1. Setting up a STEMI PCI Programme in the UK: Implications for the cath lab workforce Rob Henderson Trent Cardiac Centre Nottingham Chair, BCS Working Group on Non-Medical Cath Lab Staffing Rob Henderson Trent Cardiac Centre Nottingham Chair, BCS Working Group on Non-Medical Cath Lab Staffing NO CONFLICT OF INTEREST TO DECLARE

2. Estimating the need for Primary PCI Europe and UK UK population 60 million, at 500 pmp = 30,000 PPCI per annum 2004 data: Ludman

3. 2.3 % 2004 data: Ludman 32 % 1050 pmp 1546 pmp UK Growth needed for primary PCI ( assuming no increase in other types of PCI)

4. Consultant Cardiac Workforce requirements in the UK To provide 1500 PCI pmp To provide 2200-3000 PCI pmp To provide cardiology service Consultants pmp 3.2*4.8-8.8*52.7-84.2 Consultants for UK 196*288-528*3162-5052 David Hackett, BCS Working Group 2005 *Assumes consultants dedicated to PCI; assumes UK population 60 million 424 consultants did PCI in 2004 (BCIS) – but majority not dedicated to PCI 710 cardiologists (663 wte) in 2004 (DOH) 630 cardiologists in 2003 (RCP) *Assumes consultants dedicated to PCI; assumes UK population 60 million 424 consultants did PCI in 2004 (BCIS) – but majority not dedicated to PCI 710 cardiologists (663 wte) in 2004 (DOH) 630 cardiologists in 2003 (RCP)

5. Non-Medical Cardiac Workforce requirements in the UK To provide 1500 PCI pmp To provide 2200-3000 PCI pmp To provide invasive cardiology service To provide cardiology service Non-medical clinicians pmp 7.5*11-15*50.4-61.0168-211? Non-medical clinicians for UK 450*660-900*3024-366010080-12660? David Hackett, BCS Working Group 2005 *Assumes Nurses, Physiologists, Radiographers dedicated to PCI work Assumes UK population 60 million Information about available staff very limited *Assumes Nurses, Physiologists, Radiographers dedicated to PCI work Assumes UK population 60 million Information about available staff very limited

6. Available non-medical clinical staff? RegisteredWorking? Working in cardiology? Working in cath labs? Nursing* (March 2005) 672 897 registered with NMC 623 846 adult general nursing 623 846 adult general nursing?? Cardiac Physiology** ~3500 ~1800-2000 SCST members ~2000- 3500 ? Radiography*** 23 397 registered with HPC 16 329 SOR members in NHS 16 329 SOR members in NHS190(1.2%)? *Nursing & Midwifery Council website – includes staff working overseas **Jackie Howard, Catriona MacGregor – excludes cardiographers *** Audrey Patterson – 1563 SOR members work outside NHS *Nursing & Midwifery Council website – includes staff working overseas **Jackie Howard, Catriona MacGregor – excludes cardiographers *** Audrey Patterson – 1563 SOR members work outside NHS

7. Estimated UK catheter laboratory vacancies NursingPhysiologyRadiography 14 labs 2133.5 Vacancies per lab 0.140.930.25 Extrapolated to 160 labs* 2214940 Preliminary data – includes diagnostic and PCI labs BCS Non-medical Cath Lab Staffing Working Group survey 2005 *BCIS 2004 Preliminary data – includes diagnostic and PCI labs BCS Non-medical Cath Lab Staffing Working Group survey 2005 *BCIS 2004

8. Catheter laboratory work Traditional roles in the UK Cardiologist and trainee Do procedure Cardiologist and trainee Do procedure Nurses (1-2) Puts patient on table Draws up drugs Opens equipment Nurses (1-2) Puts patient on table Draws up drugs Opens equipment Physiologist (1-2) Sets up & monitors pressure line & ECG Physiologist (1-2) Sets up & monitors pressure line & ECG Radiographer (1) Turns on machine and controls C arm Radiographer (1) Turns on machine and controls C arm (Perfusionist – IABP)

9. Catheter laboratory staffing for PCI in the UK BCS Non-medical Cath Lab staffing Working Group survey 2005 Preliminary data from 6 PCI centres BCS Non-medical Cath Lab staffing Working Group survey 2005 Preliminary data from 6 PCI centres 6.0 5.8 6.6

10. Catheter laboratory staffing for PCI UK Number PCI 120060040004302900900 Cardiologist111111 Trainee/SpR101011 Nursing122222 Physiology121012 Radiography000011 Total4*553**67 *and a cleaner **and a porter

11. Catheter laboratory staffing for PCI *and a cleaner **and a porter

12. Catheter Laboratory Multi-skilling Cardiac Cath Lab practitioner project –London South Bank University Middlesbrough generic worker training –In house programme Nottingham nurse radiography training –In house programme Need national coordination and funding Cardiac Cath Lab practitioner project –London South Bank University Middlesbrough generic worker training –In house programme Nottingham nurse radiography training –In house programme Need national coordination and funding

13. Conclusions A national primary PCI service will need additional medical and non-medical staff capacity - but there are currently significant staff shortages More trainees and multi-skilling will help but may not solve the problem entirely If primary PCI is to be rolled out across the UK we need multidisciplinary, flexible, and innovative solutions to medical & non-medical workforce problems There is an urgent need for robust information about non- medical catheter laboratory staffing to facilitate future planning A national primary PCI service will need additional medical and non-medical staff capacity - but there are currently significant staff shortages More trainees and multi-skilling will help but may not solve the problem entirely If primary PCI is to be rolled out across the UK we need multidisciplinary, flexible, and innovative solutions to medical & non-medical workforce problems There is an urgent need for robust information about non- medical catheter laboratory staffing to facilitate future planning

14. BCS non-medical catheter laboratory staffing survey 2006 All cath lab managers ….please, Please, PLEASE…… complete the survey form and return to BCS All cath lab managers ….please, Please, PLEASE…… complete the survey form and return to BCS

15. Physiology staff vacancies SCST survey November 2003 60% response Extrapolated to 100% 15% 8% 2005 London survey estimated physiology vacancy rate at 23% (79 wte)

16. Catheter Laboratory Multi-skilling Multiple projects across UK Often driven by local need Cost of training and release from work Need transferable qualification Multiple projects across UK Often driven by local need Cost of training and release from work Need transferable qualification

17. National guidelines and staffing BCIS/BCS recommendations 2005 –‘….dedicated multidisciplinary team…’ –‘….multi-skilling should be encouraged…’ –No statement on appropriate staffing levels ESC PCI guideline 2005 –No statement on staffing ACC/AHA PCI guideline 2005 & STEMI guideline 2004 –No statement on staffing BCIS/BCS recommendations 2005 –‘….dedicated multidisciplinary team…’ –‘….multi-skilling should be encouraged…’ –No statement on appropriate staffing levels ESC PCI guideline 2005 –No statement on staffing ACC/AHA PCI guideline 2005 & STEMI guideline 2004 –No statement on staffing

18. Estimating the need for Primary PCI 58 NHS PCI units (2004) STEMI in England (MINAP) All MI in UK (Dawkins) 37000137000 30525 (75% PCI) 34250 (25% PCI) PCI / unit / day 1.41.6 Modified from David Hackett, BCS Working Group 2003

19. Primary PCI in the UK 2004-2005 2004 data: Ludman In 2004 51 centres did 3447 PCI for STEMI (1438 PPCI) Data from 55 of 58 NHS centres In 2004 51 centres did 3447 PCI for STEMI (1438 PPCI) Data from 55 of 58 NHS centres Number of centres doing routine primary PCI

20. Catheter laboratory staff training StaffRegistrationTraining NursingNMC 3 yr degree course &1-2 yr experience PhysiologyHPC (from 2005) 4 yr degree course RadiographyHPC 3 yr degree course & 1-2 yr experience HPC - Health Professions council NMC - Nursing & Midwifery Council HPC - Health Professions council NMC - Nursing & Midwifery Council