Non Medical Referrers (radiology) - FAQs

Radiological imaging requesting in BNSSG Primary Care

Frequently Asked Questions

Requesters

• What professional groups can request radiological imaging under the BNSSG Protocol?

Registered Named professionals (Non-Medical Referrers or NMR) who are Nurses, Pharmacists, Paramedics, Physiotherapists, Podiatrists. They will be employed in BNSSG Primary Care and meet the relevant criteria outlined on the protocol.

• What about GPs?

GPs (including locum GPs) do not fall under this protocol

• What happens if I am a locum employed to work in GP?

You can register via the onboarding form ensuring all of the practices support your access and provide an end date to remove you from the ICE system.

• Where is the main webpage for information and relevant resources

https://avonlmc.co.uk/guidance/radiological-imaging-for-non-medical-requesters/

• What form do I need to complete to assess my competency?

https://avonlmc.co.uk/guidance/radiological-imaging-for-non-medical-requesters

• What form do I complete to confirm referrer competence?

https://avonlmc.co.uk/guidance/radiological-imaging-for-non-medical-requesters

• How do I audit my practice?

Please see the protocol for further information under the audit section

https://avonlmc.co.uk/guidance/radiological-imaging-for-non-medical-requesters

IRMER Training

• Why do I have to do IRMER training?

The use of ionising radiation for medical exposure is regulated by the Ionising Radiation (Medical Exposure) Regulations 2017 (IRMER) and subsequent amendments. IRMER includes the requirements for referrers of medical exposure to ionising radiation. The role of some registered healthcare professions other than medical and dental include that of referrer, and this is supported by the Regulations.

• Where can I access IRMER training?

For training dates 

See 2025 North Bristol NHS Trust/ UHBW Med Physics IRMER training sessions:

• • Monday 20th January 2025 9am-11am 
  • Tuesday 15th April 2025 10am-12pm
  • Wednesday 16th July 2025 10am-12pm
  • Monday 6th October 2025 10am-12pm 

Applicants should contact nmr@nbt.nhs.uk for a Teams link to any one of these courses

Please keep an eye on REMEDY or email the following: NMR@NBT.NHS.UK and RadiationProtectionTraining@UHBW.nhs.uk if any queries regarding IRMER training.

What training do I need to do if I am able to request MRI’s?

• Please complete the eLFH MRI safety training found here and send your completed form to NMR@NBT.NHS.UK and RadiationProtectionTraining@UHBW.nhs.uk

• Who keeps a record of my information?

NBT and UHBW Acute Trust Imaging Managers and your own practice

• How often do I need to do IRMER?

Your IRMER certificate is valid for 3 years. You need to apply to update this certificate and attend further training.

• If I did IRMER outside the region, can I request in BNSSG?

This will be verified on a case-by-case basis by the Imaging Managers at NBT and UHBW. You may be asked to attend further training.

Working environments

Who holds the clinical governance regarding this protocol?

ALMC are the facilitators for this change and have brought together the relevant system partners to agree on the contractual documents

The clinical governance and line management of individual NMRs remains with the practices and the Acute Trust Imaging Managers. ALMC and GPCB are happy to offer guidance and advice where appropriate.

• What if I work across practices?

You need to ensure all of the practice details are included in the onboarding form, including GP Practice and signed by all employers.

• What if I move practice within BNSSG?

You will need to complete a new ICE Application form and the follow the onboarding process.

ICE Entitlements

• Where can I access ICE training to know how to use ICE?

There is a page on GP team net

How do I know the correct patient pathway?

Please look on REMEDY for patient pathways and refer to the imaging policy for specific professional entitlements.

• How long will it take for me to be onboarded?

This depends and is on a case-by-case basis.

• Why isn’t ICE allowing me to request imaging?

You have not been given permission but the acute trust imaging managers. Ensure you have followed the onboarding process before contacting the Imaging Teams.

• Why can I only request for one acute trust?

You need to ensure your managers have requested ICE access for both NBT and UHBW. Please complete the form

• If a patient has an Xray in one trust then I refer for an MRI/USS or CT in another, why will this be cancelled?

This is due to the continuity of care but if you note on the request where the previous image was taken this will enable the trusts to access both images. If this is an image taken by a private provider, then this image needs to be imported onto PACS. Please contact: UHBW: pacssupport@uhbw.nhs.uk OR NBT: nbt.radiologypacs@nbt.nhs.uk

• Why can’t I request MRI?

Only FCP MSK Physios & Podiatrists can request MRIs according to the specific presentations identified in the BNSSG Protocol and per REMEDY patient pathway.

• Who can request USS?

Only FCP MSK Physios can request USS according to the specific presentations identified in the BNSSG Protocol and per REMEDY patient pathway.

• Can I request TV USS?

Only nurses who are FRSH trained can request TVUSS for lost coils as per USS protocol. Please email kerri@almc.co.uk for more information.

• Why can’t I request DEXA scans?

DEXA is not included in the protocol as this is managed by the Rheumatology Teams. There is a pilot project in progress to identify specific capabilities and requesting criteria required by professionals and more information will be released soon.

• I already have an ICE account. Do I need another?

You will need an ICE account for each NHS Trust’s ICE you access.  But you may also need multiple accounts for a Trust’s ICE if you work across multiple care environments (e.g GP, Trust, and/or Community).  This is a result of different configuration required and to help associate test requests and reports to the correct originating Organisation, Locations and Clinicians.

If you work in multiple GP surgeries, you should only need a single ICE account with access to all the surgeries added to it.  Access can also be added/removed as you join/leave surgeries.

• I am an Advanced Practitioner – why can’t I request imaging other than Plain Xrays?

Imaging entitlements for NMRs will vary according to your employed role, scope of practice, capability, patient pathway, the area you work in, the governance in place and the risk that is deemed manageable by the Imaging Managers at the Acute Trust.

This protocol should support any change in national guidance after agreement with the Acute Trust Imaging Committee

• Why are my imaging entitlements limited?

Imaging entitlements are reflected according to your employed role identified on your ICE application form.

• Why can’t I request under my own name?

You will always have a GP lead on your requests and can request under your own name if the ICE application form was completed correctly and in full.

• Why don’t reports come back to me?

Reports will be returned to the individual requester as long as the ICE application form has been completed in full and this practice has been supported and agreed by your employer and clinical supervisor.

• Can we use ICE mail?

ICE mail is a communication app that is not currently available for General Practice but there are discussions in enabling this in the future.

• What do I need to do to if I leave practice?

Employers need to inform NBT and UHBW to mark you as a leaver and you can be removed from the ICE system.

• What do I do if I change practices?

Your new employer needs to complete an ICE application form depending on your employed role and area of work.

• Can I use this protocol if I am subcontracted to work in Primary Care or BNSSG ICS?

Yes. As long as your practice or PCN has signed the SOP for subcontracted staff found here and you meet the criteria outlined in the protocol found on ALMC webpage. You can only request within your scope of practice and entitlement and whilst you are employed and working within BNSSG General Practice.

• Can I request imaging for children under 16 years of age?

This requires a separate protocol and agreement with the Imaging Managers. There are future plans to implement this.

• Why don’t reports get returned to me?

This has not been indicated on your ICE application form as a practice supported by your employer.

• Why can’t Physician Associates request imaging?

Physician Associates cannot request imaging in Primary Care at present because they are not a registered profession. In some cases, in acute settings, they have been allowed to request non-ionising images (MRI or USS) but the decision for this entitlement is down to the imaging managers for our trusts and this is not allowed in BNSSG. Once the official registration process has been announced there will be a staged roll out of expansion of entitlements and this will be cascaded after local IRMER committee approval.

• What happens if a request gets cancelled or rejected by the acute trusts?

There are various reasons why images get cancelled (duplicate requests, patient request). This is different to the image being rejected due to the requirement for more information on the request.

• What if the demographic information for the patient is incorrect?

Please email the ICE teams at the acute trust to ask them to action this change.

• We have been having issues with adding our HCAs onto our ICE system and not being able to request. Why is this?

Due to HCAs not being qualified nurses, if not stated upon the starter request for them to have (pathology) requesting rights, they are only given admin access (view only).

• We have been having issues adding our staff members in general practice to the ICE system

Due to a known bug in EMIS, for prescribers in general practice (only) EMIS will override the ICE username with the prescriber number.  So, for these users, the prescriber number will need to be used as the ICE username.  The field in EMIS this relates to is GMP PPD Code under the Professional Numbers on the users EMIS account.

• Does the Severn Pathology team have access to provide ICE web portal links to all users?

The ‘labs’ do not have admin access to ICE to provide these details.  The ICE support teams for each Trust are who can update them in their respective systems. 

• Why can’t I find my patient on the ICE system?

When accessing ICE via the web portal, you will only being able to search for and request against patients that are registered in the system.  Therefore, patients such as asylum seekers, those that have recently moved into the area, etc, are unlikely to be known to the Trust and therefore will not exist in the system.  The interop access allows for digital requests to be submitted by GPs, but they are stored on a Deferred Orders List until the patient is ‘properly’ registered on the Trust’s PAS which then creates a hospital number and record that the order can be assigned to.  Therefore, current business continuity processes for these patients will need to be followed.

• Is there an ICE web access as a backup for EMIS outages

Practices need to provide each staff member with a username, which can be retrieved from EMIS via the ICE section in EMAS Manager. Users can reset their passwords on the ICE portal using the 'reset password' option. Please ensure you record the ICE usernames in EMAS Manager in a way that they can later extract.

What do the national regulatory bodies say?

British Institute of Radiographers

https://www.bir.org.uk/media-centre/position-statements-and-responses/guidance-for-non-medical-referrers-to-radiology.aspx

• RCN

Royal College of Nursing (2021) Clinical Imaging Requests from Non-Medically Qualified Professionals [online]. London: RCN. Available HERE from:

• NHS England

Health Education England (2020b). Analysis of the online workshop to consider the impact of COVID-19 upon and the implications for the future of advanced and consultant practice. [online]. Available HERE from:

• Who do I contact if I need advice or information about imaging for Non-Medical Referrers (NMR)?

Your first place will be the dedicated emails below

NBT: nmr@nbt.nhs.uk 

UHBW: RadiationProtectionTraining@UHBW.nhs.uk

If you have further concerns, please email kerri@almc.co.uk

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.