Executive summary

The review panel thanked the trust for accommodating this review.

This follow-up Learner Review of Clinical Radiology at Northwick Park Hospital was arranged to gather further feedback from resident doctors (RDs) following the previous review on 15 August 2024, in order to understand actions taken and if these had the desired impact on their training experience.

Whilst it was acknowledged that this follow-up review was undertaken within a short timeframe, the review panel found that there were still some issues yet to be resolved within the clinical radiology department. These included concerns around rota arrangements in and out of hours, as well as an intense workload leading to exhaustion and burnout amongst RDs. The structure of the teaching programme required further work, and there were still instances of inappropriate professional discussions of colleagues amongst some consultants which impacted the culture of the department. In addition to these similar issues, the panel had serious concerns about the clinical supervision of RDs running the acute ultrasound list, which had a complex case mix including head and neck, breast and paediatrics patients. RDs reportedly had difficulty accessing support from consultants whilst running this list.

NHS England – London’s Education Quality Team intend to conduct a follow-up Work Programme Meeting (WPM) to clinical radiology at Northwick Park Hospital in 2025, to continue to assess the impact of mandated actions on training within the department.

NHS England’s Intensive Support Framework (ISF) rating of clinical radiology at Northwick Park Hospital remains at ISF 3, and the programme remains in General Medical Council (GMC) Enhanced Monitoring.

Progress against additional mandatory requirements issued within this report will be monitored on the Quality Management Portal on a quarterly basis. 

Review overview

Background to the review

NHS England – London’s Education Quality conducted a follow-up Learner Review of Clinical Radiology following concerning feedback received in the Urgent Risk Review of the same programme on 15 August 2024.

The NHS England review panel issued one Immediate Mandatory Requirement (IMR) at the recent review around some resident doctors not knowing who their clinical supervisors were, and / or had not had any meetings with them. Other concerns raised included bullying and undermining, cultural issues within the clinical radiology department, high workload and significant consultant vacancies which was felt to impact support to the department’s training requirements.

This follow-up Education Quality review sought to obtain further feedback form resident doctors and understand if changes implemented following the previous review had the desired impact on their training experience within Northwick Park Hospital.

The Trust provided the following evidence in preparation for this review:

• Clinical Radiology Educational Supervisor list 2024-25
• Clinical Radiology Action Plan 2024
• Exception Reports August-November 2024
• Radiology Update prior to NHSE visit
• Learner groups and Clinical Supervisors – November 2024
• Local Faculty Group (LFG) Meeting 19.09.2024
• LFG Meeting 28.11.2024
• On Call Rota updated 28.10.2024
• Poster for Improving Feedback Culture
• Quality Improvement – Feedback Northwick Park
• Teaching Timetable 11 -15 November 2024
• Teaching Timetable 14 -18 October 2024
• Teaching Timetable 18 – 22 November 2024
• Teaching Timetable 25 – 29 November 2024
• Teaching Timetable 28 October – 1 November 2024
• Teaching Timetable 4 -8 November 2024
• Training Programme Director and Resident Doctor meeting 19.11.2024
• Trust induction feedback – August 2024
• Work schedule – 45 – Radiology – ST2-6 – Northwick Park Hospital (NWP) and Central Middlesex Hospital (CMH) (October 2024)
• Work schedule – 85 – Radiology – ST1 Shadow – NWP & CMH (Oct 2024)

Who we met with

Learners

• 20 specialty training (ST) clinical radiology RDs between ST1 and ST5

Review panel

• Dr Richard Bogle, System Dean – North West London, Education Quality Review Lead. NHS England – London
• Dr Samantha Chippington, Head of the London Specialty School of Clinical Radiology, Specialty Expert. NHS England – London
• Dr Kate Hawtin, Deputy Head of the London Specialty School of Clinical Radiology, Specialty Expert. NHS England – London
• Dr Isobel Beal, Deputy Head of the London Specialty School of Clinical Radiology, Specialty Expert. NHS England – London
• Dr Joseph Flexen, Clinical Radiology Learner Representative
• Jane Gregory, Lay Representative
• Nicole Lallaway, Education Quality Coordinator. NHS England – London 

Review findings

It was clear to the panel that that the clinical radiology resident doctors (RDs) were a cohesive cohort who were engaged in looking for solutions to known issues within the department.

Rota

The rota arrangements for RDs were still of concern to the panel, with RDs working long days and reported of feeling burnout by the end of the working week. The panel heard that some RDs were rostered to undertake 13-hour shifts on the weekend after a full working week Monday to Friday, and that the intensity of this contributed to increased exhaustion levels by the end of the working week. RDs reported that there were two zero days attached to every weekend shift now to try to mitigate burnout, however some RDs felt that by the end of these weekends, they were exhausted and had limited productivity. The panel heard that RDs were tasked with devising a draft rota, and that the proposed rota presented to management was met with resistance. However, it was acknowledged that this may have been due to inadequate information sharing regarding the full staffing complement in the department.

Coordination of the current rota was under the responsibility of one RD who did not work on site at Northwick Park Hospital. It was reported that they checked regularly to ensure any unexpected rota gaps due to sickness was filled, and that they were supported by the department to outsource rota gaps at an escalated rate if they were unable to fill rota gaps with a locum doctor. It was felt that the one session per week allocated to undertake this task was not enough, and this work impacted on their training time. The panel heard that administrative support was recruited to support the RD with this piece of work, but at the time of this review, they had not met with them yet. It was felt that the rota still required significant input from a radiologist due to the nature of the work.

Clinical supervision

At the previous quality review, concerns were raised about the volume of cases on the solo acute ultrasound lists. RDs reported that work was done to reduce the number of cases, and that often the radiology department assistants (RDA) worked with RDs when devising the ultrasound lists. The panel heard that there was an informal agreement that lists would be limited to eight patients for specialty training year 2 (ST2) RDs, ten patients for ST3-4 RDs and twelve patients for ST5 RDs. It was also noted that if the RDA believed a RD could work through their list faster, they would book more patients onto their clinic. Overall, RDs felt they had more control over their lists and felt able to pushback on numbers if needed. However, the panel had serious concerns about the clinical supervision of RDs running the acute ultrasound clinic when there was specialist, complex cases involving head and neck, breast and paediatrics patients. The panel heard that the acute consultants were available if RDs required support during this clinic, however if the specific case was not the acute consultants’ subspecialty, RDs were advised to seek support from other consultants. This was sometimes via ‘PACSchat’, an online platform, although RDs did not always receive a response from consultants via this mechanism. The panel felt that it was not appropriate to have a complex case mix including head and neck, breast and paediatrics patients on an acute general ultrasound list, and that often in other hospitals, these cases would be separate on a subspecialist list. In particular, the panel was concerned about RDs looking after paediatric patients on the ultrasound list, as it was not clear if RDs had undertaken the appropriate Safeguarding Children Level 2 training required. RDs also highlighted that the acute consultants were visibly stressed due to a large workload and were required to review scans for three hospitals including Northwick Park Hospital, Ealing Hospital and St Mark’s Hospital. Some RDs felt that this created additional pressure on consultants and also impacted their ability to provide support to RDs when running the solo acute ultrasound list.

The panel heard that during their ST1 year, RDs had one session per week shadowing another RD working on the acute ultrasound list and had additional dedicated lists with consultants and sonographers. It was reported that this enabled RDs to run their own solo acute ultrasound clinics when they were working at ST2 level.

The review panel were pleased to hear that RDs training in clinical radiology had allocated educational supervisors and were able to meet them regularly during their placement.

Teaching

The panel heard that there was not a clear teaching programme in place for RDs, and it was felt that the busyness of the department, for both clinical radiology RDs and consultants, impacted on time available to deliver and attend teaching. The panel heard that there were ongoing discussions between RDs and the Training Programme Directors (TPDs) about how to structure the teaching programme. Some RDs reported that they worked on coordinating a draft teaching programme and presented this to the Training Programme Directors (TPDs). It was reported this would be implemented in February 2025, however RDs were concerned about the availability of consultants to attend and deliver teaching according to this programme as consultants did not appear to have protected time. RDs reported that some consultants were committed to teaching and were forthcoming to RDs with ideas for teaching sessions they would like to deliver, but the onus was placed on RDs to find time for this to take place. The panel felt that having a dedicated consultant responsible for devising the teaching programme would be of benefit here, and that management engagement in the teaching programme would support consultants to deliver this.

Facilities

In the previous review it was noted that there was limited availability of workstations. The review panel heard that one of the rooms had since been repaired and made available for use by RDs and consultants, whilst a second room still had issues with a leak which meant that one workstation was unusable when it rained. In addition, the panel heard that there was a designated room for three consultants to sit in, with a ‘hot seat’ space for RDs to sit in and space for an administrative colleague in the middle. RDs reported that they felt able to approach the consultants for support if they had a general query, but support regarding specific subspecialty queries was more difficult to obtain.

Culture of the department

The previous quality review highlighted concerns around cultural issues within the clinical radiology department, which included disparaging or belittling remarks made by consultants about RDs in public. The panel heard that this was still a known issue, with some instances of RDs overhearing inappropriate professional discussions of their colleagues by some consultants in the department. It was felt that the General Medical Council’s National Training Survey (GMC NTS) 2024 results and the previous quality review may have polarised some consultants, as RDs felt that some consultants were more engaged in training whilst others seemed to be more withdrawn. The majority of RDs reported that they were aware of the process for raising concerns, and that they would either go to their educational supervisor, the Director of Medical Education, the Associate Medical Director or the Freedom to Speak Up Guardian. However, some RDs felt that their experience of overhearing inappropriate professional discussions of colleagues was normalised to the point that they would not raise it as a concern, with some RDs reporting that they did not feel it would achieve anything.

The review panel heard that the Civility Saves Lives session was held during a Clinical Governance meeting, but RDs felt that the session was not advertised well or flagged as important for them to attend, and that they were informed just a week prior to the session that it would take place. The panel also heard that a team building day was facilitated by NHS Elect, which clinical and educational supervisors attended with RDs at specialty training grades 1-3 (ST1-3). It was felt that this meeting was positive, and that it was good to meet consultants RDs were less familiar with face to face and in a non-work setting.

The panel were pleased to hear that RDs had access to a photobook which enabled them to recognise who the clinical radiology consultants were within Northwick Park Hospital.

There was not a clear consensus on whether RDs would recommend the Northwick Park Hospital clinical radiology department to friends and family for treatment, as RDs stated that the department had talented radiologists, but that the workload was high, and they were behind on acute lists.

Areas that are working well

Areas for improvement

Mandatory requirements

Report approval

Report completed by: Nicole Lallaway, Education Quality Coordinator
Review lead: Dr Richard Bogle, System Dean – North West London
Date approved by review lead: 24 January 2025

NHS England authorised signature: Dr Elizabeth Carty, Interim Local Postgraduate Dean
Date authorised: 10 February 2025

Final report submitted to organisation: 10 February 2025