Urgent action required to rebuild echo workforce 

Published 07/06/2023

The British Society of Echocardiography (BSE) has today published an independent report warning that specialist echocardiography services across the NHS are experiencing unprecedented challenges as they struggle to retain, recruit and train staff.

Whilst the release of the Government’s NHS Workforce Strategy appears to have stalled again, the BSE is calling for the urgent adoption of Professor Alison Leary’s recommendations to retain existing echocardiographers within the NHS and to build the sustainable workforce required for the future.

The shortages in the echo workforce were first highlighted by the BSE in 2017. Since that time demand for echocardiograms has increased and many departments are still tackling post-COVID backlogs.

Progress has been made in increasing the number of trainees in the system, in particular via the Echo Training Programme, however, against the backdrop of the increasing demand and pressures on the workforce, the focus must now switch to retention. A survey prior to the report found that half of the workforce were doing unpaid work with a further third reporting they don’t have the time or capacity to complete all their scans during work time. It also highlighted significant issues with morale. A lack of a clear progression pathway for experienced echocardiographers has resulted in many feeling exploited and undervalued.

This is leading to a problem with both retaining and training staff. Commenting on the report, Dr Claire Colebourn, President of the BSE, said:

"Pressure on echocardiography services has created a perfect storm for the workforce, with clinicians lacking time to train new staff and the workload leading to staff burnout and retention issues with more experienced members. Echocardiography requires highly complex work which is both physically and cognitively demanding.

"Comments from our workforce survey paint a worrying picture whereby staff are unable to complete their duties, are doing unpaid work, and in some instances are suffering from burnout and fatigue. Not only is this a serious threat for the NHS’s diagnostic capacity when it comes to the burden of heart disease, it may be putting patient safety at risk.

"We are urging NHS England, the National School for Healthcare Science, policymakers at the Department for Health & Social Care, and other key stakeholders to respond to our report recommendations if we are to avert a serious problem with this vital NHS service."

The report highlights retention strategies, pointing to the importance of experienced clinicians in developing a sustainable workforce for the future. 

It focuses on the lack of career structure for echocardiographers, with a workforce focused on direct clinical work while lacking the capacity to do important quality assurance and safety work, service development work, or train the next generation.

The report recommends:

  • Implementing a formal national career pathway in echocardiography to make services sustainable and promote retention
  • Recognising the advanced level role of an echo educator
  • Enabling diagnostics by increasing training capacity and utilising new models such as a slow lane to promote the growth of skilled novice workers and attracting returners
  • Developing new roles which help distribute work such as administrators, data managers and support workers

In March, the National School for Healthcare Science published its Educator Workforce Strategy. It also recommended recognising echo educators with a view to improving retention, encouraging staff to return, as well as addressing burn out and insufficient time due to increasing service pressures.

Dr Tom Ingram, Chair of the BSE Workforce and Leadership Committee urged all involved in cardiovascular care to read the report and support its recommendations. He said, "This report highlights loud and clear the jeopardy faced by cardiology departments up and down the country. Without senior cardiac physiologists it is not possible to deliver an effective echocardiography service. Without timely access to echocardiography, it is not possible to deliver a meaningful cardiology service. The BSE is grateful to Professor Leary and Dr Punshon, and the members who inputted into the survey and workshops which facilitated this report. This document outlines a clear strategy to aid the retention of senior colleagues and it is an essential read for all stakeholders involved in the care of patients with cardiovascular disease."

Read the full report