3. Time to review the AVS qualification?

Does a “qualified” Vascular Scientist need the AVS qualification? 

Conversations at a recent Professional Standards Committee meeting prompted submission of this article to the Newsletter. We were considering what constituted a “qualified” Vascular Scientist and realised that in the year 2020, there isn’t a single answer to this question. This led to more questions: What has changed? Does this matter? What are the implications for the current and future workforce? Why are there so few AVS? Why can’t we recruit to AVS posts? Our aim in writing this article is promotion of discussion. These are personal views on the issue and should not be interpreted as the official view of the SVT. 

The SVT developed the current qualification of “Accredited Vascular Scientist” or “AVS” in the mid-1990s and the aim of this rigorous accreditation process was, and still is, “to ensure individuals are able to achieve and maintain high standards of diagnostic vascular investigations for the benefit and safety of patients”. The AVS qualification is recommended by the SVT for all individuals practising vascular ultrasound in the UK 1. 

However, this is not the only training route available. We now have the National School of Healthcare Science Scientist Training Programme which includes training in Vascular Science 2. Its graduates are eligible for registration with the HCPC as Clinical Scientists, providing employers assurance around standards for its registrants 3 . There are also many standalone training courses including University based Postgraduate Certificates, Diplomas and Masters level qualifications. The practical content of these is variable and many Vascular Departments will only consider employing graduates with qualifications from a CASE-accredited course 4. CASE is the Consortium for Accreditation of Sonographic Education and this organisation accredits ultrasound courses with the help of members of various professional bodies including the SVT. 

The current number of AVS staff, including honorary members is around 260. This figure remains fairly static, with no significant increase in the numbers of clinically active AVS year on year. This year with the challenges of Covid-19, we have been unable to complete the practical exams as usual, so the number of new AVS’s may not compensate for those retiring/lapsing.  

So we thought it may be helpful to address the question of “Do we need AVS?” both from the perspective of a Head of Department who employs staff and also a trainee who is navigating their way through the various trainee routes in the hope of securing a post as a “qualified” Vascular Scientist.. 

Head of Department’s perspective  

As an employer, and supporter of the AVS qualification, our departmental requirements for a Band 7 “qualified” post have always been AVS. Our STP graduates have been encouraged to gain AVS as have our “in-house” trainees. I feel that AVS assures us of a high level of theoretical understanding and practical skill gained through completion of over 2000 scans during at least 3 years full-time vascular scanning. During recruitment, this level of experience together with demonstration of skills at interview, assures me that a candidate meets the requirements for one of our band 7 posts. This view that Band 7 requires highly specialist expertise is reinforced when I consult the NHS national job profiles (see Healthcare Scientist job profile https://www.nhsemployers.org/~/media/Employers/Documents/Pay%20and%20reward/Healthcare_Science_Generic.pdf  

However, our experience at Portsmouth has been that it is very difficult to recruit anyone with AVS to a band 7 position, even with the added attraction of a recent additional Recruitment and Retention payment. We have easy access to National parks, airports, ferries to Europe, outlet shops, historic cities as well as beaches and a warm micro-climate – why wouldn’t you want to relocate to the South Coast? 

So, I started to wonder if our expectations were out of date and inconsistent with the current job market for qualified vascular scientists. I contacted other Heads of Department to ask what their criteria were for band 7 posts and had replies from 17 Vascular Labs. A simple summary of their current Band 7 criteria is given in the table below. 

*Annex 21 can be used where there will be a significant change in skills during a training period and enables pay to be determined as a percentage of that for qualified staff 5 .  

Some labs use a combination of the above qualifications with local sign-off for Band 7, particularly arterial and reflux sign-off for STP graduates, with some only giving Band 7 to their own locally trained STP graduates.  Some labs focus wholly on local sign-off and skills and don’t require specific qualifications. Many labs have additional criteria including performance management linked to salary/band with use of gateways aligned to levels of competency. Some use clauses in contracts to assure progression in salary on achievement of goals (e.g. AVS) and some use a decrease in salary/band or end of contract for non-achievement of goals within a specified time frame.  

Some labs offer a salary incentive for achievement of AVS, for example additional R&R (Recruitment and Retention 6 ) or payments of up to 15% in additional salary. One lab differentiates between scientists and advanced practitioners using national NHS job profiles 7 . 

Despite AVS being at the top of the wish list, there is widespread acknowledgment that this now appears to be an unrealistic expectation. Acknowledgement that Agenda for Change banding criteria needs to be aligned to market forces, appears widespread in the attempt to attract candidates for vacant posts. Allocation to a particular band or pay point is now less dependent on what were previously considered “essential” qualifications and skills, and this widespread practice has, I believe reduced the necessity for trainees to achieve AVS.  

In my survey, all Heads of Department stated that AVS was their gold standard for Band 7, but in practice do not appear to be insisting on this qualification. I believe that those of us with responsibility for recruitment, need to carefully consider how we can reverse the trend of awarding “qualified” Vascular Scientist Band 7 posts without including a requirement for candidates to achieve AVS. We have a duty to ensure that clinical experience and the ability to act autonomously within professional responsibility match the requirements of the Agenda for Change role descriptors for the banding we are allocating.  

I believe that we can only redress this supply and demand inequality if we act in unity. A unified approach will ensure that pressures to “match” what other departments are offering will be minimised and will allow us to encourage a renewed emphasis on the importance of AVS. Achievement of the required scan numbers will require managers and staff to proactively forward plan and arrange visits to other units as required. And the advice of Human Resources departments will help us to consistently implement banding allocations and establish and evaluate progress towards clearly documented expectations.  

Recent trainee’s perspective 

As a trainee through the ‘old’ (non-STP) route, I can see the benefit of AVS status. It demonstrates the ability to perform a wide range of vascular scans with sufficient experience demonstrated and is a peer assessment of competence. However, with the rising number of Vascular Scientists coming from an STP background, I can understand the reluctance for trainees, obliged to become HCPC registered, to fulfil this additional requirement, particularly if their Trust is satisfied with HCPC registration. So why bother? In some Trusts there is a financial incentive for STP trainees; the lure of a higher banding or a bonus of some kind. But for many trainees HCPC registration is all that is required to secure that higher wage.  As the ‘on the job’ training becomes less accessible, particularly for graduates expecting entry at a band 5 or 6 level, and the STP route appears to be the main point of entry into vascular ultrasound, will the AVS requirement become defunct?  

Certainly, many trainees struggle to obtain numbers of particular scans, the classic example being varicose veins, although the division of services within imaging departments can be variable meaning there can be a shortfall for many trainees of multiple scan types. Many AVS members happily offer up their centre for trainees to attend and train at, but the ability to do this also lies with the support of the Trust. If the Trust isn’t invested in AVS accreditation, and have a busy clinical service to run, they may not support the trainee taking time away to train in scan types that provide no direct benefit to the Trust. 

However, the HCPC training has a minimal set of standards in regard to scanning, and unless a trainee is invested in by their particular training lab, they may graduate as a Clinical Scientist being able to confidently scan only carotids, DVTs and AAAs.  As we know, this is a significant part of routine work but by no means the only scans we are required to perform. Conversely, some smaller vascular ultrasound units will only need to perform a small subset of scans, so do we alienate these members because they may never achieve accredited scientist status? 

This debate is not new, but the change is the desirability for HCPC registration for all, and the development of ‘equivalence’. So how do we move forward to a point where AVS and HCPC registration can go hand in hand? Perhaps mapping the AVS theory exams to the STP curriculum, and then waiving the necessity for STP trainees to sit these exams as well, at least for the physics element? I am not sure of the way forward, but I do think there needs to continue to be an incentive for trainees to achieve AVS for the SVT to continue to thrive. 

Conclusion 

There is a lot for us to consider and discuss in terms of our training routes and what we consider to be a “qualified” vascular scientist. We understand that the Education Committee are in the process of mapping STP equivalence against our AVS qualification and are also surveying opinion from members around the scan requirements for the AVS qualification. We encourage you to fully participate in these forums for discussion, as they are vital to ensure AVS is retained as an achievable robust qualification which is valued in the workplace as we continue our journey towards registration for our profession. 

Alison Charig, Head of Vascular Assessment Unit, Portsmouth Hospitals University Trust. 

Ellie Blaxland, Vascular Scientist, Cardiff and Vale, University Hospital Wales. 

References and Links 

1 SVT Education page https://www.svtgbi.org.uk/education/  

2 https://nshcs.hee.nhs.uk/programmes/stp/ 

3 https://www.hcpc-uk.org/standards/  

4 http://www.case-uk.org/  

5 https://www.nhsemployers.org/employershandbook/tchandbook/annex-21-arrangements-for-pay-and-banding-of-trainees.pdf 

6 https://www.nhsemployers.org/tchandbook/part-2-pay/section-5-recruitment-and-retention-premia 

7 https://www.nhsemployers.org/pay-pensions-and-reward/job-evaluation/national-job-profiles 

8 https://www.svtgbi.org.uk/media/resources/Generic_service_spec_ref_july_2018_final__RCs_additions__8mvnPr6.pdf