We are working on it: building a sustainable governance model for point‑of‑care ultrasound

Point of care ultrasound (POCUS) is now used widely across acute, community and primary care settings, supporting earlier clinical decision making and improving patient flow. As its use expands, imaging networks and clinical services increasingly recognise the need for a more consistent, governance led approach that aligns POCUS with wider diagnostic priorities. This is not about restricting practice — it is about ensuring safety, visibility and sustainability as POCUS becomes part of modern NHS pathways.

Current practice across the UK is highly variable. Training, documentation, image storage and escalation processes differ significantly between organisations and specialties. This variation is well recognised by clinicians, Radiology departments and national diagnostics teams. It reflects the natural evolution of an emerging modality rather than any failure of policy. As NHS England strengthens governance expectations across imaging services, there is now a clear opportunity to bring POCUS into the same structured environment that supports other diagnostic modalities.¹

International experience shows the benefits of consistent governance. Organisations such as the American College of Emergency Physicians (ACEP)², the American Institute of Ultrasound in Medicine (AIUM)³, the Australasian Society for Ultrasound in Medicine (ASUM)⁴ and the Canadian Point of Care Ultrasound Society (CPoCUS)⁵ emphasise competency based training, image storage, audit and clear scope of practice definitions. These principles are increasingly relevant to the NHS as imaging networks work to reduce unwarranted variation and improve system level visibility of diagnostic activity.

Workforce pressures further highlight the need for a sustainable governance model. Radiology faces a 30% shortfall of clinical radiologists, projected to rise to 40% by 2028⁶, and many trusts report sonographer vacancy rates of 10–20% alongside rising ultrasound demand. Accurate recording of POCUS activity, with images stored and examinations registered correctly, provides a truer representation of diagnostic workload and supports more effective workforce and capacity planning. Repeat scans, often due to missing images, undocumented findings or unclear escalation, contribute to avoidable pressure on already stretched teams. A consistent POCUS governance approach can reduce unnecessary duplication, improve documentation quality and ensure radiology capacity is focused on inpatients, complex imaging and cancer pathways. When POCUS is governed well, it supports — not competes with — radiology, creating a more efficient and resilient diagnostic system.

There is growing recognition across imaging networks, clinical services and national diagnostics discussions that POCUS requires a more consistent governance approach. Early local work in some regions, including draft integrated care system (ICS) level models and strengthened audit processes, shows the potential for a more structured national direction. The opportunity now is to build on this emerging work and align POCUS governance with the wider imaging transformation agenda.¹

A sustainable governance model for POCUS in the NHS would include:

• clear scope of practice aligned with clinical pathways
• standardised training and competency assessment, building on British Medical Ultrasound Society (BMUS) standards⁷
• mandatory image storage on picture archiving and communication system (PACS) or vendor neutral archive (VNA) platforms to support audit, escalation and continuity of care
• structured documentation using consistent reporting templates
• defined escalation and referral pathways, including failsafe processes
• equipment standards and asset management aligned with Radiology governance
• integration with Imaging Network audit cycles and national datasets

These components support safer practice, reduce unwarranted variation and ensure POCUS activity is visible within system level planning. Strengthening POCUS governance is not a criticism of current practice — it is an opportunity. With coordinated leadership, Imaging Network engagement and alignment with NHS England’s imaging transformation priorities¹, the NHS can build a sustainable, safe and consistent model that supports both clinical teams and Radiology services.

We are working on it — and the foundations for a national approach are already taking shape.

References

1. NHS England. Imaging Transformation Programme, 2023–2026.
2. American College of Emergency Physicians (ACEP). Emergency Ultrasound Guidelines.
3. American Institute of Ultrasound in Medicine (AIUM). Practice Accreditation Standards.
4. Australasian Society for Ultrasound in Medicine (ASUM). POCUS Standards.
5. Canadian Point of Care Ultrasound Society (CPoCUS). National Certification Pathways.
6. Royal College of Radiologists. Clinical Radiology Workforce Census.
7. British Medical Ultrasound Society (BMUS). Minimum Training Standards for Point of Care Ultrasound, 2023.

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