Workforce and job planning

Physician workforce

The number of nuclear medicine physicians recorded in the 2018–19 census of consultants and higher specialty trainees in the UK is: 

Role

Total

Proportion working less than full time (LTFT)

Consultant

86

20%

Higher specialty trainee

9

33%*

*HST LTFT percentages are calculated from JRCPTB data to give overall figures which may differ from those in the census
These figures relate to physicians who work substantively for the NHS.

An allocation of 300–350 whole-time equivalent (WTE) consultants in the UK was proposed by the Federation of Royal Colleges of Physicians of the United Kingdom in the 2002 Census of consultant physicians in the UK: data and commentary. This equates to about 100–150 WTE nuclear medicine specialists within hubs linked to cancer centres and 200–250 WTE nuclear medicine specialists or radionuclide radiologists in the spokes. At that time, this number was regarded as the minimum required to manage increasing workload complexity in multimodality imaging and molecular therapies and rising commitments to MDT participation. Since then, nuclear medicine activity nationally has increased exponentially with increased demand for multimodality imaging, consultant input to MDTs and major developments in radionuclide therapy bringing with it a requirement for additional consultant posts. The fact that around 30% per cent of nuclear medicine consultants will reach retirement age within the next 10 years can only exacerbate consultant workforce issues.


Job planning

The job plan below is an example included as guidance and not intended to be prescriptive. Activities will vary according to population served, demographics and location. For further information, see the BMA/NHS Employers guidance from 2011.  

Consultant job plans will vary according to hospital size and range of nuclear medicine services provided. Commitments include reporting sessions, outpatient clinics, special procedures and MDT meetings. Additional time is required for paediatric imaging and cardiac stress testing. On-call commitment is rare in a few subspecialised centres, eg lung scan, renal transplant imaging and inpatient therapies.  

General internal medicine commitment is generally none, with the exception of very few consultants in Scotland.  

Duties such as non-patient administration, teaching and training are supporting commitments, and these can be performed flexibly.  

Many nuclear medicine consultants have managerial duties as heads of departments and statutory responsibilities with respect to the Administration of Radioactive Substances Advisory Committee (ARSAC). Many also contribute to the work of radiation protection and research ethics committees. There is a pressing need to develop academic molecular imaging and radiotherapies.  

The figures in table 1 below are an average guide and assume uninterrupted clinical activity. Typical workload also includes referral vetting, justification of procedures, patient assessment, manipulation of drug therapy where appropriate, procedure supervision, discussion with patients and colleagues, review of other imaging/case notes and authorisation of final reports. Reporting of imaging should not be in isolation but reference made to previous imaging of the patient available on PACS.  

Table 1: Sample consultant job plan

Activity

Workload

Programmed activities (PAs)

Direct clinical care

General nuclear medicine

Depends on casemix

2–3

Myocardial perfusion stressing

8 patients

1

Myocardial perfusion reporting

8–10 patients

1

PET-CT imaging and reporting

6–7 patients

1

SPET-CT imaging and reporting

7 patients

1

MDT meetings

1–2 meetings per week

0.5–2

Inpatient therapy

2 patients

1

Outpatient clinics

2 new patients + 6 follow-ups

1

Outpatient therapy*

4 patients

1

Patient administration

Correspondence, patient and referrer advice, draft of Standard Operating Procedures, local clinical ARSAC duties

0.5–1

Supporting professional activities

Work to maintain and improve healthcare quality

Education and training, appraisal, service development, audit, governance, CPD, revalidation, research, departmental management

2.5

Other NHS responsibilities*

eg medical director, clinical director, lead local clinician, educational supervisor, etc

Variable by local arrangement

External duties*

eg work for deaneries, royal colleges, specialist societies, Department of Health, governmental bodies, etc

Variable by local arrangement

* Allows time for consent and discussion prior to treatment

Clinics

The figures in table 2 below are an average guide for reporting times and other clinical activities in nuclear medicine. Please note the times are additive so if there is a routine planar imaging and SPET-CT in the same patient it is important to add the times taken for both imaging modalities. 

Table 2: Guidelines for reporting and clinic times for nuclear medicine studies

 

Time required (min)

  Procedure

Non-training environment

Training environment

Routine non-imaging studies, planar imaging and bone densitometry

10–15

15–20

Tomographic imaging (SPECT)

15–20

20–30

Complex procedures including SPECT-CT, paediatric studies and image co-registration studies* 

30–40

40–50

PET-CT and PET-MRI**

30–45

45–60

Stressing before cardiac imaging, including prior assessment and advice on drug treatment

25

30

Outpatient radionuclide molecular radiotherapy

 

 

New patient

45 

60

Follow-up

20

25

Inpatient therapy: Variable according to length of patient stay and amount of care outpatient therapies shared with other specialties. On average, allow 40 min for a pre-treatment, 60–120 min on day of administration and 20 min per day per patient on subsequent days or follow-up visits.

Multidisciplinary meetings ∗∗∗

Preparation

60–240

60–240

Presentation

60–240

60–240

CT=computed tomography; PET=positron emission tomography; SPET=single-photon emission tomography, MRI=magnetic resonance imaging
This would include most paediatric studies
∗∗ Multiple studies may need to be viewed and quantification performed
∗∗∗ These may vary in length and complexity from a few patients per month to over 100 patients every week

27/02/2020