Frequently asked questions

How is the BSE supporting the Level 3 pilot project?

The BSE is funding the upbanding of the pilot site physiologist/scientists to Band 8a and is paying the costs of the University of Swansea Clinical Skills course. We are providing template SOPs, patient information, access to the logbook portal to upload evidence of completion of competencies, patient logbook cases and audit documentation.

How will the upbanded funding work?

Upbanding funding will begin at the start of the data collection period and will last for 12 months. We anticipate that the cost efficiencies demonstrated through the project will ensure that departments maintain the banding after the funding ends.

How were the pilot sites chosen?

Pilot sites were chosen following a competitive application process. This process took into account;

• Evidence of consultant cardiologist, business manager and echo department lead support
• Evidence of capacity to establish a new Valve, ICC or HF clinic within the pilot timeframe
• Nomination of a suitably qualified physiologist/ scientist with a minimum of 5 years BSE accreditation able to take on the role
• Evidence of support available from the wider MDT to enable the physiologist/ scientist to engage fully with the Swansea course and complete all data collection requirements of the pilot.

The EOIs closed on Monday 13 April 2026 at 10:00.

Applications were welcomed from all settings and healthcare systems across the UK, providing the clinic would be newly set up during the pilot.

Our ambition is that participants will prove their value at the higher banded rate and will continue to expand physiologist / scientist-led services within their centre.

Who was on the review panel?

The review panel included senior officers of the BSE and representatives from the relevant stakeholders. For instance, representatives from the British Inherited Cardiac Conditions Society (BICCS), British Heart Valve Society (BHVS) and the British Society for Heart Failure (BSH) helped choose the sites. We also involved representatives from the devolved nations to choose sites in Scotland, Wales and Northern Ireland.

How is the project being funded?

We have received project specific funding from NHS England, the Scottish Government and Health Education Improvement Wales.

How will Level 3 participants be assessed?

There will be a practical assessment involving a video case viva assessment (similar to what is currently undertaken for all other BSE accreditations). Level 3 accreditation will be awarded on completion of the pathway as defined for the pilot project.

There will be a significant amount of study involved in the Clinical Skills course, plus the need to shadow a consultant cardiologist or relevant healthcare professional for a period. It is a strict requirement of participation in the programme that data is collected before during and after the pilot programme.

Participation requires completion of two modules which make up Clinical Assessment education at Swansea University; Applied Pathophysiology and the Clinical Assessment. We have been extremely fortunate that the University, and in particular, Dr Emma Rees, have chosen to work with us on this project, setting up an additional course specifically for our project participants.

View the accreditation pathway

How will the clinics work?

We anticipate that at least one clinic a week will be required, ideally two if possible. 

The minimum number of patients should be four per week over one clinic. We hope that time and cost efficiencies will enable the pilot sites to increase to two clinics over the period of the project. The physiologist/ scientist will identify the patients to be included in the clinic with oversight from the cardiologist and other members of the multi-disciplinary team.  

In patients with non-severe native valvular heart disease and heart failure, the physiologist / scientist will undertake a structured clinical assessment and review the patient’s medical history to identify symptoms or signs suggestive of disease progression. These findings will be evaluated alongside the echocardiogram to determine whether disease severity has progressed since the previous assessment. Where disease remains non-severe and the patient is asymptomatic, results and future surveillance timeframes will be communicated by the physiologist / scientist and sent to their GP. This pathway would continue until the disease progresses to a severe stage, at which point referral for cardiologist review would be initiated.

Level 3-accredited physiologists / scientists will play a key role in the surveillance and screening of inherited cardiac conditions. In addition, Level 3 physiologists / scientists can independently deliver cardiomyopathy family screening clinics with results and surveillance timeframes communicated by the physiologist, with referral for cardiologist review initiated only when electrocardiographic or echocardiographic abnormalities are identified.

How will the project be evaluated?

Our evaluation will use quantitative and qualitative methods to answer the following questions:

• Do physiologist / scientist-led clinics create more capacity in the system?
• Do physiologist / scientist-led clinics free up cardiologist time to see new patients?
• Do physiologist / scientist-led clinics improve the patient experience?
• Does the advanced physiologist / scientist role encourage retention in the echocardiogram workforce?
• Is the proposed accreditation process robust and fit for purpose, demonstrating accurate and reliable decision-making by the lead physiologist / scientist?
• How are the physiologist / scientist-led clinics being implemented – and what does this tell us about barriers and enablers to expansion of the numbers?
• Do physiologist / scientist-led clinics lead to cost savings in the review process?
• The first step will be a data collection exercise to benchmark the current performance of the test sites, collecting three months' data on:
  • the time from echocardiogram referral to cardiologist consultation
  • the number of cardiologist appointments, and what proportion of them lead to further intervention
  • workforce efficiency metrics (e.g. time spent with patient)
  • patient outcomes (multidisciplinary team review, quality of life assessment, intervention referral)
  • capacity in the consultant cardiologist clinics and waiting times for appointments

We will then repeat collection of the same benchmarking data for three months after the initial 6 months implementation period to assess the impact of the change.

We will capture data on the patient experience before and after implementation using patient satisfaction surveys.

To capture views on how the pilot clinics have been implemented, examining the difficulties and successes, we will conduct interviews with the Head of Department, the scientist leading the clinic, and the associated cardiologist of each clinic, followed by a group discussion with key staff from all the pilot clinics to discuss common issues and learning points. Topics will include an assessment of the value and relevance of the proposed accreditation process.

Staff satisfaction surveys will be conducted before and after implementation, to allow us to estimate the likely effect on staff retention of wider application. This will include both the senior staff involved in the clinics, and also more junior staff, to ascertain whether they will be more likely to continue in the specialism if they feel they will also be offered opportunities for development.

We will calculate the per patient costs of the pathway before and after the change to evaluate the budget impact and cost effectiveness of the revised pathway.

We will publish the evaluation findings in peer-reviewed journals and present at conferences to disseminate knowledge and advocate for broader adoption.

The evaluation will be carried out by a research fellow at Leeds University using Jisc Online Surveys. Data analysis will be carried out using STATA version 18.

What benefit would the patients receive?

We believe this project will streamline the pathway for patients, leading to a number of benefits. In the current system, patients have to attend their echo appointment and then return for a separate appointment to see the cardiologist, often weeks or months later. This is at best an inconvenience for the patient. For many people it could mean taking additional time off work, potentially having to arrange additional childcare or other care responsibility cover. There are the added transport/parking costs and for some, the additional wait can cause stress and anxiety. By upskilling and empowering the physiologist / scientist to clinically assess the patient, perform the echo, give the patient the results, arrange appropriate follow-up and document this to the patient and GP, we will be streamlining the service, reducing the number of visits required for each follow-up. This initiative will also help to reduce the carbon footprint for these patient pathways – an important consideration for hospitals working towards a net zero NHS.

Will there be a process for providing feedback?

We will actively be seeking feedback in many ways, including from patients, and from participants. The feedback will prove vital in the final evaluation report.

If these pilots are successful, what is the estimated timescale for the roll-out of Level 3?

The project plan includes a period of data collection before the clinics begin. We are aiming to have the clinics set up in September 2026, with final data collection starting six months later, over a period of 2-3 months. We will then produce the full evaluation report and resulting business cases, and template documents. Assuming that the project achieves all that we believe it will, we will look to roll out Level 3 accreditation and campaign for the national programme in October 2027.