined in medicine butMosbys dictionary4 refers to independence and the giving ofadvice. The DOH guidance emphasised that non-medicalconsultancy consists of four domains of practice. Thesecomprise professional leadership and consultancy, practiceand service development, and education training anddevelopment but that roles are rooted in the domain ofexpert clinical practice. The clinical element has been welldemonstrated in nursing,5e7 and within radiography.8e10

The non-medical consultant literature included papers ontransformational leadership,11 problem areas,12 and roleguidance.13

Fyffe14 and Guest et al.3 evaluated advanced andconsultant practice roles in nursing and highlighted majorissues. Within the allied health professions Turnpenny16 didan evaluation of early successes and challenges. Interactionwith medical staff showed a mixed picture of support,17e19

but also resistance3,20 and the desire for the medicalestablishment to retain control.21

Fairley22 found leadership the key aspect of consultancyin nursing, and examples of leadership styles includetransformational,23 entrepreneurship24 agent for change 25

and strategic.14 Literature was also reviewed aroundtraining for these posts 26 and academic attainments.27,28

The literature showed that the concentration in non-medical consultancy had been on expert practice andleadership, and a broad understanding of the non-clinicalareas appeared to be lacking. Support was very variableboth from medical staff and peers, and individuals experi-enced personal challenges.

Subsequent to this research Guest et al published theirfinal report15 and further papers on the consultant radiog-rapher concept have been published,29,30 with other workin the electronic edition of Radiography December 2008.The Society of Radiographers (SOR) website also includesprofiles of existing consultants.31

Methodology

The research cohort consisted of the whole population ofthirteen consultant radiographers registered at the DOH31st March 2005, less the researcher. Of the remaining 12,10 agreed to participate. All had been in post less than twoyears.

To set the posts in context they were examined toestablish how closely they adhered to the official guidance,including the advertising and appointment process. Then,based on the nursing research that showed that postholdershad perceptions about their roles which influenced theirsubsequent job satisfaction,3 the views of the appointees

about their roles were collected, before exploring theiractual experience in practice.

Data collection and analysis was done in three phases.

Phase 1

The posts were set in context by comparing all their jobdescriptions with the original DOH documentation,2

together with the specimen job description in the ImagingWorkforce Design Manual32 using the five elements ofWalk’s argumentative comparison.33 The frame of refer-ence was the consultant job descriptions compared to theDOH guidance. The working thesis was that the literatureand job descriptions would compare accurately. Theorganisational scheme involved comparison on a point bypoint basis using an Excel spreadsheet, the sections ofwhich were then linked to make the comparison.

Phase 2

A self-administered electronic questionnaire collectedquantitative information about the posts and postholdersperceptions of their role. The questionnaire was adapted(with permission from Redfern) from that used by Guest etal in their study into the impact of the consultant nurse,midwife and health visitor.3 The modified questionnaireconsisted of forty questions in eight sections coveringbackground information about appointees and their posts,structure of posts, training for the role, breadth of post,level of support they received and their clinical skills. Anumber of sections from the original questionnaire wereomitted, such as morale, job satisfaction and careerprogression, as it was felt that these are very subjective,difficult to measure and would be mentioned during theinterviews if they were of concern.

The modified questionnaire was piloted by sending it outto a consultant nurse and consultant physiotherapist asthere were too few consultant radiographers to pilot it withthem. Using advanced practitioners to pilot the question-naire was inappropriate as there is a significant widening ofthe role into four domains of practice at consultant levelcompared to the predominantly clinical role of advancedpractitioners.34 The pilot identified minor typographicalerrors in two questions which were corrected.

Nine of the ten questionnaires were returned electroni-cally. The manually completed form was transferred to anelectronic version by the researcher before all werecombined into one master copy. Tables or illustrative alpha-betic answers by content analysis were created from this.

Phase 3

A grounded theory approach using semi structured tele-phone interviews was used to explore the experience ofconsultancy. At a mutually convenient time a series ofopen and semi open questions to be asked. An interviewguide ensured key topic areas were discussed using thelower levels of direction from Whytes scale of directive-ness35 e i.e. making encouraging noises, reflecting onremarks made by the interviewee, and probing the lastremark by the interviewee. No attempt was made to probe

Table 1 Personal experience required.

Essential experience Number of trustsspecifying competency

Facilitating change 9Research experience 7Good CPD or political awareness 3Teaching, management, leadership, innovation, audit, quality assurance,

clinical governance or service improvement experience1

Desirable experienceSpecialist clinical practice, research experience, change management

or an understanding of the research agenda3

Teaching experience, publication, project management, or links to a university 2Research, complaint handling, decision making, or management development experience. 1

Role of the consultant radiographer 191

earlier observations, or return to earlier answers, althoughnew topics were introduced. In this way interviews werekept free flowing but controlled and lasted from thirty fiveto sixty minutes. All conversations were tape recorded andtranscribed within 48 h of interview. These were thenreturned to interviewees to agree accuracy and clarifyambiguities.

Analysis used the iterative process after Burnard.36 Thishas 14 separate stages involving reading and rereadingtranscripts to identify common elements, and then amal-gamating them into common subject areas. Interviewtranscripts were read and broad themes identified. Bysystematically coding these under different headingscommon ideas emerged. In turn these were reviewed togroup similar headings together into categories, which wereexamined to remove duplicates. Once this was completedall transcripts were reread to confirm and verify the finaloutcome and categories. The final themes then emergedfrom these categories.

Ethical approval

The research was approved by the National Health Service(NHS) Central Office for Research Ethics Committee.Approval was then obtained from the NHS Research andDevelopment Committee in each Trust where the researcherand where each consultant radiographer was employed.

Results

Job descriptions

Comparison of the job descriptions with the guidance andspecimen job description showed that posts were verysimilar and included all four domains of practice. Theprinciple domain constituting 50% of roles was expert clin-ical practice in the areas of oncology, breast care, neuro-radiology, gastrointestinal and emergency care. Up to 12clinical competencies were listed with an average of 8.4but a mode of 10. The other three domains occupied theremaining 50% of workloads in differing proportions, withbetween four and fourteen non-clinical competenciesrequired for each. In addition a plethora of other tradi-tional ‘management’ roles were included from health and

safety, budgeting, creating business cases, complaintshandling, recruitment, and radiation protection to qualityassurance and clinical governance. The one exception hadexpert practice as the dominant domain with only passingreference to the other domains.

The personal specifications required of candidates weremixed but all included some form of postgraduate clinicalqualification. A Masters degree was specified for nineposts, and a teaching, a leadership and a managementqualification required in three, with one specifyinga prescriber.

Essential and desirable experience was specified sepa-rately for the four individual domains, with an element ofoverlap. A number also specified a certain number of yearssince qualifying (Table 1).

Questionnaire

All posts were subject to DOH or Strategic Health Authorityapproval and national advertising, but as far as is known bythe appointees most had only one applicant. There appearsto have been only one multiple candidate set of interviews.Eight appointees were previously in a post in theirappointing trust and six were also involved in the creationof these new roles.

All held postgraduate qualifications, eight in theirspecialist clinical practice and two held other postgraduatequalifications, three held full Masters Degrees with indi-viduals holding a variety of management and teachingqualifications. Half were studying to complete a Mastersdegree with one taking a postgraduate certificate and onea Doctorate.

Once in post all felt that the qualifications required fortheir roles were appropriate. While six felt a Doctorate washighly desirable they did not feel it should be a requirementat appointment. Individual mentions were made ofteaching and research qualifications.

Before being appointed all consultants felt they hada good feel for the priorities and time they would spend inthe various domains of their posts but once appointed thischanged (Table 2).

The one area they were unsure about, and this had notchanged since they were appointed, was the criteria forsuccess.

Table 2 Time spent working in each domain.

Domain Expected time Actual time worked Average time

Clinical practice 50% 50e80% 60%Leadership 11% 5e15% (One post 80%) 11%Practice and service development 11% 5e25% 13%Education and research 26% 10e20% 13%

192 P. Ford

All consultants took over the traditional role of medicalstaff in their areas of expert practice to some extent, leadingteams, developing best practice, training and supervisingstaff. They had a major involvement but not the lead role inresearch, improving and promoting best practice, witha lesser contribution in developing new partnerships,management, clinical governance involvement and involve-ment with strategy at trust level. All felt their most impor-tant priority was clinical practice followed by leadership,with training and research of significantly lesser priority.

Support from line managers was mixed, ranging from‘none’ to ‘a great deal’. The majority found they had‘little’ feedback on their job performance, or personalsupport with their activities and difficult tasks. Theyacknowledged that they received a slightly higher level ofpraise and appreciation. Consultant support from theirfellow professionals in these same areas was slightly higher,but in contrast they generally experienced ‘a great deal’ ofsupport from senior medical staff.

All found their roles provided a great deal of freedom toact and plan their clinical work, choosing what to do andhow to do it. Within the non-clinical domains they still hadconsiderable freedom but there was less independentworking. This degree of self-determination createda feeling of isolation.

Once into their roles many consultants started to doadditional clinical work. They also identified furthertraining they required, and areas where new permissionswould enable them to extend their clinical skills (Table 3).

In their roles consultants had a responsibility for estab-lishing safe working practices, ensuring adherence toprotocols, and patient safety but the only specific clinicalgovernance roles were two consultants who chaired eitherclinical governance or discrepancy meetings.

A number of small audits were identified ranging fromwaiting times and biopsy rates to referral numbers. Changesand improvements enacted following audit includedchanging of practice, introduction of new equipment,increased training of team members, changes to reportingstyles, and increased biopsy rates under imaging control.

Areas where consultant involvement had made innova-tive changes in their departments included increased onestop clinics, waiting time reduction, introducing ‘hotreporting’, radiographer led services and clinics leading toradiographer discharge of patients, acute primary carereferral and reporting, FAST scanning, and the introductionof vacuum assisted biopsy. Other initiatives included allradiographers being able to assess patients and refer toother departments with a written opinion, nasogastric tubeinsertion, and adjustments to patient’s journeys such asdirect referral for colonoscopy, or coordinating pelvic floorexaminations.

The volume of work published was limited, with just fourhaving had papers accepted as first author, although fivehad posters presented. Individuals had written a chapterfor a book, were co-authors, or had a paper in preparation.Three had no authorship to their names.

Telephone interviews

Questions at interview were asked around a series of topicareas e role creation, and how present roles compared toprevious ones, the most unexpected aspect/surprise aboutappointments, what gave the most satisfaction and biggestchallenge,howroleshadchangedandcouldcontinuetochangeand develop in the future, improvements to patient care thathad been achieved, training and the best way to prepare forconsultancy, and extent of involvement in research.

From the iterative analysis of the transcripts it emergedthat:

� success in patient care created conflict in keeping thebalance of the other aspects of consultancy;� leadership in clinical care and improving patient path-

ways was evident but involvement in service redesignwas limited;� the breadth and level of national commitment required

of individuals was positive for the consultant role butcreated personal challenges for individuals;� leadership and the degree of autonomy improved

patient care but created challenges around isolationand lack of personal support; and� support was very positive from other clinicians but less

positive from peers and senior departmentalmanagement.

Interlinking these further

� Lack of peer and management support created prob-lems in maintaining the balance of consultancy.� Strong success in patient care was not reflected in

service redesign.� Pressure to enlarge the clinical element reflected on

the education and research commitment.

From these observations a number of themes weredeveloped.

Consultancy and role creationRole creation was largely driven by the shortage of radiolo-gists and need to meet targets, coupled with recognition thatradiographers were capable and already undertaking muchof this work. Leadership of a specific area of clinical care andsupport for a neglected group of patients was also cited.

Table 3 Additional clinical competenciesobtained/desired.

Additional clinical competencies being undertaken

Fast Access and Scanning in Trauma (FAST) ultrasoundexaminations- by a non ultrasound based consultantPatient assessmentReferral for other examinations or to other cliniciansAttendance/involvement on ward roundsAdvising on further management

Therapy consultants were reviewing patients, delineatingand prescribing radiotherapy, determining theradiotherapy fields, marking up skin cancer andusing high dose radiotherapy

Additional training/experience desiredPatient assessmentPrescribingPhlebotomyExtended range of examinations within specialist area- including those from other subspecialties- anal ultrasound

Areas where courses could not be found- magnetic resonance image- nuclear medicine reporting

Other areas of working desired but not yet approvedAngioplasty and stentingSentinel node biopsyVirtual colonographyBudget holding for specialist servicesSampling and adjusting warfarin levelsReferral for additional examinations

Aspiration to be an ARSAC license holder

Role of the consultant radiographer 193

Development into consultancyThe transition of roles from advanced to consultant prac-tice varied from little real change to increased breadth andmajor strategic and national involvement. All undertookwork previously done by a radiologist, providing both clin-ical and team support, including to managers, and strategicinvolvement included aspects of the managerial role.

Independent working was a feature of all posts, withmany experiencing significant challenges, isolation andpoor support. Examples included lack of radiologistsupport, isolation outside the normal radiographer andradiologist circle of communication and interaction, havingto break down traditional barriers, and gaining acceptance.

Experience of consultancyDespite observations about their challenges all had beenpleasantly surprised at how well their posts had beenaccepted, with greater support than they had expected,although this was generally stronger external to their depart-ments. A constant observation was the degree of autonomythey had to plan and execute work as they saw fit. Thisfreedom of action was unexpected, but with it came a feelingof isolation and in some cases alienation from professionalcolleagues who failed to understand the role. Their absence

from the clinical service when undertaking strategic workingand the non-clinical domains was not understood by others,and they felt the pressure of being pulled in different direc-tions while trying to maintain local influence.

Patient careThere was universal agreement that roles had madeimprovements to the patient journey and the achievementof targets. Comments were made about speeding diagnosisand treatment, and establishing a complete package bybeing the patients advocate to improve patient informationand support, They felt they had made services moreaccessible to patients and reactive to their needs, and wereable to move between physicians to link services and bringpeople together. Improvements to patient pathwaysinvolved moving between modalities and working withother departments in partnership.

Education and developmentAll consultants had education roles ranging from preparingin house teaching packages and doing tutorials to universityinvolvement as a lecturer.

Opinions about educational preparation necessary fora consultant role ranged from universal satisfaction withcurrent clinical course provision to identification of lead-ership skills, ‘management’ skills, project management,strategic working and mentorship as being desirable.Masters level academic achievement was thought essential,and two would have liked to be able to sit an appropriatemedical fellowship examination. There was also agreementthat consultants should obtain a doctoral degree, but studyshould be a component of posts once appointed, not asa prerequisite for applying.

Research and auditResearch involvement was varied, from being asked tocontribute to other people’s research and setting upresearch projects, to being the coordinator of internationaltrials. One comment, echoed to an extent by others, wasthat to do meaningful research involves a heavy commit-ment. One day a week is probably not enough and morecould conflict with other domains of practice.

Obtaining a doctorate was felt to be the key to achievingthis element of posts.

Multiple small audits were being done but little had beenpublished by the majority of interviewees.

Discussion

The complex interweave between the data collected andtopics that emerged during the analysis of the interviews isdiscussed in the context of a number of overarchingthemes.

Consultancy and role creation

The shortage of radiologists was a factor in a number ofappointments, and this, as well as the self-perceivedpriorities of the appointees, created the impression thatthe primary purpose of posts was to relieve the pressure ofthe clinical workload. Amongst the radiographers there was

194 P. Ford

no evidence to support Fairley’s 22 or Guest’s et al. 15

finding among consultant nurses that the clinical aspect issubordinated to research, education, leadership and prac-tice development. This begs the question about whichapproach is the correct one for such posts.

While there are differences in the roles of medicalcompared to non-medical NHS consultants the core ofconsultancy according to the Royal College of Psychiatrists37 is to provide leadership, service design and development.The Royal College of Obstetricians and Gynaecologists 38

states that the traditional model of indirect supervisionhas changed to one of direct clinical, education andmanagement. The role of non-medical consultants followsthis. Within imaging patients are referred for investigation,and in some instances treatment, before being returned tothe clinicians who have the overarching responsibility forcontinuing patient care. In this respect the clinical work ofthe consultant radiographers was no different to that ofa consultant radiologist.

Donovan and Manning39 made much of the ability ofmedical consultants to be able to refer patients to otherclinicians or for other imaging modalities but the consultantradiographers were able to do the same. The radiographersalso felt they had a coordinating role with the ability tomove easily between the traditional medical specialistclinical areas.

Despite most appointments being internal all the jobs inthis study followed the DOH guidance for approval andinterview. The cohort were strongly in favour of this as onlythe best candidate should be appointed, despite Price andPaterson40 asserting that ‘‘it should be possible for thoseradiographers already practising at the consultant level todemonstrate this merit without the need for opencompetition’’.

Development into consultancy

Post holders had acquired specialist clinical skills prior toappointment and felt they had a good understanding of theroles and the level of clinical skills required. They wereunsure of the criteria for success and this situation had notchanged since their appointments. While this was similar tothe situation found by Guest et al in nursing,15 where itinfluenced job satisfaction, this did not seem to be an issuefor the radiographers.

Turnpenny 41 found the average time spent in clinicalpractice of 55% by the radiographers was greater than theother allied health professionals average of 47.5%. This washigher than the average for nurses at 44%, and there wasnot the wide variation of a quarter doing just 30% anda quarter working 70e80% clinical demonstrated by Guestet al.3 A factor in this may have been the nursing concen-tration on professional leadership whereas the radiogra-phers felt expert practice was their priority.

Experience of consultancy

Guest et al.15 found that the greater the feedback andinteraction with managers in nursing the less they felt roleoverload and conflict. For the radiographers while rela-tionships with managers were generally good, feedback was

limited with little direct support, but no specific personalpressures were identified due to this. Whether this was dueto the nature of the strong individuals appointed ora characteristic of professionals working in radiography wasnot explored.

The DOH guidance on role creation2 stated that consul-tants were not managers and should not have any managerialresponsibility. All postholders were positive about theirconsultant role despite this lack of authority. This was similarto the work of Guest et al.3but was in contrast to the nursingfindings of Masterman and Cameron42 who found it was verydifficult to manage change without managerial authority.

Within nursing Scott43 expressed the view that roleswere divisive, but the radiographic experience was morepositive, with a high level of acceptance from seniormedical staff. Support from line and professional managerswas limited and very different to the nursing experience.3

Whether this was real lack of support or just being left toget on with their job was not explored.

Within the group mentorship by a radiologist wasmentioned at a number of interviews and was generallygood but two of the research cohort had issues in this area.This raises the question of what the relationship should be.It is possible that a lack of direct supervision or endorse-ment of their work led to this perception as their commentsgave the impression that they may not have been demon-strating the level of autonomy inherent in the roles. Asidefrom this a number felt the general level of self-determination and isolation they experienced wasa source of pressure and in this aspect was similar to theexperience reported by one nurse anonymously.44

While the consultants felt that their professional bodyprovided very little support, in practice it may not have knownwhat support to provide. Since the end of this study a consul-tant radiographer group has been established and providesinformation on dedicated pages on the SOR website.45

Lack of managerial authority within departmental struc-tures was not the issue found by Redfern and Christian innursing.46 Initial difficulties in nursing were overcome asroles matured according to Bowler and Malik.47This may havebeen a stage that the radiographers did not go through.

Patient care

The innovative practice cited by the radiographers had notbeen subject to audit but all were confident that theirleadership was a factor. Manley 48 identified trans-formational leadership as the key quality in consultantnursing, but in radiography what Yuki termed new leader-ship 49 was more evident. Lord and Maher 50 demonstratedthat this is where members of teams are influenced ratherthan the organisation, and by team leaders attributed withskills and influence which are greater than they actuallyhave. One radiographer observed that working in a proac-tive environment where such roles existed was key.

Education and development

The variety of seemingly random academic qualificationsheld by the research cohort in addition to their clinicalpractice fitted the apparently opportunistic pattern

Role of the consultant radiographer 195

Marsden et al 51 found typical of the NHS. None identifiedthat they had or would use online training packages, NHScourses or the framework for development published by theNHS Modernisation Agency Leadership Centre.52

They all agreed that advanced clinical skills wereessential, and that training for these is already wellestablished and easily measured. While this was thoughtnot to be enough they were unable to quantify any yard-stick for anything else, similar to the lack of measures ofgeneral NHS management experience found by Keighly.53

The SOR issued a career framework document in 200228

but appointees made no reference to this.References were made to the personal qualities required,

such as determination and perseverance, motivation andstrength of character as well as emotional intelligence. Allthis fits Ashworth’s 54 original ideas of the importance ofinterpersonal skills, although the radiographers thoughtthese were no substitute for a good range of experience.

When questioned about preparation for consultancy,mentorship and the use of personal development plans waswidely supported, but no mention was made of using theappraisal process. Responses were generally vague and fittedCastledine’s view 55 that development of such a course wouldbe difficult if not impossible, although attempts have beenmade to design such a course by the Wessex Deanery.56 Ageneric consultant pathway has been suggested by the WestYorkshire Nurse/AHP Consultant Network 57 but the contentof these courses appears very varied.

The nursing 27 and radiographer 28 professional bodiessuggest doctoral qualifications are necessary and the Wes-sex Deanery 56 has stated that it will require this of allcandidates from 2010. Amongst the early nursing appoint-ments 65% of candidates held either doctoral or Mastersqualifications,3 but these early nursing posts had a highattrition rate. McSherry and Johnson 58 found this onlysettled down with the later nursing appointees, who heldpostgraduate certificates more than Masters Degrees similarto the radiographer appointments. Perhaps this demon-strates that academic prowess is not a key characteristic forsuccess in these posts.

The research cohort felt that consultant posts are verypractical and to require such high academic qualifications atappointment was both unrealistic and unachievable. Therewould be too few candidates applying for posts. The irony ofthis argument is that they all agreed that possession ofa research qualification for their posts was desirable, anda doctoral qualification is recognised by the United KingdomCouncil for Graduate Education 59 to be the highest researchtraining vehicle. In practice they felt that obtaining thequalification once in post was more appropriate.

Research and audit

All consultant posts made mention of research and Gamblinget al 60 asserted that research is a requirement not an optionfor such roles however any research mentioned was princi-pally linked to academic qualifications.

This area of non-medical consultant practice needsstrengthening, perhaps in conjunction with a Doctoral quali-fication. The consultants sitting on Research Ethics Commit-tees, and coordinating international trials, demonstratedstrategic involvement. This could be a position from which to

introduce evidenced based practice and certainly the groupwere involved in disseminating good practice as invitedspeakers, publishing papers and contributing to books.

Since this research finished evidence collected by Jonesand Snaith 61 showed emerging consultant involvement inprimary research. That it has taken time to developresearch protocols and identify funding is perhaps under-standable while individuals were establishing new posts,particularly in the light of the Wessex Deanery assertion 57

that ‘‘engagement with meaningful research and develop-ment is difficult on less that two sessions a week’’.

Audit is part of the role and limited audits were beingundertaken but no mention was made of using it to identifyor explore weak areas of practice, as demonstrated byWoodward et al within nursing.62

Limitations of the research

The research cohort was small so assessment of the degreeof data saturation was difficult, and making generalisationsis potentially flawed, but it was a whole population studyand the majority of participants contributed in some way tothe majority of findings. All posts were relatively new andthere was relatively little variation in their outlines. Thiscould mean that while posts are becoming establishedopportunities for real innovation are limited.

This study was limited to the views and perceptions of theconsultants themselves about their roles, for the reasonspreviously stated. A more robust assessment of the consul-tant radiographer role would require a 360 degree assess-ment to include the views of peers, managers and patients.

Confidentiality

During the research process confidentiality issues emerged.

� There were a limited number in the research cohort, all ofwhom had been subject to a high professional profileeither locally, at national meetings, or on theSORwebsite.� The number in any individual area of clinical expertise

was limited.� Interviewees were very open about their experiences

and individual incidents during the interviews and itwould not have been difficult to relate remarks back toone or two individuals.

Attempts to edit work to create ‘anonymised’ tran-scripts omitted much valuable information so the decisionwas made to work from the full transcripts but omit specificidentifying information from the results.

Conclusion

This research involved a small cohort of appointees to thefirst consultant radiographer posts. As such they weresubject to a high profile while trying to establish theirroles. In their opinion these first posts have beensuccessfully established, with a wide degree of acceptanceand credibility. They were strongest in the expert clinicalpractice element and individual patient care. Professional

196 P. Ford

leadership was evident, with education and training wellsupported. The strategic element of roles was not welladdressed, and research involvement was low.

More recent evidence seems to be showing that as postsbecome embedded within the profession numbers areincreasing, roles are maturing, and posts are encompassingall domains of practice and additional modalities morecomprehensively. Further research is needed in this area asthe nursing experience was that role overload was posi-tively related, and job satisfaction negatively related, totime in post.

Conflict of interest statement

The researcher was personally known to all researchparticipants but this was declared to the COREC ResearchCommittee who approved the research.

The study was not funded by sponsorship.

Acknowledgements

The author wishes to thank all participants who agreed toparticipate, and also to Dr Sally Redfern who gave approvalfor the questionnaire used in the original Kings Fund NursingStudy3 to be adapted for this research.

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