The Quality Standard for Imaging

The Colleges have been considering for some years whether UKAS accreditation best serves our members and Fellows and the services in which they work. Developing an in-house scheme will enable us to further enhance the support we give our members and Fellows, and will give us richer insights into the challenges they face as they strive to provide excellent patient care. Our workforce is under significant pressure, and as Colleges we agree that the time is right to develop an improved service that is more responsive to, and inclusive of, service developments now and in the future. The Colleges' approach will be proportionate, risk-based, transparent and supportive.

The Royal College of Radiologists (RCR) is the professional organisation for clinical radiologists and clinical oncologists, incorporated by Royal Charter. The College of Radiographers (CoR) is the professional organisation for diagnostic and therapeutic radiographers. Together, through the development and application of the Quality Standard for Imaging as well as through their other work programmes, the Colleges promote and develop medical imaging for the benefit of the public in the UK and globally.

The Colleges are charitable organisations whose sole focus is on working for the benefits of our members and Fellows, the services in which they work, and the quality of care they provide to their patients. As Colleges, we believe we are better placed to meet the needs of services and patients, through effective engagement with our members and Fellows through a College-led endorsement scheme and QSI Quality Network.

UKAS offers accreditation services to its customers, based upon the Colleges' Quality Standard for Imaging. The Colleges, as the owners of the Quality Standard for Imaging and the QSI logo, will aim to provide a more holistic service in the form of a QSI Quality Network, that will support services in evaluating and improving the quality of the care they provide, as well as providing a supportive network of peers through which to share good practice and learn from each other, and professional development opportunities. Our formal evaluation of services' achievement of the QSI is just one element of the overall scheme that the Colleges are developing, and within that we will work with services to manage the demands of the evaluation process.

The Colleges are committed to co-designing the endorsement scheme with services to ensure it meets their needs, both at service and network level. However, our plans are to adopt a periodic evaluation cycle that will comprise an on-site visit every three years, with remote evaluation activity in the interim to ensure continuing compliance focused on particular areas of risk rather than on the standard in its entirety. The Colleges will also reduce the burden of assessment without losing rigour, through a proportionate approach to our work. The Colleges' scheme recognises that services differ in their nature and therefore will demonstrate their attainment of the Quality Standard for Imaging through applicable indicative inputs; we anticipate that a focus on outcomes and a flexible dialogue make our scheme an attractive prospect.

The Colleges are considering terminology, and may choose a different word to endorsement as we engage further with stakeholders.

Accreditation involves the assessment of the competence and impartiality of an organisation and the compliance of their work to nationally and internationally recognised standards. In the UK, UKAS is the national accreditation body.

Endorsement refers to the holistic evaluation of diagnostic imaging departments and the quality of the service they provide by a team of individuals with experience in delivering similar services, and with a specific intention to facilitate the improvement of quality over time. Endorsement will nonetheless involve the application of the QSI with a level of objectivity and rigour that is commensurate with the esteem in which the Colleges' Quality Standard for Imaging is held.

Practice in the sector has tended towards moving away from use of the term 'accreditation' by bodies other than UKAS to avoid any confusion of association with UKAS as the national accreditation body.

Once the Colleges' agreement with UKAS comes to an end at the end of June 2024, we will no longer support UKAS accreditation - we will only support our own scheme.

The Colleges have worked hard with our members and Fellows over many years to ensure that the standards statements set out in the QSI reflect what is required to deliver an effective imaging service that provides excellent patient care. It is not in the Colleges’ interests to seek to apply those standards with anything other than objectivity and rigour. As part of our scheme, we will continue to identify areas where our reviewers agree that services are not achieving our standards and outline the action that needs to be taken if endorsement is to be awarded.

The Colleges are committed to fully resourcing this scheme, and will be appointing a dedicated staff team to join our existing Quality Improvement Partners in developing and delivering it. We already benefit from the significant and long-standing expertise of our existing staff in delivering quality assurance and enhancement schemes of this kind, and from many years of experience of working collaboratively with our members. Our team, together with the wider team of expert reviewers we will build, will ensure our approach reflects best practice. We are committed to ensuring that our staff have the range of skills required to work productively and sensitively with services and review teams to reach appropriate, evidence-based consensus in their application of the Quality Standard for Imaging.

We will be recruiting colleagues with skills across the full range of diagnostic imaging modalities to work with us as reviewers over the coming months. We are considering a number of different ways in which we can incentivise services to release staff to work with us, and will be mindful of workload demands when inviting colleagues to participate in review activity. Further details regarding the anticipated commitment and the benefits to both the individual and the service of getting involved will be available in the coming months.

The Colleges are considering a range of potential financial models for the QSI Quality Network and endorsement scheme, and whilst we aren't in a position to confirm specifics at the moment, we can confirm our commitment to developing a fee schedule that is straightforward, transparent and demonstrates cost-effectiveness. We appreciate the substantial investment that services make when seeking recognition of their achievement of the Quality Standard for Imaging, and will do all we can to reduce the assessment burden whilst retaining rigour and evidence-based decision making. We will price our services in a way that recognises that reduced burden. The Colleges are charitable organisations that work solely for the benefit of their members and fellows, the services in which they work, and the patients they serve. If it happens that there is a surplus generated through QSI, it will be reinvested towards meeting those charitable objectives.

Only participants in the Colleges' scheme will be entitled to use the QSI logo.

The Colleges will develop resources to help services communicate the meaning of their award to patients and service users. Patients understand the expertise brought to bear by Royal Colleges and professional associations, and will recognise the Colleges' approval of services under the QSI scheme as a reliable quality mark.

UKAS have indicated their intention to continue to offer accreditation against the Quality Standard for Imaging as a publicly available and nationally recognised standard. On this basis, the UKAS scheme will operate as a competitor to the Colleges' scheme: it should be noted, however, that once our current agreement has come to an end in June 2024, the Colleges will not support UKAS in this endeavour and will not permit UKAS to use the QSI logo. Services will need to determine which scheme best meets their needs.

As such, there will be no expectation or requirement that currently-accredited services should transition to the Colleges' scheme; however, the Colleges value and recognise the work that services will have put into attaining accreditation and will therefore offer a 'fast-track' admission process for those services who do wish to participate in the Colleges' scheme and QSI Quality Network. We will write to services soon to confirm further details, and will work with services to ensure the availability of that fast-track process aligns with their established assessment schedule - whether that falls before June 2024 or after.

Services will need to determine which scheme best meets their needs. We do not recommend that services seek both accreditation and endorsement, as this will create more work for departments: our expectation is that departments will join will one scheme.

The Colleges will invite services to express their interest in joining the new scheme in the coming weeks, however, feel free to email [email protected] to express your interest at any time. Colleagues who express an interest on behalf of their service will receive priority invitations to participate in the series of workshops we have planned in the Autumn of 2023 to co-design our scheme.

Services will need to consider whether UKAS accreditation or the QSI Quality Network and endorsement scheme offered by the Colleges best meets their needs. The Colleges' scheme represents a long-term investment in quality improvement, and will facilitate this over time through the provision of peer support and learning, professional development and feedback on both the areas that services need to address in order to meet the requirements set out in the QSI, and on areas of innovative or otherwise excellent practice. As Colleges, we would welcome you expressing an interest in joining our scheme, and would be happy to talk to you further about any questions you have.

Services will need to consider whether UKAS accreditation or the QSI Quality Network and endorsement scheme offered by the Colleges best meets their needs. The Colleges' scheme represents a long-term investment in quality improvement, and will facilitate this over time through the provision of peer support and learning, professional development and feedback on both the areas that services need to address in order to meet the requirements set out in the QSI, and on areas of innovative or otherwise excellent practice. As Colleges, we would welcome you expressing an interest in joining our scheme, and would be happy to talk to you further about any questions you have.

The Colleges are committed to making the process of signing up to the new QSI Quality Network and endorsement scheme as straightforward as possible. We value and recognise the work that services will have put into attaining accreditation and will therefore offer a 'fast-track' admission process for those services who do wish to participate in the Colleges' scheme and QSI Quality Network. We will write to services as soon as applications are open to confirm further details, and will work with services to ensure the availability of that fast-track process aligns with their established assessment schedule - whether that falls before June 2024 or after.

We are looking forward to co-designing the details of our new scheme with services, but at this stage anticipate a three year cycle of on-site visits and remote review activity, and will work with individual services to agree an appropriate review schedule.

Over the coming year nothing will change: support will continue to be available from our QI Partners. After June 2024, we will not support those on the UKAS scheme as we will no longer be part of it. We will support those on the Colleges’ scheme and will be co-designing that with you over the coming months to ensure it meets your needs.