Assessing the barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X‑ray reporting service within the NHS in England: a systematic literature review

Introduction
The United Kingdom (UK) government’s healthcare policy in the early 1990s paved the way adoption
of the skills mix development and implementation of diagnostic radiographers’ X-ray reporting service. Current
clinical practice within the public UK healthcare system reflects the same pressures of increased demand in patient
imaging and limited capacity of the reporting workforce (radiographers and radiologists) as in the 1990s. This study
aimed to identify, define and assess the longitudinal macro, meso, and micro barriers and enablers to the implementation
of the diagnostic radiographer musculoskeletal X-ray reporting service in the National Healthcare System (NHS)
in England.

Methods
Multiple independent databases were searched, including PubMed, Ovid MEDLINE; Embase; CINAHL,
and Google Scholar, as well as journal databases (Scopus, Wiley), healthcare databases (NHS Evidence Database;
Cochrane Library) and grey literature databases (OpenGrey, GreyNet International, and the British Library EthOS
depository) and recorded in a PRISMA flow chart. A combination of keywords, Boolean logic, truncation, parentheses and wildcards with inclusion/exclusion criteria and a time frame of 1995–2022 was applied. The literature
was assessed against Joanna Briggs Institute’s critical appraisal checklists. With meta-aggregation to synthesize each paper, and coded using NVivo, with context grouped into macro, meso, and micro-level sources and categorised
into subgroups of enablers and barriers.
Results The wide and diverse range of data (n = 241 papers) identified barriers and enablers of implementation,
which were categorised into measures of macro, meso, and micro levels, and thematic categories of context, culture,
environment, and leadership.

Conclusion
The literature since 1995 has reframed the debates on implementation of the radiographer reporting
role and has been instrumental in shaping clinical practice. There has been clear influence upon both meso (professional
body) and macro-level (governmental/health service) policies and guidance, that have shaped change
at micro-level NHS Trust organisations. There is evidence of a shift in culturally intrenched legacy perspectives within and between different meso-level professional bodies around skills mix acceptance and role boundaries. This
has helped shape capacity building of the reporting workforce. All of which have contributed to conceptual understandings of the skills mix workforce within modern radiology services.