The Interventional Radiology Committee of the Royal College of Radiologists (RCR), in collaboration with the British Society of Interventional Radiology (BSIR), have released a statement for interventional radiology (IR) service provision in the UK to supplement the existing Provision of Interventional Radiology Services (POIRS) document. This supports both longitudinal care and ownership of patients by interventional radiologists, and has been met with approval from the IR community.
In a document entitled “The clinical role of interventional radiology (image guided surgery) in patient care”, the two bodies write: “The Provision of Interventional Radiology Services (POIRS) has been revised, and the second edition is due to be published this summer (2019). This statement has been released by the Royal College of Radiologists (RCR) and British Society of Interventional Radiology (BSIR) to introduce the POIRS document, identify the benchmarks for interventional radiology and to highlight the competencies of interventional radiologists in patient management, both in an inpatient and outpatient scenario, obtained as part of their subspecialty training.”
Speaking to Interventional News about how this joint statement will affect interventional radiologists in the UK, BSIR president Trevor Cleveland (Sheffield, UK) comments: “IR has changed considerably, even between the 2013 version of this document and today. Interventional radiologists are using increasingly complex techniques and treating more complex clinical situations, often in an emergency environment. This includes acute bleeding (associated with trauma and iatrogenic injury) in a number of organ systems. The treatment of sepsis, whilst to some degree a core radiology skill, in more complex situations requires more advanced techniques. As such, interventional radiologists have become essential to the effective functioning of many acute services. This is in addition to an expanding range of elective treatments, including oncology, as well as the more established IR procedures, such as angioplasty and stenting, and more recently stroke treatment and prevention. These are delivered across both adult and paediatric populations.
“Yet there remains a relatively small number of interventional radiologists who can provide this service, in an environment where the emergency commitment is increasing for this group. The POIRS update provides current information, informed by both the BSIR membership and the RCR Census survey, on the present service delivery, and the numbers that need to be included in the workforce planning going forward.
“Key to this is delivering a timely service for patients (making the best use of the IR skills that we have now, including ensuring that IR skills are not unnecessarily lost as a result of the reconfiguration processes and/or an imbalance of emergency commitment) and future planning. Trainees are our future, and we must ensure that we have an environment that encourages enthusiastic young doctors, and the capacity to meet the expanding needs. Add to this the likely loss of IR skills as some of the present community reach retirement (which is compounded by the pension tax laws which mean that, like in General Practice, experienced doctors are being effectively encouraged to leave or to reduce their activity).”
As an “essential part of modern medicine”, the BSIR and RCR joint statement introducing the anticipated POIRS document outlines how interventional radiologists can act to widen the provision of IR services in the UK. There are four conclusions:
- IR is a subspecialty of clinical radiology requiring an additional year of training, compared to diagnostic radiology (six years total) to be certified by the General Medical Council (GMC) IR Certificate of Completion of Training.
- IRs receive training appropriate to their scope of practice, enabling them to clinically manage patients under their direct care, throughout the patient pathway, and provide clinical advice for patients under the care of other clinical specialties.
- To deliver this clinical care, IRs require appropriate clinical time, infrastructure and support from their employing organisations, including access to outpatient clinics and inpatient beds.
- Trusts should be supportive of IRs who wish to deliver high quality longitudinal care on a par with many fellow specialists.
Commenting on these conclusions, and the ramifications she envisages they will have for British IR, Clare Bent, an interventional radiologist at The Royal Bournemouth and Christchurch Hospitals, Bournemouth, UK, says: “The IR benchmarks and a focus on the development of a subspecialty IR curriculum are both key to the provision of a robust, competent IR workforce who can deliver comprehensive, longitudinal, high quality care in both an inpatient and outpatient setting. Ward rounds, outpatient clinics, and admitting privileges with adequate and appropriately trained support staff are all integral factors in the optimisation of patient centred care for the IR specialty.
She continues: “The diverse nature of IR service provision and continual innovations in the specialty mean that trained interventional radiologists are best placed to provide information and consent for such minimally-invasive procedures—which in turn improves patient experience, understanding, and confidence. Formalising the IR clinical role will bring clarity to the doctor-patient relationship for the IR speciality, establish a standardised IR management pathway and will allow allocation of appropriate funding streams. The less invasive approach that IR offers allows rapid recovery, reduced in-hospital stay and reduced morbidity and mortality, with a profound impact on healthcare economy.
“This interim statement is a step forward in supporting interventional radiologists, as clinicians, to deliver high quality patient care to the UK population.”
Cleveland is in accordance, explaining how the document, which “represents a close collaboration between BSIR and RCR”, provides “as representative a statement as possible, including engagement from Members and Fellows of both organisations.” He goes on to explain that, as such, “it provides a framework for change and development, and serves as guidance to the wider healthcare community including interventional radiologists, radiologists more generally, commissioners, NHS England and Health Education England. We hope that it will act as a useful support for the real and effective changes that need to take place to ensure a high quality and equitable service, which patients deserve.”
In advance of the publication of the POIRS document this summer, Cleveland stresses its significance: “The POIRS document is an enormously important one, which provides information on IR procedures, and guidance for future planning. It seems highly likely that the attractiveness, for patients and healthcare services alike, of IR procedures will result in a continued expansion. Innovation and equipment development are also likely to continue, with further techniques and applications being identified on a regular basis. Key to these is the expert interpretation and training in imaging that IRs have. Whilst it may be appealing to split off some of these activities for short-term reasons, IRs offer a skill set that extends across a wide range of clinical scenarios and teams. The major challenge facing us at the moment is delivering an emergency service, in a timely equitable fashion, whilst maintaining and developing a sustainable workforce. This requires an elective practice that underpins the emergency service. The issues raised and recommendations made in the POIRS document are key to achieving this for NHS patients.”