Morag Stout

What is your current role?

I have been a General Medical Consultant Sonographer with NHS Greater Glasgow and Clyde (NHSGGC) since 2010. While I am based at Glasgow’s Queen Elizabeth University Hospital, I cover 10 sites that together look after a population of over 1.4 million people.

I work clinically around half the time, scanning across multiple acute and ambulatory care sites where I, like all of our sonographers, teach trainee radiologists and sonographers. I believe the clinical role of a consultant sonographer is crucial. I have had a passion for ultrasound since I was a student radiographer, and this has never waned. I qualified as a radiographer at a time when it was difficult for radiographers to progress into general medical ultrasound.

Nevertheless, my tenacity paid off and I qualified as a sonographer in 1998 and haven’t looked back. Caring for the patient and the challenge of finding a helpful diagnosis in their journey excites me to this day. I developed into this role through building up extensive clinical experience, completing an MSc, having active involvement in research, publication, presentations, strategic planning and lecturing, all enabling me to demonstrate my ability to work across all four pillars of consultant level practice and consultancy.

What skills have been important in your career to date?

I believe leadership starts from the ground up. In order to create a team that feels supported and indeed to continuously develop a service, you must keep sight of the challenges facing sonographers and the wider workforce in the NHS. I pride myself on being a good, objective listener and communicator. This helps me to identify service gaps and areas for improvement and expansion. Collaborating with sonographers, radiologists and clinicians serves to optimise patient pathways.

What are the main aspects of your role?

Since I’ve been in post, NHSGGC has formed an ultrasound steering group, which I chair. This includes representation from radiologists and sonographers from each sector and from management. We work together to ensure evidencebased practice is adhered to in regard to vetting, scanning and reporting of ultrasound. I facilitate sonographer audit, CPD and discrepancy meetings. As practitioners, we are all accountable for our actions but governance in ultrasound is predominantly my responsibility – whether it be clinical or otherwise.

As well as clinical teaching, I guest lecture at Glasgow Caledonian University on its general medical ultrasound postgraduate course and have mentored undergraduates in their final year dissertations. Strong links with educational establishments are key to the consultant role. Most recently, I have become clinical lead for the new NHS Scotland Academy, where we plan to start a national ultrasound training programme. I also guest lecture at national events such as those run by the British Medical Ultrasound Society (BMUS).

Involvement in audit and research is another key component of the role, both as a researcher and as a facilitator or advisor for sonographers and the wider medical workforce. I have been involved in many projects over the years but of late, these include the ‘Galvani’ study, in which immunocompromised patients have a line placed into their spleen to stimulate their immune system, and a national project with the Scottish Society of Gastroenterology that has shown huge variability in the vocabulary used in ultrasound of the liver. The group aims to develop a national protocol for patients being scanned for abnormal LFTs and in particular, look at language used in cases of suspected cirrhosis and fatty liver. We are shortly due to publish a paper on this work. I am proud that many of our sonographers have successfully completed their MSc and I help students identify a topic (that is often beneficial to our service) and then appropriate funding streams.

Professional leadership is the most significant part of my role. I am approachable and strive to maintain a supportive, collaborative workplace. I play a lead role in consultations with clinicians around imaging pathways. I am currently working with stroke physicians and radiologists to identify best practice and access for transient ischaemic attack (TIA) and stroke across NHSGGC and with orthopaedic oncology around the use of ‘lumps and bumps’ ultrasound.

I have a special interest in venous thromboembolism (VTE) and regularly contribute to our NHSGGC VTE group. I am also a member of Society and College of Radiographers (SCOR) Consultant Radiographer Group and have served as vice chair of the Ultrasound Advisory Group; as a result, I have close links with SCOR colleagues and regularly discuss new guidance and issues. In addition, I am a member of the BMUS Professional Standards and Consultant Sonographers Group and an assessor for non-traditional route sonographers keen to register as a sonographer through the Institute of Physics and Engineering in Medicine (IPEM).

The Scottish Clinical Imaging Network (SCIN) aims to improve imaging services by developing a work plan to steer service modernisation, improve quality, ensure provision of an effective service and anticipate future needs and requirements. Nationally, I chair the SCIN Ultrasound Special Interest Group (SIG). This group’s members include a lead sonographer from each health board, an equipment procurement lead, a SCOR representative and an educationalist. We have so far devised a governance framework for the use of locums and agreed a national job description for band 7 and 8A sonographers. We share information, discuss any equipment concerns and support each other. 

Are there any particular projects you’re involved in at the moment?

The Scottish Radiology Transformation Programme (SRTP) is an ambitious programme funded by the Scottish Government that aims to transform the way radiology services are delivered in Scotland. Its vision is of “a world class, person-centred, sustainable radiology service that continually improves the health and wellbeing of the people of Scotland”. I lead the ultrasound stream for this programme, which involves participation in groups such as those focused on national workforce planning, quality and data, advancing practice and quality standards.

Part of the consultant role is pushing boundaries and involvement in talks at national levels helps facilitate this. In conjunction with SCIN SIG members, the SRTP ultrasound stream has produced a vision paper on what makes a quality ultrasound service in Scotland. Significantly, a questionnaire to all boards in Scotland last year allowed us to ascertain the current position of ultrasound in Scotland. This information demonstrated that there was a national sonographer shortage: demand outstripping capacity for years, multiple vacancies, imminent retirements and difficulties in recruiting good locums. There was also a need for more ultrasound rooms. Recommendations from this paper were for significant investment in training additional sonographers and radiologists. This would allow funded backfill of radiography staff, pressure to be taken off acute sites and specialist training for some boards.

Amid COVID-19 and Scotland’s subsequent five-year recovery plan, the plan of the NHS Scotland Academy ultrasound programme came to fruition. This is an exciting opportunity for ultrasound in Scotland and I am excited by its potential to improve ultrasound services across Scotland.

As clinical lead, I played a large part in submitting a business case to Scottish Government groups outlining different phases of the project and scoping facilities required and staffing models. This programme will be a welcome addition to clinical ultrasound teaching in Scotland. It is hoped this will continue to grow and opportunities for training at the academy will be open to wider staff groups moving forward. We are also considering different training routes in the future.

What are the main challenges you face?

It is impossible to strategically plan for a service without an overview and involvement in the management team. This has taught me a myriad of information in regard to access, targets, finance, procurement, human resources and wider issues across the board. Mutual support with the management team is imperative to make a consultant role work. I value the support of our clinical director, consultant body and staff.

The COVID pandemic has been a remarkably challenging time for staff in the NHS. Staff sickness levels are high and morale is low. As a consultant, it is my responsibility to recognise this and try and improve things in the future. COVID has given us a chance to reflect on what we did before and change things as appropriate. Radiographers and sonographers are a very much in demand and rightly so. My biggest wish is for retention of staff and staff satisfaction at work to improve. We as a profession need to think outside the box at encouraging staff to work or stay working with us. While not always feasible to pay more due to Agenda for Change constraints, we can at least be flexible and, importantly, fair to all staff. Staff need to feel valued. Although UK and Scottish Governments are planning on increasing diagnostic capacity, we direly need the most important commodity – happy, well trained, supported staff – in order for this to work.

There are many other challenges in this role – not least the work‒life balance and without doubt, the day-today firefighting (something many will recognise). I consider ‘the juggle’ incredibly hard as all aspects of the role are important and ploughing forward in one can come at the expense of another. You cannot have clinical credibility if your name is not on a report. You cannot expect staff to do something you would not do yourself. You need to be involved in education and research and be supportive of others who want to be involved. You must have a good understanding around the minutiae of management processes. Most importantly, you must lead by example, be hard-working, consistent and honest, show integrity, and be a great communicator.

What has proved most useful in your development?

One of the steepest learning curves for me personally was being able to hold my own at high-level meetings and with clinical colleagues. Forming good interpersonal relationships with lead clinical specialists and other consultant radiographer colleagues continues to be invaluable and is beneficial to all parties. Being part of a national forum makes you look at the bigger picture and hone your vision for a service. I am proud of the connections I have accumulated over the years, and these continue to grow.

As someone who at one time was the only consultant radiographer in NHSGGC, I am delighted to see and support more such roles in our board and nationally. Due to their unique combination of responsibilities and connections, a consultant is perfectly positioned to drive change in our NHS. All consultant posts are slightly different, and so most will be contributing to the four pillars of consultant practice and consultancy in different ways, and this is OK.

Do you enjoy being a consultant?

It is an extremely rewarding career that I often have to pinch myself is my job. Each week is different. I continue to learn, continue to meet new people and challenges, continue to try to improve things. It is certainly never mundane. But without doubt, the most rewarding part of my role is still to be with patients – that’s why I loved ultrasound in the first place.

Any advice for those pursuing a similar career?

Approach other leads in your area, form relationships with clinical colleagues and get involved in research. Study to MSc level at least and, if possible, offer to help out with teaching at educational institutions. Be aware of the national picture and keep working hard and doing your best. Most importantly, never forget why we are in a job – the patient!