Change font size
Change colour contrast

Gary Kemp

Palliative Radiotherapy, Southend University Hospital

What is your current role?

My area of advanced practice is in Palliative Radiotherapy and virtual simulation at Southend University Hospital. So a large part of my role and responsibilities covers autonomous palliative field placement with plan approval and prescription on behalf of the consultant for delegated patients. This involves localisation of treatment site and application of fields or, where necessary, outlining target structures with addition of appropriate margins to aid in field placement. I may also need to determine treatment technique and field arrangement, depending on the treatment site. An integral part of my role is working with the consultant, getting advice and problem-solving to decide the most appropriate approach to treatment. We need to consider immobilisation and feasibility of treatment delivery, including technique and tolerability for those with considerable comorbidities, with reference to intended dose-fractionation in complex cases.

What advanced practice does your job involve?

As the palliative service has developed, I’ve gained additional responsibilities such as getting patient consent and acting as a non-medical prescriber for any treatment-associated side effects that can be managed with medication. The ability to accurately interpret and use diagnostic imaging and correlate this with planning scans is fundamental to accurate treatment planning, but also enables me to highlight to the referring consultant any areas of potential concern that could cause either acute or longer-term issues for the patient. Future proofing is key in making treatment-related decisions so there is scope to treat areas in close proximity if required at a later date.

Linked to the virtual simulation component of my job is breast field placement, including outlining tumour bed volumes and field placement while considering patient histology and risk factors for clinical decision-making. Extending from this is the autonomous outlining of nodal volumes; axilla, supraclavicular and internal mammary nodes. Other sites integrated into the virtual simulation role include the outlining of critical structures as requested by consultants for certain specific treatment areas and other tumour sites, such as skin and lymphoma, to aid in expediting service delivery. For these sites, I work alongside the consultant to make clinical decisions on treatment technique and take a leading role in clarifying the most suitable technique based on clinical factors such as treatment location and intended depth of treatment (if superficial).

How did you reach this stage in your career?

I attained my master’s degree in radiotherapy and oncology, but this was general to the profession and not linked to my area of advanced practice. So, I undertook further postgraduate modules in areas such as localisation and delivery of palliative radiotherapy, information giving informed consent and non-medical prescribing, as well as a Fellowship of the Royal College of Radiologists (FRCR) course which I was offered.

I continually gained experience through independent field placement/nodal outlining, supported by
consultant review and approval, before I developed autonomous practice. I spent time with numerous different consultants to develop consultation and assessment skills to build into both my consent practice and non-medical prescribing. In addition, I developed an enhanced understanding of dosimetric principles to aid decision-making, as well as dose-fractionation schedules and their relative merit in different clinical scenarios that I could apply to my practice with reference to patient performance status and disease burden.

What support has been valuable?

The consultants have been very pro radiographerled practice and so always very supportive during any discussions about my professional development and willing to help me gain experience. When I’ve
undertaken further education that required additional time away from my routine daily role, such as shadowing in clinics/ward rounds, the service manager was always very amenable to providing cover, giving me sufficient time to learn and gain experience.

Another radiographer also had palliative radiotherapyas their area of advanced practice, but only had autonomous practice with one consultant. When I started working alongside them, we synergistically accelerated the development of the palliative and virtual simulation pathway to develop the service,supporting one another so that we both attained autonomy across all areas at the same time.

What do you find most rewarding?

The ability to have an area of advanced practice that has a plethora of nuances, which means I’m always seeing new things and learning different skills to apply to future practices. I also appreciate having the trust of the consultants that my work is at a level to be autonomous without having to have all volumes/plans reviewed for a group of delegated patients.

What advice would you give others moving into advanced practice?

I have been lucky to work in a department that supports such radiographer-led practices and development. It depends on how you intend to integrate further education modules into practice, but discussion with the service manager and consultants is important to gain an appreciation about what is expected from both sides from your learning and development.

Gaining experience by seeing many different clinical scenarios is of insurmountable benefit as it can be applied to your future practices and help with problemsolving and decision-making in a timely manner.