Claire Senior

What is your current role?

I’m an Advanced Practitioner in rheumatology in the Rheumatology Department at Dorset County Hospital, working as part of a multidisciplinary team (MDT) to provide follow-up care and management of rheumatology patients. I see patients with predominantly inflammatory arthropathies, including rheumatoid arthritis, inflammatory and psoriatic arthritis subtypes, and osteoporosis patients, which is my subspecialty as a dual-energy X-ray absorptiometry (DXA) reporting radiographer.

I manage my own caseload of patients and contribute to answering the department’s advice line enquiries and overseeing the blood test monitoring program. I have recently taken on coordinating the initiation of zoledronate therapy for patients with osteoporosis who are seen at both University Hospitals Dorset NHS Foundation Trust and Dorset County Hospital (DCH). I also report DXA scans for the radiology department and work closely with the lead DXA radiographer at DCH and osteoporosis specialists from University Hospitals Dorset to write the reporting and vertebral fracture assessment protocols. I participate in the monthly Dorset osteoporosis MDT meetings held between University Hospitals Dorset and DCH and am part of the osteoporosis working group that develops guidelines for osteoporosis management with the local clinical commissioning group and county primary care services. In my role I work alongside the lead rheumatology practitioner to manage the practitioner team regarding workplace protocols, staffing rosters and appraisals. This position requires meetings with senior members of the hospital management team and being involved in finance decisions, waiting list management and business and governance meetings.

In my DXA reporting role, I have participated in the training of the new DXA radiographer staff. I am a mentor for the current DXA reporting trainee, providing support in her learning and signing off her portfolio. Within the rheumatology team I have provided education regarding osteoporosis management. As part of my role I have qualified as a supplementary non-medical prescriber, which enables me to prescribe medications alongside the specialist pharmacist and rheumatologist according to clinical management plans that I write for each patient. I participate in the South West DXA Reporting Group, which meets quarterly to discuss topics of interest and current research. Lastly, I am actively involved in research. I am part of an international research group investigating attitudes towards advanced radiographic reporting practice across Europe. I was invited to co-author an article for the Radiography journal regarding radiographer practice in osteoporosis care and fracture management that was published in October 2021. Within the rheumatology department I am clinical lead for a pilot trial into patient access to digital medical records.

I have recently completed a Master’s (MSc) in Advanced Clinical Practice at the University of Exeter, which had an emphasis on developing research. As part of this master’s, I have developed a new DXA reporting proforma that is in use clinically at DCH. Since completing my MSc I have applied for and been awarded a pre-doctoral clinical and practitioner academic fellowship (PCAF) with the National Institute for Health and Care Research (NIHR) with a view to developing a PhD proposal regarding osteoporosis and cervical spine fracture management.

What steps did you take to reach this position?

Following my A-levels I studied for a BSc in anatomy and physiology at Leeds University. After graduating I did work experience at a local major trauma hospital and decided to apply to the University of Exeter to study radiography, qualifying in 2009. I worked in general X-ray and the cardiac catheterisation laboratory before moving into DXA. I studied for a postgraduate certificate in bone densitometry reporting at Derby University in 2017 and took on the lead DXA reporting radiographer role at my previous trust. I decided to apply for an MSc in Advanced Clinical Practice at Exeter University in 2019 to support my interest in pursuing research and teaching, and while studying the first year of my MSc the advanced practitioner role was advertised at DCH. The role was advertised as being suitable for allied health professionals, but I was wary because I had limited experience in therapeutic patient management. Luckily the interviewing team were very open to providing suitable training and I had a very supportive team and consultant who supported my development and guided me through achieving my competencies in rheumatology patient management to become an advanced practitioner.

What support have you had and is there anything else that would have helped?

My journey to this role has been hard at times and I’m very grateful to the support of my family and also to Dr Karen Knapp, who I’ve stayed in touch with since qualifying from Exeter University. My PgCert in DXA reporting was funded by my previous trust; however, there was no protected study time allocated, which made it a challenge to complete while working full-time with a young family. This stood me in good stead for taking on the MSc, which was self-funded and as such afforded me limited protected study time until recently. I feel more people would pursue further education in radiography if there was support in terms of provision of protected study time, as well as funding support for postgraduate courses. I was lucky enough to win a scholarship for part of my MSc costs but funding the remainder of the course has been a challenge, so more access to scholarships or bursaries would open this opportunity to more people. I have been lucky enough to have support and encouragement from Dr Knapp to pursue my postgraduate studies, including my current PCAF, which is something I wouldn’t have thought I could pursue due to my full-time clinical role.

What do you find most rewarding about your role?

The therapeutic intervention element – using my new skills to make a treatment decision and the benefits it can have when I see patients returning to the clinic for follow-up visits. I love the feeling of a clinical decision I’ve made making a difference to someone. The role is seriously challenging, and not something I ever thought I’d be doing as a radiographer. It affords a great deal of autonomy and responsibility so while I can develop my role and learning in accordance with my own personal academic interests to an extent, there is also a lot of pressure that comes from managing my own caseload. I feel this role is the embodiment of the idea of advanced practice; it doesn’t matter what our background is, we can train to use our experience and understanding to cross the boundaries of our profession and work alongside other allied health professionals and nursing staff to achieve the same goals. I feel proud of my radiography background and feel this role is a great example of what we can do beyond the traditional remit of a radiographer.

What advice can you offer others?

I would advise anyone wanting to pursue a similar advanced practice role to talk to other allied health professionals and nursing staff in the area you are interested in. What do they do? What could you bring as a radiographer to that area? Our skills are far more transferable than we think they are! Also, there are many postgraduate qualifications in advanced practice, and these are key to developing and demonstrating understanding of the advanced practice role and to gaining experience in research techniques, governance and leadership that are key parts of any advanced practice role.