WALES CARDIAC PHYSIOLOGY WORKFORCE PROJECT Commissioned by The Cardiac Networks Co-ordinating Group
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WALES CARDIAC PHYSIOLOGY WORKFORCE
PROJECT
Commissioned by The Cardiac Networks Co-ordinating Group
About Tangerine Bee Analysts
o Rupa Chilvers, Director/Senior Analyst
o specialise in health and social care workforce analysis
o strategic level research including case studies, mathematical modelling ad
planning analysis
o completed a UK wide review of the cardiac physiology workforce on behalf
of the British Heart Foundation in collaboration with the NHS Workforce
Review Team
o working towards a methodology for regional level cost-based workforce
planning models to assist service planning and delivery
o further information on www.tangerinebee.com or email
o commissioned by the Cardiac Networks Coordinating Group to carry out an
analysis on the cardiac physiology workforce in Wales
Aims of the Project
o Description of the workforce currently delivering cardiac physiology services
including age profile; grade; specialist skills; skill mix, and local level workforce
issues.
o Description of the current levels of demand, including activity levels and
waiting lists.
o Potential future activity levels based on the Access 2009 targets.
o Potential directions for workforce development, new roles, and new ways of
delivering the service with options for training to meet service demands.
o Quantitative projections for the future supply and demand of the service,
including a projection to 2015.
Project Methodology12 Trusts and 19 sites providing cardiac physiology services
Workforce Data 19/19 Sites
Activity Data 10/12 Trusts and 13/19 Sites
Telephone Interviews
Reference Panel for assumptions testing
Summary of the Findings
o Gap in projections between supply and demand continuing beyond 2011
o Immediate attention required to meet 2009 Access Targets
o Skill mix with both administrative and clinical support is instrumental in
increased productivity and efficiency within departments
o Specialist training is essential in growing the required workforce
o Training models for new entrants into the profession needs to be reviewed
and guarded to ensure future supply and demand
o Analysing changes in patterns for the different services within the
department is essential for workforce design
o Contextual issues such as physical space, controls on referrals, and digital
technology is likely to impact on service delivery
Mainly ECGs, some ambulatory monitoring
Mainly ECGs, assistant in exercise testing, echos and catheter labs
ECGs, ambulatory monitoring and reporting, exercise testing, echocardigraphy, tilt-table testing, pacemaker/ICDs programming and follow-up, technical support for electrophysiology, catheter lab work incuding angiograms, angiography, primary PCI, technical support for cardiac surgery, open access and direct referral clinics including chest pain clinics etc.
Recruited through local press and NHS Jobs websites(UCAS for university based trainees)
Advertising through SCST Journal, NHS Jobs websites, Agencies (occassionally)
Experience and in-house training
4 year degree training (off site university course (for employees) and (on site clinical placement (for university students) with exams
In-house training with exam for ECG Certification
Experience and in-house training
Courses, in-house training and exams
WORKFORCE DEVELOPMENT
ATO/Cardiographer
Senior ATO/Cardiographer
Trainee Cardiac Physiologist
Cardiac Physiologist (CP)
Specialist training/Advanced CP
Specialist/Senior/Chief CP
KEY
Current Route for Training in Wales-University of Swansea (UCAS)- Westminster University (Trainee)- Manchester Metropolitan University (Trainee)
About the Cardiac Physiology Service and Context
Service Delivery Headlines
o 13 out of 19 units operate as joint respiratory and cardiac physiology
departments
o All departments operate between 8.30 and 5.30pm with some exceptions for
OOH service for ECGs (by ATOs) and emergency work
o Number of ECGs carried out vary from 350 to over 1500 per month per
department
o Echocardiograms account for majority of the non-invasive workload
o Implant:Follow-up ratio is very high with UHW carrying out 48 implants and
425 follow-ups in 2006 (37 and 441 respectively for 2005)
Monthly activity for cardiac interventions/ tests (2006)
0
100
200
300
400
500
600
700
800
900
WrexhamMaelor
Singleton Morriston BronglaisGeneral
UniversityHospital of
Wales
Princess ofWales
West WalesGeneral
Llandough RoyalGlamorgan
hospital
mth
ly a
vera
ge (n
)Ambulatory 2006ETT 2006Echo 2006Catheterisation 2006Pacing/Devices 2006
0
2
4
6
8
10
12
14
Available Planning
service status
hosp
itals
(n)
physiologist-led open/rapidaccess clinics
other non-cardiologists ledopen/rapid access clinics
ETT outpatient clinics
Number of sites carrying out or planning physiologist-led or non-cardiologist led open or rapid access clinics
Level of agreement on the ease of changing core hours within departments
0
2
4
6
8
10
12
1- TotallyDisagree
2 3 4 5 - TotallyAgree
level of agreement
hosp
itals
(n)
easy tochange core
Level of agreement on the disruption caused by annual leave and sick leave taken by cardiac physiologists and the unplanned and inpatient work on services within the department
0
2
4
6
8
10
12
1- TotallyDisagree
2 3 4 5 - TotallyAgree
level of agreement
hosp
itals
(n)
annual leave not disruptive
sick leave not disruptive
unplanned work notdisruptive
0
2
4
6
8
10
12
0 5 10 15 20
hospital
card
iac
room
s(n)
Non-invasiveonly
Non-invasiveand invasive
Specialistsecondary
TertiarySpecialist
Number of cardiac rooms available for cardiac physiology services by type of service
0
2
4
6
8
10
12
1- TotallyDisagree
2 3 4 5 - TotallyAgreelevel of agreement
hosp
itals
(n)
sufficient space
space to expand
Level of impact of available space on current and future activity levels
About the Cardiac Physiology Workforce
249 individuals contribute to cardiac physiology service delivery in Wales (56%
qualified, 7% in training) equating to 209 WTE
Cardiac Physiologist WTE by Band
0 10 20 30 40 50 60 70 80
TOTAL WTE
2
3
4
5U
5
6
7
8
BAN
D
WTE - ACTIVEWTE - ABSENTWTE - VACANCY
Cardiac Physiology Workforce Headlines
o Majority of the vacancies are in the South East with 7% vacancy rate for
Assistants and 12% vacancy rate for Cardiac Physiologists
o Rate of absence was 1.4% (WTE=1) and 4.9% (WTE=7.6) for assistants
and cardiac physiologists respectively. 4 WTE were expected to return by
2008
o Out of the 15 trainees, 12 already held a bachelors degree and a large
proportion were fast track students
o 11 of the trainees were expected to graduate in 2008
o 83% of cardiac physiologists are female (98% of assistants) and 40% of the
trainees are male
Cardiac Physiology Workforce Headlines
o 2% of the workforce will retire in the next 5 years with further 18% in the
next 10-15 years:
o 6 out of the 18 individuals in Band 8
o 38 WTE in band 5 and 6 (1/5th of the current workforce)
o equivalent of 5.7 WTE in echocardiography
0
5
10
15
20
25
30
35
40
WTE (%)
20-29 yrs 30-39 yrs 40-49 yrs 50-59 yrs over 60 years
Age group
Cardiac PhysiologistsAssistants
RESPIRATORY 3%
ADMIN4%
Assisting in Echos/ETT1%
AMBUL. MONITORING13%
MANAGEMENT 1%
ECG78%
Proportion of WTE spent on clinical and administrative activities by assistants
WTE spent on clinical and administrative activities by cardiac physiologists
0
5
10
15
20
25
30
35
40
45
Echoc
ardiog
rams
Invas
ive an
d foll
ow-up
Exerci
se Tole
rance
Testin
g
Ambulat
ory m
onito
ring
Respir
atory
Manag
emen
tMixe
d ECG/E
TTMixe
d and
Othe
rAdm
inistr
ation
ECG
Activity
WTE
About the Additional Demand, Targets and Projections
Additional Demand from Waiting Lists
0
5000
10000
15000
20000
25000
30000
35000
2007 2008 2009 2010 2011 2012 2013 2014 2015
year
activ
ity(n
)
ETTEchocardiogramsinvasive
2007 - 100% of over 12 week waits included in monthly activity2008 - 50% of under 12 week waits included in monthly activity2009 - remaining 50% of under 12 week waits included in monthly activity2007 -2015 - 5% increase in additional demand to allow for growth
Additional Demand from Waiting Lists
0
50
100
150
200
250
300
350
400
450
500
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
year
HC
-car
diac
phy
siol
ogis
ts
Supply Projections
Supply with 5 newcommissionedTarget- Capacity Planning
Target - new activity (no skillmix)Target - new activity WITHskill mix
Supply with what is happening now
Demand based on Departments’ assessment of Access target needsH
eadc
ount
Additional Demand from Waiting Lists
0
50
100
150
200
250
300
350
400
450
500
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
year
HC
-car
diac
phy
siol
ogis
ts
Supply Projections
Supply with 5 newcommissionedTarget- Capacity Planning
Target - new activity (no skillmix)Target - new activity WITHskill mix
With skill mix
Without skill mix
0
5
10
15
20
25
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
HC
Clinical Assistant
SATO
HC - Gap for target based on capacity
planning
HC - Gap for target - new
activity WITHOUT skill mix
HC - Gap for new activity WITH skill
mix
2007 28 56 17
2008 53 97 29
2009 89 155 53
2010 91 167 60
2011 91 178 65
2012 90 188 70
2013 90 200 76
2014 89 211 81
2015 89 224 87
Workforce Recommendations
o Increase in ATOs and Clinical Assistants to reduce requirements for large
numbers of qualified professionals
o Training other healthcare professionals may ease some of the requirements
(digital transfer of data may secure faster uptake)
o UCAS based training may be beneficial for all parts of Wales
o Scholarship model may provide a cost effective method for training
o Training requires support from Clinical Tutors and dedicated time
o Active recruitment may be more successful as region-wide events with
innovative information dissemination techniques
o Even with 5 more commissioned places and skill mix, gap in supply and demand for cardiac physiologists remains – 17 (2007), 29 (2008), 53 (2009)……. 87 (2015)
We would like to thank the commissioners of this project -
the Cardiac Networks Coordinating Group.
These project outcomes would not have been possible
without the participants of the project. We would like to
applaud the heads of departments, information officers
and reference panel who all responded quickly with
comprehensive levels of information to assist us with this
project.
For further information on this project, please email
[email protected] or please call me if you would
like to discuss the implications of these findings for service
delivery in your area.
Thank youwww.tangerinebee.com 01392 254441
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