During the COVID-19 pandemic, the author (pictured above) worked at a vaccination centre supporting one of the largest public health programmes in recent history. This experience reinforced the importance of multidisciplinary working, adaptable roles, and prevention-focused care, and continues to shape her professional values and motivation.

I began my career as a Therapeutic Radiographer, but a long-standing interest in supporting older adults led me towards advanced practice in frailty - this is the story of my journey into community-based care, and how this role helps realise the ambitions set out in the NHS 10-Year Health Plan for England¹.

In 2020, several months into the COVID-19 pandemic, I found myself increasingly concerned about some of my most vulnerable patients - older, frail and often socially isolated. The volume of referrals I was making for additional social care and practical support highlighted the consequences of fragmented systems, inequitable access to services, and the vulnerability of a considerable proportion of my patient cohort. Alongside an appetite for professional progression within a context of ongoing fiscal challenge, this prompted me to apply for a role as an advanced practitioner in frailty.

The role appealed partly because the job description was refreshingly inclusive of allied health professional (AHP) backgrounds, but more importantly because I recognised how my oncology expertise and holistic understanding of patient journeys could support and strengthen care across hospital and community pathways.

Virtual wards, also known as Hospital at Home services, deliver hospital-level care in patients’ own homes. They support active treatment and recovery where possible, while also enabling patients whose condition may not improve to remain at home in a familiar environment, with care aligned to their preferences, and reducing pressure on inpatient services. Patients are cared for by a multidisciplinary team that can deliver assessments, diagnostics, prescribing and treatments such as intravenous therapies, replicating many elements of acute care outside traditional hospital settings².

Evidence from Cochrane reviews shows that Hospital at Home models achieve comparable clinical outcomes to inpatient care, with no significant difference in mortality at six months or hospital readmission rates between three and twelve months. Patient satisfaction is consistently higher for care delivered at home, while treatment costs and the number of people requiring residential care at six months are lower than for traditional hospital care, while keeping familiar routines and environments supports faster recovery and improved patient experience³. Avoiding unnecessary hospital admissions, particularly for older or frail patients, reduces the risk of hospital-associated harms such as deconditioning, delirium, falls and infection. It helps patients maintain their independence and promotes recovery in familiar environments, especially important for people living with dementia⁴. Hospital avoidance eases pressure on acute services, improves patient flow, generates financial savings and enables more personalised, goal-concordant care⁵, while supporting earlier diagnosis and timely treatment. In the South East of England, virtual ward models are helping to reduce non-elective hospital admissions and generate financial benefits, with two to three patients admitted on average preventing one hospital admission, with more established models achieving a 1:1 ratio, resulting in an estimated saving of over £10 million each year⁶.

 East Kent Urgent Care Service team (author pictured third from left). The team is comprised of consultant geriatricians, specialty doctors, frailty specialist GP, consultant nurse practitioners, qualified and trainee advanced practitioners from both nursing and AHP backgrounds, occupational therapists, nurses, clinical leads and unregistered nursing, therapy, and care support staff.

Adapting to community-based practice

Immediate challenges included adapting to community-based working: an environment that is by nature less controlled and at the heart of patients’ homes and personal lives, frequently during periods of acute medical need. This was compounded by the relative lack of immediate peripheral support when compared with hospital-based practice. Working in the community requires clinicians to adopt multiple roles simultaneously, acting as the primary clinician responsible for assessment, diagnosis and treatment decisions, often as the only professional present. This can include taking and interpreting clinical observations and point-of-care blood testing, inserting intravenous lines, liaising with carers and wider services, and managing complexity, risk, uncertainty and complex clinical decision-making. It also involves attending to the small but essential practicalities of daily life, from making a cup of tea and changing a bed to feeding the cat and assisting with toileting, all to ensure patients can remain safe at home, while also offering counselling and emotional support to patients and their carers.

Transferable skills 

Many of the core skills developed during my career as a Therapeutic Radiographer translated naturally into the new role, including a high level of attention to detail, a structured, analytical and logical approach to clinical decision-making, and strong critical thinking skills, particularly in complex or evolving situations. The ability to think creatively and adapt practice to individual patient needs proved invaluable when managing uncertainty in an unfamiliar environment. My oncology background also supported the development of advanced communication and rapport-building skills, including the capacity to establish trust quickly, deliver sensitive or distressing information and support patients and their families through emotionally charged situations, particularly at the end of life. 

While these professional skills were already embedded, advanced clinical skills were developed through completion of the three-year MSc in Advanced Clinical Practice, supported by direct clinical supervision and ongoing continuing professional development. It is important to acknowledge, however, that both the course and clinical practice were a steep learning curve, often accompanied by imposter syndrome, fluctuating confidence and moments of self-doubt. There were times when I questioned my choices and felt intimidated by course colleagues whose knowledge appeared infinite, having come from paramedicine or acute medicine backgrounds. 

I remember being on the brink of tears just before my Objective Structured Clinical Examination, even though I had prepared thoroughly, my self-belief felt fragile. Achieving a score of over 90% was a pivotal moment; it almost felt like permission to accept that I did belong in this space, that I had meaningful expertise to offer, and that I could actually embrace a sense of professional legitimacy as an advanced practitioner in frailty. The MSc period was defined by perseverance, countless hours of study and the sacrifice of precious time with my young family. Was it worth the proverbial, and occasionally literal, blood, sweat, and tears? Without a doubt!

Prescribing, governance and advocacy

Support from colleagues, educators and my professional body has been one of the most significant enablers of my development. As my training progressed, it became evident that prescribing outside the traditional umbrella of cancer represented a grey area for Therapeutic Radiographers. Although legislative prescribing rights existed, there was limited governance or assurance to support those working in non-traditional roles.

Addressing this gap became a defining feature of my advanced practice journey. My involvement in raising awareness, through continued stakeholder engagement at both local and national levels, targeted campaigning, and advocacy for Therapeutic Radiographers and AHPs more broadly, helped build momentum that led to clearer governance documents and more inclusive guidance, recognising and providing assurance for Therapeutic Radiographers in non-traditional roles. The introduction of NHS England’s Prescribing Support and Assurance Framework⁷ and updated Society of Radiographers guidance on advanced and consultant practice⁸ has provided much-needed clarity and assurance. 

Contributing to the rewriting of the Society’s scope of practice for advanced and consultant practitioners has supported workforce development, enabled safer and more flexible prescribing, and reflected the evolving contribution of AHPs across health and care systems. Since then, I have had the opportunity to share experiences with Therapeutic Radiographers training as advanced practitioners in stroke and cardiothoracic, who are now able to support their patients more effectively through prescribing, with the associated autonomy and positive impact on patient care.

‘Left Shift’

The NHS 10-Year Health Plan emphasises the need to shift care from hospital to community settings, move from sickness to prevention, and accelerate digital transformation¹. My journey illustrates how AHP-led advanced practice can be successfully integrated into community-based pathways to support these priorities.

With one in two people in the UK expected to be diagnosed with cancer during their lifetime⁹, more prevalent than many long-term conditions around which services are routinely designed, such as cardiovascular and respiratory disease¹⁰, Therapeutic Radiographers are uniquely positioned to contribute across the care continuum. Our understanding of the physical and psychological impacts of cancer and its treatment enables us to support people beyond diagnosis and treatment, into recovery, long-term condition management, frailty and prevention-focused care.

I encourage radiographers considering expanding their scope of practice and stepping into more innovative roles to look beyond the basements and concrete maze of traditional pathways, and to consider how they can bring their expertise into multidisciplinary teams, and where it is they can make a broader impact.

This example of AHP advanced practice demonstrates the “left shift” in action, bridging oncology, frailty and urgent care pathways to deliver integrated, timely, and patient-centred services. Roles like mine provide evidence that workforce planning, service redesign, education and regulation must evolve to reflect clinical capability. Unlocking the full potential of AHPs is essential for creating a responsive, resilient, and efficient healthcare system to ensure the NHS is “fit for the future”¹.

Clinically, I am enthusiastic about working more closely with our oncology colleagues in the acute sector to provide a more integrated, holistic approach for people with frailty who are living with, and undergoing treatment for, cancer. Many of our frail patients wish to avoid hospitalisation wherever possible, so ensuring that advanced care planning and ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) discussions¹¹ happen early is vital. By coordinating care across oncology and community teams, we can support patients to stay at home safely where possible, deliver goal-concordant care and reduce the risks associated with fragmented services.

From an AHP leadership perspective, I continue to contribute to local, system and national strategy to ensure the recognition, inclusion and full utilisation of AHPs across the four pillars of practice. This includes advocating for our inclusion in more integrated workforce planning at all levels of practice, and promoting greater equity in prescribing rights, so that we have a workforce equipped to meet the challenges of an ageing population, rising complexity, and the need for timely, patient-centred care  - aimed at supporting the goal of having AHPs in “the right place, at the right time, with the right skills”¹².

In 2025, a consultation was held on prescribing rights for Diagnostic Radiographers: it’s a start, and I’m hopeful, but significant inequities for AHPs remain, particularly when it comes to advancing practice.

The legal prescribing scope for Therapeutic Radiographers in the UK, like that of other AHP colleagues, remains limited compared to nurses, restricting AHPs’ ability to practise as fully autonomous clinicians, which can delay optimal patient care and place AHPs at a professional disadvantage. Governance must evolve alongside workforce transformation, which continues to be a challenge. Raising the profile of AHPs and ensuring smaller professions are not overshadowed is crucial: celebrating achievements, recognising successes, and supporting one another through special interest groups and communities of practice are essential steps in strengthening our collective impact.