UK Radiopharmacy Workforce Issues

1. UK Radiopharmacy Workforce Issues BNMS/UK Radiopharmacy Group

2. Radiopharmacy Staff Two main groups of staff • Scientific • Technical

3. 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

4. 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

5. 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

6. Registration Issues- Scientific staff • 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

7. 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 • 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?

8. Registration Issues - Technologists Two possible registers • Clinical technologists • RPSGB

9. Registration Issues - Technologists • Clinical Technologists Register (currently voluntary but will be HPC Registered) • 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

10. Registration Issues - Technologists • Royal 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

11. Succession Planning/Recruitment -Scientific • Critical 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

12. Succession Planning/Recruitment -Scientific • Critical 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

13. Succession Planning/Recruitment -Scientific • 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

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

15. Effects of Recruitment/succession planning on patient care • Non-delivery of services to 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

16. Effects on Patient Care – cont’d • Lack of ‘Qualified Persons’ (QP’S) for Radiopharmacy • 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 • Manufacturers Authorisation (IMP’s) granted by MHRA • Separate from ‘Specials’ Licence or section 10 exemption • Named QP on Manufacturing Authorisation (IMP)

17. 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 • Applications assessed by MHRA until May 2006 • A limited no of MA(IMP) units for radiopharmacy in UK • 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 • i.e. QP’s with other pharmaceutical experience will not be able to be named

18. Possible solutions

19. 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 posts

20. 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

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

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