Qualified RRs have been contributing effectively to reporting PFI for decades. However, staffing and financial constraints in NHS affecting ongoing effectiveness:

• Number qualified RRs is very low/100,000 population; this cannot usefully contribute to reporting output productivty given rising demand for NHS imaging services.
• Shortage of radigraphers in UK does not provide adequate workforce to upskill as RRs, given they are often required to provide image aquisition. 
• Lack of adequately trained staff trained in image acqusition exist to allow RR training.
• Lack of training posts/recurrent funding precludes growth in RRs.
• Training sufficient numbers of PFI RRs can release radiologists to undertake more complex image reporting tasks and procedures. This requires radiologist support for training and ongoing continuing professional development support.
• Postgraduate training programmes are expensive. Current costs and limited contribution of PFI RRs to make any useful contribution to total PFI reports is a very inefficient model.
• Few career progression opportunities; most RRs constrained to AfC band 7, with little opportunity to develop as advanced practitioner in higher AfC bandings.
• Majority of examination types reported are MSK/CXR, with few AXR. 
• No consistency for implementation of RR job plan. Expectations/roles/boundaries therefore unspecified posing potential organisational/individual/patient risks.
• The number reports expected/session was very diverse and outwith the Royal College of Radiologists guidelines [2].
• Minimum number reports needs to be defined and adopted to ensure adequate caseload/mix to maintain clinical acumen and manage expectations for RRs within and between hospitals.
• No specific baseline postgraduate qualification is required for RRs reporting PFI.
• CPD opportunities which are essential to enable maintenance of competence and capability are limited by NHS staffing/funding constraints.
• Governance of RRs reporting PFI need to be robust and comparable to radiologists.
• The standards published by the Royal College of Radiologists for reporting practitioners (MSK and CXR) should be utilised by all departments with PFI RRs [5,6].
• Figure 7 shows recommendations for future practice for RRs reporting PFI examnations.