UK Radiopharmacy Workforce Issues UK Radiopharmacy Workforce Issues BNMS/UK Radiopharmacy Group

Radiopharmacy Staff Two main groups of staff Scientific Scientific Technical Technical

Radiopharmacy Staff - Scientific  Radiopharmaceutical Scientists –Mainly radiopharmacists RPSGB registered Internationally recruited – not eligible for RPSGB registration –Radiochemists –Scientists from physical or life science backgrounds  Developed specialist expertise in science and practice of radiopharmacy

Radiopharmacy Staff - Technical Technologists  Radiopharmaceutical technologists –Pharmacy technician –Nuclear medicine/medical physics technologist –Radiographer –Chemistry or other scientific background All of these groups may be full-time or rotational through radiopharmacy. May all perform same technical roles in the specialty

Registration Issues- Scientific staff Registration Issues- Scientific staff  Some Radiopharmaceutical Scientists are also registered pharmacists –Royal Pharmaceutical Society of Great Britain (RPSGB) practising register of pharmaceutical chemists  non-specialist register (mainly Community Pharmacists- over 80 %)  Registration as a Pharmacist in UK – does not require any knowledge and experience of radiopharmacy  Majority of registered pharmacists will not have knowledge and experience in specialty  5-year route to registration through approved pharmacy degree and pre-registration training

Registration Issues- Scientific staff Not all Radiopharmaceutical Scientists are eligible for registration with RPSGB Not all Radiopharmaceutical Scientists are eligible for registration with RPSGB –E.g Radiochemists and scientists who do not have an approved pharmacy degree and pre-registration training –Internationally recruited highly qualified and experienced radiopharmacists (usually recruited to Head of Service posts) RPSGB may not recognise primary training because they need to be eligible to work in Community Pharmacy for UK registration

Registration Issues- Scientific staff Registration Issues- Scientific staff Some Radiopharmaceutical Scientists (including pharmacists) have been able to register on HPC clinical scientist by ticking ‘medical physics’ modality via grandparent route Some Radiopharmaceutical Scientists (including pharmacists) have been able to register on HPC clinical scientist by ticking ‘medical physics’ modality via grandparent route –Problems with registration as there is no modality for Radiopharmaceutical Scientists (includes Radiopharmacists and PET Radiochemists) –UK grandparent route now closed registration only through accredited courses – no route for radiopharmaceutical scientists –Need to recognise Radiopharmaceutical Scientists on Clinical Scientist register to be able to register staff –Clinical governance issues of employing experienced staff where there is no route to registration?

Registration Issues - Technologists Registration Issues - Technologists Two possible registers Clinical technologists Clinical technologists RPSGB RPSGB

Registration Issues - Technologists Clinical Technologists Register (currently voluntary but will be HPC Registered) Clinical Technologists Register (currently voluntary but will be HPC Registered) Require recognition on clinical technologists register Require recognition on clinical technologists register — Only route via 4 year clinical technologists degree  Does not recognise radiopharmacy as a specialty alongside nuclear medicine, radiation protection etc  Radiopharmacy technologists cannot be released from posts to undertake all nuclear medicine imaging aspects

Registration Issues - Technologists Royal Pharmaceutical Society of Great Britain pharmacy technicians registerRoyal Pharmaceutical Society of Great Britain pharmacy technicians register –May not be eligible for RSPGB register for technologists (does not specifically recognise radiopharmacy) –Staff would need to undergo vocational general pharmacy technician training – not achieveable if working in radiopharmacy –Pharmacy technician training – NVQ level 3  Does not provide the level of underpinning knowledge and skills for radiopharmaceutical science and practice

Succession Planning/Recruitment -Scientific Critical shortage of senior level Radiopharmaceutical Scientists in UKCritical shortage of senior level Radiopharmaceutical Scientists in UK –Very few senior specialists left in UK Very sparse from Cornwall to Scottish Borders Variable service across UK with varying problems Difficult for current small pool of senior specialists in providing a professional NHS network throughout UK – –Developing strategies for future NHS radiopharmacy services – –Promoting patient safety e.g Providing timely advice Setting standards – –Co-ordinating education and training programmes

Succession Planning/Recruitment -Scientific Critical succession planning problemCritical succession planning problem –Lack of defined career structure –Retention problems –Lack of funding for training posts –No official route of entry –No structured training up to senior (Consultant) level –Specialty may not survive unless succession planning issue addressed –Registration issues

Succession Planning/Recruitment -Scientific Serious recruitment problems Serious recruitment problems –Lack of trained scientists in specialty –Vacant posts unfilled – specialist posts lost –Some posts only filled by international recruitment International shortage –Expansion of PET will need people who are not available –Qualified pharmacists – many career options in NHS  Do not want to specialise in work if does not offer career progression  Most UK hospitals do not offer basic grade pharmacist rotational training in Radiopharmacy

Succession Planning/recruitment - Technologists Lack of skilled staff Lack of skilled staff No official entry route No official entry route No defined career pathway No defined career pathway Registration issues Registration issues No training routes No training routes Lack of experienced radiopharmaceutical scientists to provide and support training Lack of experienced radiopharmaceutical scientists to provide and support training

Effects of Recruitment/succession planning on patient care Non-delivery of services to patients Non-delivery of services to patients Cannot implement high quality service for patients Cannot implement high quality service for patients –Patient safety compromised –Cannot meet Health Care Standards Lack of patient responsiveness Reduction in patient choice of scan Cannot implement or develop new patient services Cannot implement new technologies or develop better techniques Patient waits increase – both out-patient and in-patient Cannot implement NICE guidelines

Effects on Patient Care – cont’d Lack of ‘Qualified Persons’ (QP’S) for Radiopharmacy Lack of ‘Qualified Persons’ (QP’S) for Radiopharmacy Seriously hinder or halt clinical trials in Nuclear Medicine Seriously hinder or halt clinical trials in Nuclear Medicine –E.g targeted radionuclide radiotherapy –New radiotracers for clinical nuclear medicine Preparation of radiopharmaceuticals as Investigational Medicinal Products requires Preparation of radiopharmaceuticals as Investigational Medicinal Products requires –Manufacturers Authorisation (IMP’s) granted by MHRA –Separate from ‘Specials’ Licence or section 10 exemption –Named QP on Manufacturing Authorisation (IMP)

Effects on Patient Care- cont’d Grandparent clause for obtaining QP(IMP) for staff with experience in releasing radiopharmaceuticals for clinical trials prior to May 2004 Grandparent clause for obtaining QP(IMP) for staff with experience in releasing radiopharmaceuticals for clinical trials prior to May 2004 –Applications assessed by MHRA until May 2006 –A limited no of MA(IMP) units for radiopharmacy in UK Now requirements for QP (IMP) Now requirements for QP (IMP) –Satisfy requirements permanent route of Directive 2001/83/EC –Member of RPSGB, Royal Society of Chemistry or Institute of Biology –Appropriate practical experience working under full manufacturing licence (not ‘Specials’) or MA (IMP –Virtually impossible to obtain for radiopharmaceuticals QP status for being named on licence requires relevant practical experience and knowledge for radiopharmaceuticals QP status for being named on licence requires relevant practical experience and knowledge for radiopharmaceuticals –i.e. QP’s with other pharmaceutical experience will not be able to be named

Possible solutions

Regional/National Radiopharmacy Expert Posts Formal recognition of Regional/National Radiopharmacy Expert posts Formal recognition of Regional/National Radiopharmacy Expert posts – Formalising a UK network of Consultant Radiopharmaceutical Scientists – Consultant Pharmacist or Consultant Healthcare Scientist accreditation – Provide hub and spoke structure – Post would provide professional mentorship and training Will require funding for postsWill require funding for posts

Specialist training posts for radiopharmaceutical scientists Need to be supernumerary Specialist postgraduate route for HPC clinical scientist registration –via vocational MSc in Specialty plus practical experience or European Postgraduate Specialisation Certificate route Specialist pharmacist training posts in Radiopharmacy – –undertaking MSc in Specialty plus practical experience – –Centrally funded – UK wide issue Supervised training by Senior Expert Radiopharmaceutical Scientist

Technologist recruitment/training Structured training provision for radiopharmacy Structured training provision for radiopharmacy Radiopharmacy syllabus for Clinical Technologists degree Radiopharmacy syllabus for Clinical Technologists degree –Registration as clinical technologist

Career Framework Progression Radiopharmacy part of Healthcare Science Radiopharmacy part of Healthcare Science Radiopharmacy NOS produced and mapped to Healthcare Science career pathway Radiopharmacy NOS produced and mapped to Healthcare Science career pathway Need for recruitment to support expansion in long term Need for recruitment to support expansion in long term Establish posts along career pathway Establish posts along career pathway