Radiographer degree apprenticeships: where are we now?

Apprenticeship requirements

As well as the programme meeting the professional standards of proficiency and standards for education and training in order to gain approval from the HCPC, an apprenticeship programme needs to satisfy the Educational and Skills Funding Agency (ESFA) and IfATE requirements too. Additionally, we applied for and gained College of Radiographers approval too. The requirements of all these organisations needed to be considered when designing the course curriculum, assessment strategy and the delivery method. 

In terms of specific apprenticeship requirements, the ESFA stipulates that each apprentice has at least 20% off-the-job study time per week and that the apprentice is able to complete their apprenticeship within their contracted hours. It is worth highlighting that the 20% off-the-job study time is a minimum requirement and in our experience the apprentices are averaging in the region of 30% off-the-job time over the course of the programme. It is really important to note that the off-the job-time can only be spent on ‘new’ learning that aligns with the apprenticeship standard (1). This means that revision for assessments cannot be counted and so employing departments need to be flexible to allow their apprentice learners time for activity such as this. 

In order to satisfy the IfATE requirements, each apprentice must be able to evidence that they have achieved all of the requirements of the integrated end point assessment (set by IfATE). This means each apprentice must provide evidence that they have achieved each of the knowledge, skills and behaviours listed within the apprenticeship standard and have these verified by both the employer and education provider, complete all practice assessment documentation and pass every module of the degree. Additionally they must reach Level 2 maths and English. It is worth noting that even if every other part of a radiography apprenticeship programme had been achieved, without an approved Level 2 maths and/or English qualification, an individual is not able, under the apprenticeship rules, to graduate. The government publishes a list of recognised qualifications that do meet the maths and English requirement for apprenticeships which includes Level 2 functional skills. Our top tip for employers would be to support any prospective apprentices with achieving these qualifications if they need to ahead of starting a radiography apprenticeship, as we have noted that studying for these qualifications on top of studying for a radiography degree is particularly challenging. 

We were aware that there would be a lack of understanding about apprenticeships, for ourselves as well as in practice, as this type of provision is such a new and different way of delivering radiography education. Hence it became clear that as a higher educational institution delivering the apprenticeship, we would need to work closely with our clinical partners to increase awareness of the nuances of the degree apprenticeship delivery route.

The key point was to ensure that clinical employer partners, radiography colleagues, our own educational team and our learners truly understood that the end radiography qualification is the same as that delivered by what is now being seen as the ‘traditional’ method of undergraduate education. So, the ‘same destination different route’ mantra arose. Another feature of the degree apprenticeship is the requirement for learning within the workplace. Traditionally this learning is focussed on clinical skills development but for our apprenticeship programme, it also needed to encompass the development of theoretical understanding as it applies to practice, albeit supported by learning materials and activities provided by ourselves. We therefore needed to ensure that the radiographers working alongside apprentices understand the structure of the course and the purpose of workplace-based learning.

It also became apparent that radiographers working alongside the degree apprentices needed to see the apprentices as being ‘paid to learn’ and not ‘paid to work’, and to recognise that degree apprentices should be supernumerary and supervised as per pre-registration radiographers. This was particularly important for those degree apprentices who had formerly been assistant practitioners: whilst possessing clinical competency within their previous scope of practice, it was still important that, as degree apprentices, they were still regarded as learners. This was essential to enable them to expand and develop their scope of practice so as to meet the HCPC Standards of Proficiency for Diagnostic Radiographers, meaning that they needed support to develop their skills so as to be able to undertake imaging of all age ranges, modify technique and to be supported in making that transition to autonomous practitioner. There also needed to be clear understanding that not all work-based learning activity is or would be patient facing meaning there would be times where degree apprentices are present in the department but not undertaking patient facing activity or undertaking radiographic examinations. 

The relationship between the clinical placement site and the Higher Education Institution (HEI) is different for apprenticeships mainly in that the employing hospital contracts the HEI to provide the apprenticeship programme. During the contracting phase there needs to be a clear understanding of where responsibilities lie whilst ensuring there is two-way dialogue and sharing of information about the degree apprentice’s progression and performance. As degree apprentices are employees, the employer is responsible for their recruitment (and any internal candidates must be re-contracted as apprentice radiographers​), managing performance and conduct, including Fitness to Practice​, managing professionalism e.g. punctuality, professionalism, sickness monitoring and management​, annual leave​, provision of uniforms​, radiation dose monitoring​ and mandatory training​. The education provider would be expected to lead on academic misconduct and any Fitness to Practice concerns arising whilst the apprentice is undertaking academic elements of the course. There is an expectation that any concerns about a degree apprentice’s progress, performance and/or conduct would be discussed between the employing organisation and the HEI, and a learning agreement signed by both of those parties and the apprentices themselves permits the sharing of this type of information.

Initially there was concern as there seemed to be a perception amongst some that the degree apprenticeship in diagnostic radiography was an easier option. We have therefore felt that it has been very important to spread the word to ensure that this myth was busted. Whilst degree apprentices spend approximately 70 to 80% of their time in the workplace and may therefore demonstrate clinical competence quickly, they still need the same academic underpinning to support their practice, as any ‘conventional’ student. All radiography graduates, regardless of the route chosen, have to achieve the same level of knowledge and understanding regarding the underlying theory that meets the HCPC Standards of Proficiency.

An initial concern regarding the apprenticeship was that it would diminish placement capacity for ‘conventional’ students. However, our experience is that employing departments have been inventive with learner rostering and this has allowed, as intended, apprentices to be additional learners within departments. The fact that apprentices are in department all year and not tied to clinical placement weeks means that there can be some flexibility in their rosters. Depending on the terms of their employment, as they are employees, they can often work shifts (provided there is appropriate supervision). 

A challenge for some employers has been ensuring that degree apprentices are able to get the full range of clinical experience required by the HCPC. This has meant, in some cases, that departments have had to arrange for their apprentices to go to other trusts or employers for secondments or visits. It has been pleasing how departments have embraced accepting apprentices from other employers and sharing their departments. From a university perspective we ask for information about how employers intend to provide the required range of clinical experience prior to the contract being signed. This is because we do not feel it would be appropriate, ethical even, to accept an applicant onto the course who would not be able to fulfil the course requirements.

Widening participation

Degree apprentices registered on our programme have come from a range of backgrounds and range from non-standard entry through to graduates seeking a new career. Approximately 50% enter the course via a non-standard route – this means that they do not have the traditional qualifications requested by universities, but instead have alternative qualifications supplemented by relevant workplace experience. Being able to support so many non-standard entrants is really positive for us as it opens access to our profession to a much wider pool of applicants. In addition, many of our degree apprentices have caring responsibilities and would not be able to study via a “traditional” university course for various reasons. Additionally, there are degree apprentices for whom the financial burden of a full-time university degree would mean this route is unachievable. These factors have all combined to result in a diverse cohort of learners, all of whom can and do contribute different life experiences and perspectives to the course, the university, the diagnostic radiography profession and the wider healthcare environment.

One thing we, as staff involved in the degree apprenticeship programme, have found is that our degree apprentices are highly motivated with some saying to us that this opportunity was one they never felt they would have. Some apprentices recounted that they felt they were ‘stuck’ in their existing roles with nowhere to progress to, whilst others stated that this was an opportunity they had been waiting for, or that the apprenticeship radiography position opened up an opportunity for them to have a change of career. Whilst our apprentices have proved to be highly motivated, they do also seem to feel a lot of pressure to do well. Our observation is that the pressure seems to be both intrinsic and extrinsic: for example, an apprentice might detail how they want to do well for themselves but that they also do not want to let their employing departments and families down. As a result, we have to work closely with them so as to encourage them to keep programme requirements in perspective.

Career Progression

We are in contact with some of our alumni and are already seeing some career progression to band 6 and/or specialised roles/training positions within months of qualification. This may be in part because our programme design incorporates an Employer Negotiated Module in the final year which enables apprentices to focus on / upskill in a particular area of practice. It may also reflect the fact that a number of our degree apprentices already have extensive healthcare experience prior to undertaking the degree and so have transferable experience that supports their career progression.

Practice perspective

Our employer partners have been key in ensuring the success of the degree apprenticeship programme and we could not do this without them. They have embraced the work based training element, including the ‘theory underpinning practice’ elements and have adapted to meet the needs of their apprentices. 

Karl Nottage, practice educator at Royal Devon University Healthcare, explains: “Each of our apprentices became embedded in the department quickly and were soon picking up radiographic skills. This was a great boost for their confidence and great to see their development. It is important for apprentices to be supernumerary, but this does not mean they can do what they like, they are with us to learn radiography and that is their job. At the end of the degree we want high quality radiographers, so it is important as a department to invest time and energy into supporting them and their training. Our department is richer for having apprentices within it.” 

Many of the employers have reported that the Diagnostic Radiographer apprenticeship programme has been an excellent development opportunity for existing staff and like the fact that it has provided another different option for qualifying as a radiographer. It also has been noted that the apprenticeship has helped with recruitment of radiographers in some departments, it is hopeful that retention will also be increased however it is too early to comment on this.

The work-based model of learning that our degree apprenticeship utilises has sparked national and international interest. There has been interest in the model from other countries including Scotland and Australia. Additionally, our course has a learner from another non-England based hospital. Although they are not eligible for government funding, their employer is effectively sponsoring them as the hospital felt this work-based method of delivery was one they wished to pursue.  

It is clear to us that this route into the profession is needed as a way of increasing the numbers of newly graduating radiographers entering the workforce, but also because it opens access to the profession to a much wider range of applicants. This is also recognised in the recently published NHS workforce plan where it was stated that ‘Apprenticeships will help widen access to opportunities for people from all backgrounds and in underserved areas to join the NHS’ (2). The workforce plan also sets a target of 22% of clinical staff to be trained via apprenticeships, an increase of 15% from today’s current opportunities. The plan also sets out 25–50% for paramedics, Diagnostic Radiographers, occupational therapists, dietetics, prosthetists and orthotists. Whilst we have been on a steep learning curve, we are pleased we have started this type of provision. As with all our pre-registration learners, we take great pleasure in seeing our degree apprentices progress, develop and graduate and look forward to following their journeys after graduation.

References

1. Department for Education (October 2023). Apprenticeship funding rules August 2023 to July 2024 V2, Apprenticeship funding rules 2023 to 2024 (publishing.service.gov.uk)

2. NHS England (June 2023).  NHS Long Term Workforce Plan NHS England » NHS Long Term Workforce Plan