Authors' objectives: Demand for imaging in England massively outstrips supply in terms of workforce capacity, with well-documented shortages of both radiographers and radiologists. The COVID-19 pandemic exacerbated already stretched services, which have remained ‘in crisis’. Three high profile national reports highlighted the urgent need to develop the capacity and capability of the imaging support workforce, yet it is unclear how this vital workforce is utilised.

Authors' results and conclusions: The support workforce (National Health Service pay Bands 2–4) constitutes 23.6% of the non-medical imaging workforce (22.2% median, interquartile range 14.9–29.1). Opposing deployment models were identified, based on grade preference (Band 2 or Band 3) and role flexibility (static or rotational). Wide variations in job titles, roles, grades, competencies and scopes of practice are evident both between National Health Service Trust hospitals and within individual imaging departments. With the exception of breast imaging, assistant practitioners (Band 4) appear underutilised in most imaging services. Imaging support workers are ‘absolutely pivotal’ to smooth patient workflow and the patient experience; however, unwarranted variations in support workforce deployment and utilisation compromise recruitment, retention, career progression and innovation. This workforce appears to be operationally managed rather than strategically planned which potentially limits the impact of the support workforce on the wider imaging workforce crisis.

Authors' methods: The study employed a mixed-methods explanatory research design, comprising six consecutive workstreams spanning 27 months: (Workstream 1) scoping review; (Workstream 2) census of imaging workforce; (Workstream 3) engagement with imaging networks; (Workstream 4) deep dive review of selected trusts; (Workstream 5) qualitative case studies; (Workstream 6) determinant framework. All National Health Service diagnostic imaging (radiology) services and imaging networks located within England were in scope. Participants included imaging network representatives (n = 18), radiology service managers (n = 24), and Imaging Support Workers and Assistant Practitioners, their supervisors and department managers (WS5, n = 113). This was an exploratory observational study. National Health Service Electronic Staff Record database (n = 144 National Health Service Trusts); interviews (n = 38); focus groups (n = 15); documentary analysis (n = 48). Inconsistent and incomplete data in the Electronic Staff Records potentially compromised data quality; however, subsequent participant-supplied data were comparable.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR133813

Year Published: 2026

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/GJJN0626

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/GJJN0626

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk